Select the target population: - Adults who wish to be a liver donor and meet all of the following initial criteria:
- Age 18 to 60 years
- No history of liver disease
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| Perform ABO blood typing and crossmatch* |
| Assess if donor is in good health and medically fit for donor hepatectomy: |
| Obtain donor history | - Medical history:
- Hypertension
- Diabetes
- Lung disease
- Heart disease
- Gastrointestinal disease
- Autoimmune disease
- Neurologic disease
- Genitourinary disease
- Hematologic disorders
- Bleeding or clotting disorders
- History of cancer
- History of infections
- Medication use
- Allergies
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- Family history:
- Coronary artery disease
- Cancer
- Liver disease
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- Social history:¶
- Occupation and employment status
- Living arrangements and social supports
- Smoking, alcohol, and recreational/illicit drug use
- Psychiatric illness, depression, suicide attempts
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| Review cancer screeningΔ | - Cervical cancer
- Breast cancer
- Prostate cancer
- Colon cancer
- Lung cancer
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| Perform physical examination | - Height and weight
- Body mass index
- Vital signs (blood pressure, heart rate, respiratory rate)
- Examination of major organ systems
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| Perform initial testing | - Complete blood count
- Coagulation tests (PT, PTT, INR)
- Metabolic profile (electrolytes, calcium, phosphorus, BUN, creatinine)
- Lipid profile (cholesterol, trigylcerides, HDL cholesterol, LDL cholesterol)
- Liver tests (AST, ALT, alkaline phosphatase, total bilirubin)
- Autoimmune markers (ASMA, ANA, AMA)
- Iron, iron binding capacity, ferritin
- Alpha-1-antitrypsin level and phenotype
- For patients with family history of Wilson disease: Ceruloplasmin
- For women with childbearing potential: HCG quantitative pregnancy test
- Chest radiograph
- Electrocardiogram
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| Assess if donor is a risk to the recipient with respect to disease transmission: |
| Screen for infectious diseases | - Cytomegalovirus (CMV IgM and IgG)
- Epstein-Barr virus (EBV IgM and IgG)
- Human immunodeficiency virus (RT-PCR and NAT)
- Hepatitis B virus: Hepatitis B surface antigen, hepatitis B core antibody, hepatitis B virus DNA
- Hepatitis C virus: Hepatitis C antibody, hepatitis C virus RNA
- Treponema pallidum (syphilis)
- Tuberculosis (interferon gamma release assay)
- Other potential infections based on risk for geographically defined endemic disease or exposures
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| Assess if donor liver is suitable for the recipient: |
| Advanced imaging◊ | - Triple phase computed tomography of the liver with liver volumetrics and 3D reconstruction
- Magnetic resonance imaging/magnetic resonance cholangiopancreatography
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