Living donation in liver transplantation: Overview of history, indications, and specific aspects of living donation in liver transplantation

As soon as deceased donor liver transplantation (DDLT) became a standard clinical practice, the disparity between the constantly growing number of liver transplant candidates and the supply of deceased donor organs highlighted the need for new solutions, opening the era of living donor liver transplantation (LDLT). The first preparatory experiences for the development of LDLTs were pushed by the shortage of pediatric liver grafts that was even more marked. The first step of this process was the reduced-size liver transplantation, performed by Bismuth and Houssin (1984), followed by the first reduced liver grafts transplanted in children by de Hemptinne et al. (1987). Based on this concept, split-graft liver transplantation was then developed and reported in 1990 by the Broelsch group in Chicago, confirming the possibility to treat more recipients with one liver graft limiting graft size problems (Emond et al., 1990; Pichlmayr et al., 1988). Following these pioneering works, LDLT has spread throughout the world becoming an established procedure in case of not available grafts from deceased donors, representing the standard of care liver transplant technique in Asia. Nevertheless, LDLT is characterized by technical complexity, as well as peculiar clinical and ethical aspects.