LIVING DONOR LIVER TRANSPLANT CRITERIA AND EVALUATION

Criteria for ‘rejecting’ a potential living liver donor:

ABSOLUTE:

  1. Potential donor less than 18 years in age.
  2. Single parent – donating for the child.
  3. Malignancy – except non-metastatic CNS tumours
  4. Chronic infective disorders – like active tuberculosis. Treated tuberculosis in the past with no residual ill-effects is not a contraindication to organ donation.
  5. Past history of documented deep venous thrombosis.
  6. Person on anticoagulants.
  7. Active dental sepsis.
  8. Cardio-pulmonary disease – CAD, Valvular heart disease, longstanding hypertension with target organ affliction, COPD, interstitial lung diseases etc.
  9. Diabetes mellitus – type I, with or without end organ damage.
  10. Recent viral infections – mumps, measles, chicken pox, herpes zoster etc.
  11. HIV positive status.
  12. Autoimmune disorders – collagenosis; arthritis; vasculitis etc.
  13. Unsound mental health.
  14. Previous surgery at the hepatic hilum is a contraindication for right or left lobe donation.
  15. Portal hypertension.
  16. Grade II and beyond fatty infiltration of the liver->30% steatosis
  17. History of Acute Alcoholic Hepatitis.
  18. HbsAg positive status – even if incidental and completely silent (This is not regarded as a contraindication in Japan and far east, particularly for Hep B related CLD transplants).
  19. HCV positive status – even if incidentally detected and completely silent.

RELATIVE:

  1. Potential donor more than 60 years in age.
  2. Well controlled hypertension with no end-organ damage.
  3. Well controlled Type II DM with no end-organ damage.
  4. Treated chronic infections.
  5. Active skin infections.
  6. Previous cholecystectomy.
  7. Previous non-biliary multiple abdominal surgical procedures.
  8. Alcoholism.
  9. Grade II fatty infiltration of liver – the donor can be taken up for donation after down-grading the fatty infiltration with treatment and exercise programs.
  10. Any other factor which may be thought to adversely influence the outcome of the donor as a surgical patient.
  11. Suspected coercion for organ donation.

DONOR WORKUP FOR LRLT

  1. Height-Body Weight – BMI determination
  2. Screening – Blood Group.
  3. Hemogram including Platelets
  4. Renal Function Tests.
  5. Liver Function Tests, incl. GGT
  6. Coagulation Screen – PT, APTT
  7. CXR
  8. ECG
  9. Ultrasound Doppler of the Abdomen – liver, IVC, HVs, PV, HA
  10. CT Abdomen – volumetry of the Left lobe, Right Lobe, Whole Liver, and Angiographic Phase studies for HA pattern, PV pattern, and HV pattern.
  11. MR Abdomen - volumetry of the Left lobe, Right Lobe, Whole Liver, and Angiographic studies for HA pattern, PV pattern, and HV pattern.
  12. Viral Studies – same as for the recipient. CMV IgG, IgM, HIV and Hepatitis screen is a must, others are optional.
  13. HLA Studies
  14. Counselling, if required, and Psychiatric Assessment if any member of the transplant team feels any element of coercion or pressure on the donor.
  15. Consent – twice – first at the time of the potential donor opting to donate and the second consent the day before the proposed donation, except in the situation of SAHF or FHF where this would be condensed to 24-48 hours.