Left hemihepatectomy in living donors with a thick middle hepatic vein draining the caudal half of the right liver

Donor safety is the first consideration in living related liver transplanta tion. Left hemihepatectomy including the middle hepatic vein is a reasonabl e donor procedure for obtaining a large graft for living related liver tran splantation. This procedure, however, needs to be modified in donors with h epatic venous variation. While carrying out donor hepatectomy, we encounter ed two cases showing a variant form of hepatic venous drainage comprising a thick middle hepatic vein draining segment 6 of the liver. This variation made it necessary to preserve the middle hepatic vein in the donor liver re mnant. Failure to recognize such a variant would result in congestion in th e remaining right liver of the donor. To guarantee donor safety, evaluation of the drainage area of the corresponding hepatic vein is a matter of grea t importance in donor hepatectomy.