*Purpose: In the United States, the estimated risk of death associated with live liver donation is currently quoted at 0.1% for left lobe donation, and 0.4-0.6% for right lobe donation. However, these numbers are based on historical data. The purpose of this study was to examine death rates in living liver donors in the United States between 2002-2020 in order to update this risk estimate. We hypothesized that the risk of death between 1-6 in 1000 liver donors would be an overestimate in the present day, particularly as the United States has accrued additional experience with live donor liver transplantation.

*Methods: United Network for Organ Sharing (UNOS) data was obtained on living liver donors who underwent donor hepatectomy between June 1, 2002 and June 10, 2020. Liver donors for domino transplants were excluded. We defined two eras; Era 1: June 1, 2002-June 15, 2011 and Era 2: June 16, 2011-June 1, 2020. Death rates among the two eras were compared at the 75^th, 90^th, and 95^th confidence intervals.

*Results: A total of 5497 liver donors underwent donor hepatectomy during the time period, of whom 5150 had follow up data available for analysis. Of these 5150, 2477 occurred during Era 1 and 2673 occurred during Era 2. A total of eight deaths occurred, with four deaths in each era. Causes of death, and time frame of death, as reported by UNOS, are shown in Table 1.

The cumulative incidence of donor deaths was 0.14% in the entire study period, and was 0.16% in Era 1 and 0.15% in Era 2. In Era 1, 3 live liver donors died within the first 90 days after donation (1.2 deaths per 1000 donors; 95% CI 0.2-3.5; 90% CI 0.3-3.1; 75% CI 0.5-2.6). In Era 2, 4 live liver donors dies within the first 90 days after donation (1.5 deaths per 1000 donors; 95% CI 0.4-3.8; 90% CI 0.5-3.4; 75% CI 0.7-2.8). There was no statistically significant difference between these rates (p=0.78).

*Conclusions: In the United States, the risk of death associated with living liver donation remains extremely low. In contrast to the historical quoted risk of death of 0.1-0.6%, our findings suggest that the risk of death may actually be closer to 0.1-0.2%. Importantly, the 95% confidence intervals of our estimates for death rates in both eras do not include the previously upper limit of 6 deaths per 1000 donors. These conclusions are limited by a lack of granular data, but suggest that living liver donation may be safer than previously thought.

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