Background The high mortality rate associated with fulminant hepatic failur
e combined with the Limited availability of cadaveric organs requires consi
deration of alternatives to conventional cadaveric transplantation. Use of
the donor right lobe in adult-to-adult living donor transplantation holds p
romise in a variety of circumstances, including high-acuity situations.
Methods. A 28-year-old male with fulminant hepatic failure secondary to hep
atitis B was referred to our institution. He rapidly progressed to grade TV
encephalopathy, and laboratory values were indicative of a poor prognosis
without transplantation. He was listed for transplantation as UNOS status I
. Three siblings were simultaneously evaluated for living liver donation. F
ollowing established protocols, we completed donor evaluation in less than
24 hr, and donor right lobectomy and living donor transplantation were perf
ormed within 36 hr of the recipient's admission to our center,
Results. The donor surgery was uncomplicated, and the patient was discharge
d on postoperative day 4. The recipient experienced full recovery and was d
ischarged home on postoperative day 14, Of note, the first offer for a cada
veric liver came more than 60 hr after Living donor transplantation.
Conclusions, Thorough donor workup can be completed in less than 24 hr with
out inappropriate abbreviation of the evaluation. Simultaneous workup of wi
lling individuals prevents unnecessary delay. Living donor transplantation
should be considered for patients with fulminant hepatic failure who are ap
propriate transplant candidates.