Donor Considerations

  • Evelyn Hsu
  • Jorge Reyes
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Pediatric liver transplantation is the standard of care for children with end-stage liver disease. Innovations and refinements in surgical technique over the last half century have propelled the field to excellent long-term outcomes posttransplant. Future advances in pediatric allocation and organ utilization will help realize the goal of minimizing persistent pediatric wait-list mortality and morbidity.


Pediatric liver transplantation Donor selection Pediatric liver allocation 


  1. Abecassis MM, Fisher RA, Olthoff KM, Freise CE, Rodrigo DR, Samstein B, Kam I, Merion RM, A2ALL Study Group (2012) Complications of living donor hepatic lobectomy – a comprehensive report. Am J Transplant 12:1208–1217CrossRefPubMedPubMedCentralGoogle Scholar
  2. Adam R, Cailliez V, Majno P, Karam V, McMaster P, Caine RY, O'Grady J, Pichlmayr R, Neuhaus P, Otte JB et al (2000) Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study. Lancet 356:621–627CrossRefPubMedGoogle Scholar
  3. Almaas R, Jensen U, Loennecken MC, Tveter AT, Sanengen T, Scholz T, Holm I (2015) Impaired motor competence in children with transplanted liver. J Pediatr Gastroenterol Nutr 60:723–728CrossRefPubMedGoogle Scholar
  4. Bismuth H, Houssin D (1984) Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery 95:367–370PubMedGoogle Scholar
  5. Bismuth H, Morino M, Castaing D, Gillon MC, Descorps Declere A, Saliba F, Samuel D (1989) Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg 76:722–724CrossRefPubMedGoogle Scholar
  6. Bourdeaux C, Darwish A, Jamart J, Tri TT, Janssen M, Lerut J, Otte JB, Sokal E, de Ville de Goyet J, Reding R (2007) Living-related versus deceased donor pediatric liver transplantation: a multivariate analysis of technical and immunological complications in 235 recipients. Am J Transplant 7:440–447CrossRefPubMedGoogle Scholar
  7. Braun HJ, Perito ER, Dodge JL, Rhee S, Roberts JP (2016 May 23) Nonstandard exception requests impact outcomes for pediatric liver transplant candidates. Am J Transplant 16:3181–3191CrossRefPubMedPubMedCentralGoogle Scholar
  8. Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L, Piper J, Whitington SH, Lichtor JL. (1991). Liver transplantation in children from living related donors. Surgical techniques and results. Ann Surg 214:428–437 – discussion 437–439Google Scholar
  9. Chen C-L, Fan ST, Lee S-G, Makuuchi M, Tanaka K (2003) Living-donor liver transplantation: 12 years of experience in Asia. Transplantation 75:S6–11CrossRefPubMedGoogle Scholar
  10. Cole CR, Bucuvalas JC, Hornung R, Ryckman FC, Alonso MP, Balistreri WF, Kotagal U (2004) Outcome after pediatric liver transplantation impact of living donor transplantation on cost. J Pediatr 144:729–735PubMedGoogle Scholar
  11. Committee OPT, Committee OE. Ethical principles of pediatric organ allocation. Accessed 8 Jul 2016
  12. Emond JC, Lobritto SJ, Jan DM (2007) Chapter 25: liver transplantation: donor evaluation, surgical technique and perioperative management. In: Fine RN, Webber SA, Olthoff KM, Kelly D, Harmon WE (eds) Pediatric solid organ transplantation. Blackwell Publishing, MaldenGoogle Scholar
  13. Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, Greenstein SM, Merion RM (2006) Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 6:783–790CrossRefPubMedGoogle Scholar
  14. Feng S, Ekong UD, Lobritto SJ, Demetris AJ, Roberts JP, Rosenthal P, Alonso EM, Philogene MC, Ikle D, Poole KM et al (2012) Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants. JAMA 307:283–293CrossRefPubMedGoogle Scholar
  15. Herden U, Grabhorn E, Briem-Richter A, Ganschow R, Nashan B, Fischer L (2014) Developments in paediatric liver transplantation since implementation of the new allocation rules in Eurotransplant. Clin Transplant 28:1061–1068CrossRefPubMedGoogle Scholar
  16. Hong JC, Yersiz H, Farmer DG, Duffy JP, Ghobrial RM, Nonthasoot B, Collins TE, Hiatt JR, Busuttil RW. 2009. Longterm outcomes for whole and segmental liver grafts in adult and pediatric liver transplant recipients: a 10-year comparative analysis of 2,988 cases. J Am Coll Surg 208:682–689 – discusion 689–691.Google Scholar
  17. Hsu EK, Shaffer M, Bradford M, Mayer-Hamblett N, Horslen S (2015) Heterogeneity and disparities in the use of exception scores in pediatric liver allocation. Am J Transplant 15:436–444CrossRefPubMedGoogle Scholar
  18. Jendrisak MD, Hong B, Shenoy S, Lowell J, Desai N, Chapman W, Vijayan A, Wetzel RD, Smith M, Wagner J et al (2006) Altruistic living donors: evaluation for nondirected kidney or liver donation. Am J Transplant 6:115–120CrossRefPubMedGoogle Scholar
  19. Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB, Harper AM, Wainright JL, Snyder JJ, Israni AK et al (2016) Liver. Am J Transplant 16(Suppl 2):69–98CrossRefPubMedGoogle Scholar
  20. Kolata G (1989) First US liver transplant from live donor is set. The New York Times, 27 NovemberGoogle Scholar
  21. Lin T-S, Chen C-L, Concejero AM, Yap AQ, Lin Y-H, Liu C-Y, Chiang Y-C, Wang C-C, Wang S-H, Lin C-C et al (2014) Section 9. Technical details of microsurgical biliary reconstruction in living donor liver transplantation. Transplantation 97(Suppl 8):S34–S36CrossRefPubMedGoogle Scholar
  22. Mack CL, Ferrario M, Abecassis M, Whitington PF, Superina RA, Alonso EM (2001) Living donor liver transplantation for children with liver failure and concurrent multiple organ system failure. Liver Transpl 7:890–895CrossRefPubMedGoogle Scholar
  23. McDiarmid SV, Davies DB, Edwards EB (2000) Improved graft survival of pediatric liver recipients transplanted with pediatric-aged liver donors. Transplantation 70:1283–1291CrossRefPubMedGoogle Scholar
  24. Mohammad S, Hormaza L, Neighbors K, Boone P, Tierney M, Azzam RK, Butt Z, Alonso EM (2012) Health status in young adults two decades after pediatric liver transplantation. Am J Transplant 12:1486–1495CrossRefPubMedPubMedCentralGoogle Scholar
  25. Neto JS, Carone E, Pugliese RPS, Fonseca EA, Porta G, Miura I, Danesi VB, Guimaraes TC, Godoy AL, Porta A et al (2010) Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil. Liver Transpl 16:426–430PubMedGoogle Scholar
  26. Orman ES, Mayorga ME, Wheeler SB, Townsley RM, Toro-Diaz HH, Hayashi PH, Barritt AS (2015) Declining liver graft quality threatens the future of liver transplantation in the United States. Liver Transpl 21:1040–1050CrossRefPubMedPubMedCentralGoogle Scholar
  27. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H (1988) Transplantation of a donor liver to 2 recipients (splitting transplantation) – a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir 373:127–130CrossRefPubMedGoogle Scholar
  28. Pruett TL, Tibell A, Alabdulkareem A, Bhandari M, Cronin DC, Dew MA, Dib-Kuri A, Gutmann T, Matas A, McMurdo L, et al. 2006. The ethics statement of the Vancouver forum on the live lung liver, pancreas, and intestine donor, Transplantation Vol. 81. pp. 1386–1387; 2 p.CrossRefPubMedGoogle Scholar
  29. Raia S, Nery JR, Mies S (1989) Liver transplantation from live donors. Lancet 2:497CrossRefPubMedGoogle Scholar
  30. Reichman TW, Fox A, Adcock L, Wright L, Abbey SE, Levy G, Grant DR (2010) Anonymous living liver donation: donor profiles and outcomes. Am J Transplant 10:2099–2104CrossRefPubMedGoogle Scholar
  31. Renz JF, Yersiz H, Reichert PR, Hisatake GM, Farmer DG, Emond JC, Busuttil RW (2003) Split-liver transplantation: a review. Am J Transplant 3:1323–1335CrossRefPubMedGoogle Scholar
  32. Smith B (1969) Segmental liver transplantation from a living donor. J Pediatr Surg 4:126–132CrossRefPubMedGoogle Scholar
  33. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA (1990) Successful liver transplantation from a living donor to her son. N Engl J Med 322:1505–1507CrossRefPubMedGoogle Scholar
  34. Thomas EH, Bramhall SR, Herington J, Draper H (2014) Live liver donation, ethics and practitioners: ‘I am between the two and if I do not feel comfortable about this situation, I cannot proceed’. J Med Ethics 40:157–162CrossRefPubMedGoogle Scholar
  35. Van Meter CH (1999) The organ allocation controversy: how did we arrive here? Ochsner J 1:6–11PubMedPubMedCentralGoogle Scholar
  36. Volk ML, Goodrich N, Lai JC, Sonnenday C, Shedden K (2015) Decision support for organ offers in liver transplantation. Liver Transpl 21:784–791CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologySeattle Children’s HospitalSeattleUSA
  2. 2.Department of SurgeryUniversity of Washington Medical CenterSeattleUSA

Section editors and affiliations

  • Vicky Lee Ng
    • 1
  • John C. Bucuvalas
    • 2
  1. 1.Division of Gastroenterology, Hepatology and NutritionThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Pediatric Liver Care CenterCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations