title: Donor selection for adult-to-adult living donor liver transplantation: well begun is half done.
abstract: BACKGROUND
  Donor selection criteria for adult-to-adult living donor liver transplantation vary with the medical center of evaluation. Living donor evaluation uses considerable resources, and the nonmaturation of potential into actual donors may sometimes prove fatal for patients with end-stage liver disease. On the contrary, a thorough donor evaluation process is mandatory to ensure safe outcomes in otherwise healthy donors. We aimed to study the reasons for nonmaturation of potential right lobe liver donors at our transplant center.
  
  
  METHODS
  A retrospective data analysis of all potential living liver donors evaluated at our center from 1998 to 2010 was done.
  
  
  RESULTS
  Overall, 324 donors were evaluated for 219 potential recipients, and 171 (52.7%) donors were disqualified. Common reasons for donor nonmaturation included the following: (1) donor reluctance, 21%; (2) greater than 10% macro-vesicular steatosis, 16%; (3) assisted donor withdrawal, 14%; (4) inadequate remnant liver volume, 13%; and (5) psychosocial issues, 7%, and thrombophilia, 7%. Ten donors (6%) were turned down because of anatomic variations (8 biliary and 2 arterial anomalies). Donors older than 50 years and those with body mass index of more than 25 were less likely to be accepted for donation.
  
  
  CONCLUSIONS
  We conclude that donor reluctance, hepatic steatosis, and assisted donor withdrawal are major reasons for nonmaturation of potential into actual donors. Anatomic variations and underlying medical conditions were not a major cause of donor rejection. A system in practice to recognize these factors early in the course of donor evaluation to improve the efficiency of the selection process and ensure donor safety is proposed.
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0057, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: April
authors.initials: A
authors.lastname: Ashworth
authors.forename: Martha
authors.initials: M
authors.lastname: Behnke
authors.forename: Adrian
authors.initials: A
authors.lastname: Cotterell
authors.forename: Marc
authors.initials: M
authors.lastname: Posner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
mesh_terms: D058625:End Stage Liver Disease / Q000601:surgery*; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D019520:Living Donors / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D009929:Organ Size; D018579:Patient Selection; D011584:Psychology; D012189:Retrospective Studies; D019851:Thrombophilia / Q000453:epidemiology; D014019:Tissue Donors / Q000523:psychology; D009927:Tissue and Organ Procurement / Q000592:standards*