*Purpose: Liver donation is fundamental in increasing the pool of available grafts. Careful evaluation of each donor ensures the best outcomes for the recipient and minimizes the donor’s surgical risk. The purpose of our study is to identify the exclusion criteria for living liver donation in our center.

*Methods: This is a single-center, retrospective study. We analyzed 1212 patients that were evaluated as potential donors from August 2015 to November 2021. Recipient and donor-related reasons for exclusion were identified.

*Results: During the first phase, 637 potential donors were excluded (52.5%). The most common reasons were: BMI>32 (79.4%), recipient withdrawal (6.6%) and current or past history of cancer (5%). Other reasons included age>60, drug use/abuse, age<18 and hepatitis C. 428 patients were evaluated during the second phase. Of those, 88 reached donation (20.5%). 298 patients were excluded (69.6%). Forty-two (9.8%) patients are currently undergoing work up. Reasons for exclusion were recipient-related (66.7%) and donor-related (25.8%). Recipient-related reasons included: donor withdrawal (30.9%), complex donor anatomy (13.4%), more suitable donor available (10%), graft size issues (8.2%), medical issues (HTN, DM, obesity, neoplastic process, alcohol and/or opioid abuse, recent post-partum), (8.7%), genetic conditions (8.2%), most commonly positive factor V Leiden, followed by prothrombin gene mutation and a1-antitrypsine deficiency, ABO incompatibility (6.7%), psychiatric issues (4.6%), completed evaluation at different Transplant Center (3.6%), and financial and social reasons (3%). Donor-related reasons included: recipient received deceased donor liver transplant (DDLT) (40.2%), recipient condition improved (15.5%), recipient death (14.2%), recipient ineligible for live donor liver transplant (LDLT) (9%), intraoperative finding of cancer (1.2%), and others, such as recipient refused transplant, or needed further evaluation (19.4%).

*Conclusions: High BMI (>32) was the most common reason for donor exclusion during the initial evaluation process. Donor withdrawal was the most common recipient-related reason for exclusion during the second phase of the evaluation process. Recipient receiving a DDLT was the most common donor-related reason for exclusion. Efforts aimed in addressing potential donor obesity and education during the selection process might help increase the number of living donors for LDLT.

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