Evaluation of Living Donor Liver Transplantation in Germany: Opportunities for Expanding the Donor Pool.

Background: Living donor liver transplantation (LDLT) represents an important alternative to deceased donor transplantation, particularly in times of organ shortage. This study analyzes the selection process of living liver donors at a German transplant center that performs both living and deceased donor liver transplantations. Methods: In a retrospective analysis, potential living liver donors were evaluated. Medical data and reasons for donor exclusion were collected, and recipient cohorts were categorized according to transplantation indication and urgency. Donor outcomes were also assessed. Results: Between January 2013 and December 2023, a total of 594 potential living donors were evaluated at Jena University Hospital. Of these, 124 successfully proceeded to donation. During the outpatient evaluation phase, 357 donors were excluded. Subsequently, 237 individuals underwent inpatient assessments, of whom an additional 100 were excluded. The main reasons for donor exclusion were medical or psychological contraindications (n = 160), as well as donor-independent factors such as disease progression in the recipient (n = 90) or withdrawal of consent by either the recipient or the donor (n = 54). Particularly among recipients with malignant diseases who had little or no chance of receiving a deceased donor organ, a high willingness to donate was observed-even among distant relatives or unrelated donors. Conclusion: A standardized evaluation protocol improves the efficiency of living donor liver transplantation within the Eurotransplant region and ensures donor safety. Diverse contraindications necessitate targeted exclusion diagnostics for individual potential donors.