*Purpose: As programs have become more experienced with living donor liver transplantation (LDLT), technical hurdles have been overcome and superior graft and patient survival has been reported, particularly among pediatric recipients. While technical aspects are fairly well established, other specific parameters regarding the upper limits of donor age, BMI, and risk of heritable liver disease are not well defined.

*Methods: A 34 question survey was designed to address common aspects of donor selection, donor evaluation, surgical variations, and recipient considerations. The WHO Transplant Observatory was analyzed to determine global prevalence of LDLT. The survey was distributed globally to individuals associated with LDLT programs identified via the OPTN database, Pubmed authorship, and professional references between 7/2018-9/2018.

*Results: There were 125 survey respondents. The U.S. Program (USP) response rate was 97.7%. At least one respondent was obtained from 94.9% of countries with ≥10 LDLT cases in 2016 (International Programs, “IP”). 74% of programs performed pediatric LT, and 12% were exclusively pediatric. IP were more likely to consider LD of any blood group (66.7%) compared to USP (36.9%, p=0.02). Only 32.8% of all programs will consider LDLT for fulminant pediatric patients. Most programs (72%) do not have a PELD limit when considering LDLT. Pediatric programs are less likely to have a defined donor age limit when compared to adult programs (p=NS between USP and IP). Overall, 68% of programs have a donor BMI cutoff (median 18-32), and the mean acceptable macrosteatosis cut off was higher for IP (19.0% vs. 14.9%, p=0.02). Most pediatric programs were willing to consider first degree relatives of patients with Alagille Syndrome or Metabolic Disorders (p=NS between USP and IP). USP were more likely to consider nondirected, anonymous donors (65.1% vs. 36.6%, p=0.003). There were no differences in willingness to consider complex anatomical considerations. Overall, 79.5% of programs perform LD surgery via an open approach (p=NS between USP and IP).

*Conclusions: This study represents the first comprehensive global analysis of living donor selection and utilization in pediatric liver transplantation. While there are considerable global variations in LDLT practice patterns largely due to availability of deceased donor organs, this study has identified key aspects of donor selection criteria and utilization that can establish the standard of care for this procedure.

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