GUIDELINES FOR DONOR SELECTION AND AN OVERVIEW OF THE DONOR OPERATIONIN LIVING-RELATED LIVER-TRANSPLANTATION

Guidelines for donor selection and an overview of the donor operation are reported on the basis of our experience with 120 cases of living r elated liver transplantation (LRLT) in pediatric patients. Once the pa rents had clearly expressed their desire to serve as donors, tests wer e performed to functionally and anatomically screen the donor livers t o determine whether or not the parents' general physical condition all owed them to serve as donors. We then evaluated which of the two paren tal candidates was more suitable as a donor. The wishes of the family as to which parent should serve as donor was considered secondary and taken into account only in a few cases in which certain functional and /or anatomical abnormalities were uncovered that made the prime candid ate less suitable. For the 120 LRLTs, 135 candidates were evaluated as potential donors, 15 (11.1%) of whom were rejected for various reason s. The mean volume of blood loss during the donor operation decreased significantly from 489 g in the first 60 LRLTs to 390 g in the latter 60 LRLTs; this was accompanied by a significant decrease in the mean v olume of autologous blood transfused from 449 g to 390 g. Mean cold is chemia time of the graft increased significantly from 71.4 to 128.0 mi n. while mean operation time conversely decreased from 6.7 to 6.2 h. B ile leakage from the cut surface of the remnant liver, which was the o nly post-operative surgical complication encountered, was noted in fiv e cases. We conclude that donor candidates should be strictly selected according to basic guidelines, taking into account both the results o f preoperative screening and the wishes of the family. With this accum uled experience, we have been able to simplify our LRLT operative proc edure, resulting in decreases in blood loss volume, blood transfused, and operation time.