Are the results as good if I have a living donor compared with a cadaver donor?

Deceased donor liver transplantation has been the standard of care for patients with liver failure for more than 25 years. Hence, over time many transplant surgeons and programs have developed the skills and structure necessary to perform this operation successfully. This includes the ability to accept and list the most appropriate candidates, perform the surgery, assist in the recipient’s recovery, and provide the necessary postoperative care and support. As a consequence, there is the expectation of excellent outcomes from cadaveric liver transplantation.

In the past 10 years adult living donor liver transplantation (LDLT) programs have been developed at hospitals with the goal of expanding the donor pool. Early reports showed that living donor recipients’ outcomes were not as good as the outcomes experienced by their cadaver recipient counterparts. Later reports from LDLT programs with the most experience have now shown that LDLT can have at least equal, if not superior, outcomes. This increased effectiveness is likely attributable to the same factors that made deceased donor transplantation successful 20 years ago—experience in selecting appropriate recipients and donors, evolving surgical skill, and the infrastructure to optimize outcomes for all.

In addition, LDLT enjoys some other potential benefits over deceased donor transplantation. First, recipients may have an opportunity to undergo transplantation long before life-threatening liver-related events occur. They are likely to be in better physical and nutritional shape than patients awaiting cadaver donations. Second, the live donor liver, although smaller in size than a deceased donor liver, is more likely to have optimal donor characteristics due to the overall health of the donor. Third, the medical cost of the year before transplantation has been estimated to be approximately $100,000. By undergoing transplantation earlier in the course of the disease, much of this money can be saved. Finally, the use of live donor livers results in more deceased donor livers for patients in need of transplantation who do not have the option of LDLT. In some ways a living donor transplant may save two lives.