Living donor liver transplantation (LDLT) provides a critical alternative to deceased donor transplants, but it is not without risk to the donor. Several large, multicenter studies have quantified these risks, and the data can be summarized as follows:
Overall Mortality and Complication Rates
- Mortality: Large studies—such as the Adult-to-Adult Living Donor Liver Transplantation (A2ALL) Cohort—report a donor mortality rate of approximately 0.4% (roughly 1 in 250 donors), with estimates in various studies ranging from 0.1% to 0.5% [source].
- Complications: In the A2ALL data, about 38–40% of donors experienced at least one complication. Specifically, in one multicenter report of 405 accepted donors:
- Approximately 62% had no complications.
- About 21% experienced one complication.
- Nearly 17% had two or more complications.
The complications were graded by severity using the Clavien system:
- Grade 1 (minor): ~27% of donors
- Grade 2 (potentially life-threatening, but without lasting disability): ~26%
- Grade 3 (complications with lasting functional disability): ~2%
- Grade 4 (complications resulting in death): ~0.8%
Specific Complications
- Biliary Complications: Bile leaks occurred in roughly 9% of donors, while biliary strictures (narrowing of bile ducts) were observed in about 0.5% of cases.
- Infections: Bacterial infections were reported in approximately 12% of donors.
- Abdominal Wall Issues: Incisional hernias occurred in about 6% of donors.
- Intraoperative Events: Intraoperative complications (including vascular or bile duct injuries) were noted in about 2.5% of donors.
- Readmissions: Around 13% of donors required at least one hospital readmission post-donation, with a small subset (4%) needing multiple readmissions.
These numbers are reflective of a mix of both minor and more significant events. For example, while nearly half of the complications (grade 1) were minor and self-limited, a smaller fraction (grade 3/4) represents more serious, potentially life-altering events [source].
Factors Influencing Risk
- Intraoperative Blood Transfusion: Donors requiring blood transfusions had a significantly higher odds of complications. For example, receiving up to 1 unit of blood increased the odds of any complication by about 2.7 times, and more than 1 unit increased the risk by 4.5 times compared with donors who did not need a transfusion.
- Type of Hepatectomy: Some data suggest that left-lobe donation (which involves removing a smaller liver volume) is associated with lower risk compared to right-lobe donation. Although most LDLT in the USA uses right-lobe grafts, trends are shifting toward increased use of left-lobe grafts in an effort to reduce donor morbidity [source].
In Summary
Quantitative data indicate that while the overall risk to living liver donors is relatively low—particularly when compared to the life-saving benefit provided to recipients—the procedure is associated with a 0.4% mortality rate and a 38–40% overall complication rate. Most complications are minor (grade 1–2), but a small percentage (approximately 2–3%) result in serious outcomes such as lasting disability or death. These numbers are essential for informing potential donors during the consent process and for guiding efforts to further reduce donor risk through improved surgical techniques and careful donor selection.
Understanding these risks helps balance the ethical considerations of exposing healthy individuals to major surgery against the potentially life-saving benefits for recipients [source].