A. Primary Medical Evaluation
A medical evaluation of the potential donor should be made by a senior member of the medical staff to diminish the possible susceptibility to covert pressure. The following are recommended minimal initial criteria that should be met before proceeding with further evaluation:
- absence of systemic disease or its likely occurrence should be considered (consider genetic and environmental vulnerability);
- absence of current or past impairment to any vital organ (for example, mild chronic obstructive pulmonary disease or history of coronary artery disease); when appropriate, a liver biopsy should be performed to determine the presence of nonseropositive hepatitis and steatohepatitis;
- absence of special vulnerability to infection, blood loss, or delayed wound healing; because of the risk of peptic ulcer disease in the donor, a significant documented history of peptic ulcer disease should be considered a contraindication.
- Minors younger than 18 should not be donors. While the exact upper age limit for donation is difficult to define, it is recommended that potential donors over age 55 not be considered, as the liver regeneration process may be compromised in this age group. When considering donors over age 55, special consideration should be carefully documented and detailed by both the independent donor advocate team and the transplant center.
B. Psychiatric and Social Requirements
The transplant center should have a dedicated medical social worker. In some instances, a transplant center may choose to engage a psychologist. In all instances, there should be access to psychiatric consultation either through participation of a dedicated psychiatrist or general hospital psychiatric consultation liaison service.
- There should be a vital emotional relationship between the potential donor and the recipient, therefore, Good Samaritan donation is not recommended. Although this may change in the future, current assessment of right lobe liver donation does not justify Good Samaritan donation at this time. There should be no coercion by those close to the donor or recipient.
- The donor should be free of current psychiatric disorders. In situations where a past history of psychiatric illness exists, the illness should be in full remission with a low likelihood of reoccurrence as documented by a psychiatric evaluation.
- There should be no evidence of financial incentive or profit motive in the donor’s participation.
- The donor should not have a history of physical or sexual abuse unless the recipient’s survival is essential to donor welfare (for example, a twin brother and sister have experienced childhood abuse and suffer from stress disorders, but depend on each other for emotional sustenance).
- The donor should be able to acknowledge and understand the attendant risks of live donor adult liver transplantation and there should be appropriate documentation of that acknowledgement.
- If the donor has a history of alcohol addiction or substance abuse, there should be evidence of long-term stable abstinence with low risk of exacerbation.
- The donor should have the right and the capacity to withdraw participation at any time prior to the surgery.