Anesthetic management of living liver donors

Abstract

Purpose: Living organ donation is being performed with increasing frequency to overcome the shortage of organs for transplantation. Our experience in the anesthetic management of donors with relevant issues is discussed and complications encountered are recorded. Methods: Data were collected retrospectively and analyzed on all 22 left lateral hepatectomies performed at our institution between 1993 to 1997 for transplantation. Results: Major ethical concern was the risk to the donors and anesthetic issues were those of a major abdominal procedure. All except four donors were parents (mother/father). Average blood loss was 805 ± 479 ml and only two donors required blood transfusion. Mean operative time was 8.2 ± 1.5 hr. Thoracic epidural analgesia was the most commonly adopted mode of pain relief. Average time to return of bowel sound postoperatively was 3.1 ± 1.0 days and was not influenced by the postoperative analgesic technique used. Total duration of hospital stay was 8.4 ± 1.1 days. Three donors developed minor postoperative complications atrial fibrillation and retained JP drain; left lower lobe pneumonia; and incisional hernia. All patients recovered uneventfully. Conclusion: Living organ donors contribute towards decreasing the shortage of organs for transplantation. Minimizing the discomfort associated with the surgical intervention and providing a complication-free perioperative course will positively influence the continued availability of such donations. On review of the first 22 left lateral hapatectomies performed, we observed only minor complications. Postoperative pain was a serious problem and thoracic epidural provided satisfactory analgesia.