Persistent Financial Burdens and High Donor Satisfaction Among Living Liver Donors: A 24-y Single-center Study.

Background: Prior investigations on living donor hepatectomy have primarily focused on medical and psychosocial outcomes, with limited evaluation of financial implications. Financial support systems exist, but these are limited by strict income criteria, leaving some donors ineligible. This study sought to characterize donor-reported quality of life with a focus on postdonation financial burden. Methods: Over a 24-y period, 402 living donor hepatectomies were performed at a single institution. In 2024, donors were contacted by telephone and surveyed regarding their postdonation experiences, with up to 3 attempts made >3 wk. Results: Of the 129 respondents (32%), 24 reported adverse financial consequences of donation, most commonly lost wages (n = 18). Donors reported a median absence from work of 10 wk (mean, 11.2; SD, 8.3). Additional burdens included costs of travel, lodging, and follow-up care. Six donors reported difficulty obtaining life insurance, and 2 experienced increased premiums attributable to donation-related complications. Thirty-four donors experienced medical complications attributed to donation, including hernias, gastrointestinal upset, and liver-related complications. Despite these issues, 98.4% would donate again, 97% expressed satisfaction, and 93.7% would recommend donation. Conclusions: Living liver donors consistently reported satisfaction despite persistent financial challenges. Prospective living liver donors should be counseled during donor evaluation for the potential of financial difficulties during the donation process. Future efforts should focus on derisking the donation process by addressing nonmedical complications, such as wage loss and insurance discrimination, to better support the living donor population.