Trotter JF et al. (2006) Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transpl 21: 1485–1488

Living donor liver transplantation (LDLT) confers a small risk of donor death; however, the worldwide actual mortality of patients who undergo donor hepatectomy is unknown. Trotter et al., therefore, searched PubMed for articles published from 1989 to February 2006 for data on donor outcomes following LDLT. Nonmedical literature was also searched. Deaths were recorded as 'definitely', 'possibly' or 'unlikely' to be donor-hepatectomy-related.

An estimated 4,598 LDLTs were performed in the US and Europe during the study period; the corresponding mortality definitely caused by donor hepatectomy was estimated at 0.15%, and mortality that was definitely or possibly related to donor hepatectomy was estimated at 0.20%. The authors identified 13 deaths worldwide (and 1 donor in an irreversible coma) that were definitely caused by donor hepatectomy. Two deaths (both suicides) were considered possibly related to donor hepatectomy, and four were probably unrelated. The most common cause of death definitely related to donor hepatectomy was sepsis (five donors), followed by liver failure and unknown (two donors each), myocardial infarction, cerebral hemorrhage, pulmonary embolus and peptic ulcer disease (one donor each); the mean time to death was 37.9 days (median 11 days).

The authors acknowledge their study might not include all donor deaths, partly because it is not mandatory worldwide to report donor outcomes after LDLT. They call for known, unreported donor deaths to be documented, to improve mortality estimates.