Living-Related Liver Transplantation. Progress, Pitfalls, and Promise

The first living-donor liver transplantation (LDLT) was performed in 1988. Since then the procedure has been developed especially in Asian countries to alleviate the problem of postmortem organ shortage. Inherent to the LDLT are however its high technical, logistical, and ethical complexities when compared to postmortem donor liver transplantation. A high technical flexibility is required during the allograft procurement as well as during the transplantation procedure especially in case of adult-to-adult liver transplantation. Controversies about the inclusion of the middle hepatic vein in the graft, the necessity of the venous outflow reconstruction as well as the respective role of left or right livers in adult LDLT are still dominating most of the scientific meetings about LDLT; the definitive answer is still out. Without any doubt, LDLT represents a major ethical challenge as the donation procedure has a certain, although low, mortality risk. It is clear that it is of utmost importance to well inform donor as well as recipient about the meaning and the risk of both procedures. A good balance between donor safety and recipient benefit must be carefully evaluated especially in the Western world where this surgery is performed much less frequently than in the Eastern world. © 2014 Elsevier Inc. All rights reserved.