*Purpose: Living donor liver transplantation (LDLT) accounts for only a small percentage (< 6%) of all liver transplants performed for adult recipients in the western world. Approximately only 30-55% of potential donors are accepted as suitable candidates. A common non-immunological donor exclusion criterion includes hypercoagulable conditions such as heterozygous Factor V Leiden. Heterozygosity for Factor V Leiden occurs in 3 - 8% of the general US population. The risk factors for hematologic complications are poorly understood in these donors and are difficult to assess. At present time it is uncertain whether these hematological lab abnormalities are a reason to exclude otherwise healthy donors. The aim of this study was to determine the incidence of thrombotic complications in the donors who underwent right lobectomy with underlying hypercoagulable lab abnormalities in our center.

*Methods: A retrospective analysis of all live liver donors at our center between 01/2009-09/2021 was performed to evaluate the prevalence of heterozygous Factor V Leiden and Prothrombin II gene mutations. All donors underwent a right lobectomy. The donors were followed for two years after the hepatectomy. Thrombotic complications were defined as: DVT (Deep Venous Thrombosis), PE (Pulmonary Emboli), and Stroke/TIA. Factor V and Factor II mutation analysis were used to confirm heterozygosity.

*Results: Out of 438 donors, 17 patients had heterozygosity for Factor V Leiden (4%). None of them had heterozygous Prothrombin II or any other hypercoagulable abnormalities. There was no prior history of thrombosis in any of these donors. The median age was 45 years old and predominantly female (60%). Post-operatively all donors were placed on 30 mg Lovenox daily for DVT prophylaxis. 16 of them were discharged with no long-term anticoagulation. One patient was discharged with apixaban 2.5 mg BID (no past medical history of DVT or PE was noted in this patient). Overall, there were no immediate or long-term thrombotic complications defined as PE, DVT, or Stroke/TIA.

*Conclusions: Factor V Leiden heterozygosity should not preclude patients from candidacy for living liver donation, especially considering the current organ shortage. Every center has some degree of hematologic screening in place, but it is unclear whether donors with heterozygous hypercoagulable abnormalities truly require exclusion from liver donation. They should be considered as a valuable resource in otherwise healthy donors. More data, studies, and evidence-based recommendations are needed.

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