*Purpose: Living donation (LD) can alleviate organ shortage, but is limited by obesity compromising organ quality and donor safety. This study intends to assess the feasibility of a diet and exercise program to increase the LD pool.

*Methods: Over a 19-month period, 7 individuals (ages 18-60) enrolled into a diet and exercise program to become LD. Individuals were referred to the program if LD criteria was not met due to significant hepatic steatosis and/or a BMI >30. Program length ranged from 6-10 weeks. Participants would record their weights and activity during that period. Hepatic steatosis was determined by MRI before and after their participation in the weight loss program.

*Results: Pre/post MRI fat fractions were available for 5/7 candidates. Initial imagining demonstrated mild to moderate steatosis (range 7.6-25.8%). Following program completion, a mean 58% reduction in steatosis (43-76%) was achieved. Liver volumes changed by a mean of -15% (-9 to -24%). Mean BMI changes was -6.5% (-3% to -14%). 2/7 participants finally became LD. One candidate had an incidental finding on final imaging that precluded donation despite successful resolution of steatosis. Another candidate had improvement of steatosis but due to concerning anatomy was ruled out from LD. The remaining 3 candidates were no longer needed to donate as their respective recipients got transplanted with a cadaveric graft.

*Conclusions: Our preliminary data indicates that a 6% weight reduction resulted in halving of steatosis on imaging. Lifestyle modification is a feasible means to expand the living liver donor pool in the United States where obesity and fatty liver disease are highly prevalent.

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