Background: Proper selection of live liver donors is crucial for both donor safety and transplant recipient outcome. Non utilization of possible live donors is multifactorial and needs to be understood to minimize the waste of medical resources and time. Our aim was to study different causes of non utilization of live liver donors in our center to optimize the donor selection process.

Methods: We retrospectively reviewed potential live liver donors for both adult and pediatric recipients who have been worked up at our center between 01/2007 & 08/2012. Reviewed data included: patients’ demographics, lab results, imaging studies, reports of liver biopsies if applicable, psychosocial evaluations and donor selection committee decisions.

Results: A total of 162 potential live liver donors have been evaluated during the study period. The work up of 22 (13.6%) donors was terminated at different stages before the committee discussion because of recipient related issues in 17 cases and 5 donor withdrawals. Of the 140 donors who completed their work up, 80 (57.1%) were accepted for donation and 60 (42.9%) were declined. Of the accepted donors, 61 (43.6%) made it to the operating room; one was declined intraoperatively because of abnormal anatomy and 60 (42.9%) actually donated. The remaining 19 accepted donors (13.6%) were not operated upon because of recipient issues (8 drop-off, 6 received Deceased-Donor Liver Transplant, 4 psychosocial issues and one delisted). Considering the 60 declined donors, the causes included: fatty liver: 31 (51.6%), unfavorable anatomy: 21 (35%), small remnant liver volume: 14 (23%), reduced graft to recipient body weight ratio: 7 (11.6%), and donor withdrawal: 6 (10%). Twenty three (38.4%) potential donors had more than one cause for rejection while 37 (61.6%) had only one cause. Incidental other radiological findings as a contraindication were seen in 3 cases.

Conclusion: Fatty liver and unfavorable anatomical variations are the two most common causes of donor exclusion in our center. Recipient drop-off is the most frequent cause of non utilization of an accepted live liver donor.

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