Burckhardt Ringe, Russell W. Strong. Center for Liver, Biliary and Pancreas Disease, Drexel University College of Medicine, Philadelphia, PA, USA; Princess Alexandra Hospital, University of Brisbane, Brisbane, Australia

　　Living donation has become a valuable resource of liver grafts when deceased donor organs are not available, and this option is being increasingly offered in transplant programs throughout the world. One major concern has always been the risk for the donor. Despite 4 independent reviews published in 2006, there is no accurate information on the number of donor deaths.
　　We reviewed the medical literature since 1989 - from anecdotal reports to sophisticated surveys, to update the worldwide living liver donor mortality rate. Our goal was to also assess the accuracy of the information, assigning a certainty (C) level to each source identified which was defined as follows: C1, direct report by a member representing the transplant center where the fatality occurred; C2, indirect publication by an author not involved in the care; and C3, information based on verbal presentation or personal communication.
　　We found 11 cases classified as C1: donor deaths and centers were identified, and details of the complications were published in single case reports. In the C2 group there were 10 fatalities, and only six centers were documented by other authors. Nine donor deaths were mentioned, however, their certainty level was C1. Seven donor deaths had occurred in Europe, eight in North America, four in South America, eight in Asia, and one in Africa. Two additional donors were included: one was rescued with a liver transplant, and the other remained in a vegetative state. Based on an estimate of over 10,000 living donor liver transplants performed worldwide, the donor death rate is 0.1-0.3%. Only C1 donor deaths allowed to identify specific risk factors: preoperative medical conditions - especially liver problems, known psychosocial behavioural abnormalities - including smoking and drugs, right lobe donation, and postoperative surgical complications.
　　In order to maintain truly informed consent and public confidence in this procedure, it is imperative to report all deaths of living donors. Unfortunately, the discrepancy between published and unpublished living liver donor mortality has not changed, and the dilemma of rumors versus facts is prevailing. The only way to get accurate information is direct reporting by the transplant program where the fatality occurred This survey should encourage all surgeons performing living donor liver transplantation to disclose their own fatalities.

Date: Thursday, June 21, 2007
Session Info: Living Donor (2:30 PM-4:00 PM)
Presentation Time: 02:50 PM
Room: Gavea B, 5th Floor