Living donor (LD) liver transplantation is a surgical strategy in which a healthy individual donates a portion of their liver to a recipient with liver failure.

New data from Argentina, published in Experimental and Clinical Transplantation, show low complication rates, high donor satisfaction, and rapid return to usual activities when LDs receive structured perioperative and psychosocial support. These findings reinforce the need to approach LDs as individuals with distinct medical and emotional requirements.

Speaking with Medscape’s Spanish edition, María Florencia Fernández , MD, an abdominal organ transplant surgeon and who completed a fellowship at the Fundación Favaloro in Buenos Aires, Argentina. She is currently an associate postdoctoral fellow in the Transplant and Immunology Department, Yale University, New Haven, Connecticut, and said, “I believe that this study, by focusing on the donor experience, helps to highlight them as fully realized patients with their own needs, risks, and emotions. Furthermore, it allows us to recognize that their well-being is key not only to their recovery but also to the success of the transplant and the safety of the recipient.” Fernández, one of the study’s researchers added that in donors “documenting their physical and emotional evolution helps to change the medical and social perspective, by reinforcing the idea that donation is an altruistic act, which requires care, follow-up and respect.”

Donor Outcomes

Between 2008 and 2025, 585 liver transplants were performed at the Fundación Favaloro in Argentina. Of these, 51 procedures (9%) involved LDs. The present analysis included 41 donors (61% women) with a mean age of 30 years at the time of transplantation.

Open surgery was performed in 80% of the cases, most left lateral segmentectomy (61%). Postoperative complications occurred in 19% of the donors and were mostly mild and self-limiting. No donor death was reported.

According to the structured questionnaire responses, 61% of the LDs reported being very satisfied with the experience, whereas 7% expressed regret. Regret was associated with adverse recipient outcomes, including death or retransplantation.

Most donors (88%) stated that the procedure was explained appropriately during the preoperative evaluation. Forty-one percent reported a complete understanding of the process, 44% reported a partial understanding, and 15% reported that they did not fully understand the transplant. Surgical specialists were identified as the primary source of information by 59% of participants.

Postoperative quality of life (QoL) was favorable. Eighty-eight percent of the patients reported feeling the same as before the surgery, and 12% reported feeling better. Physical symptoms include malaise, abdominal distension, nausea, and vomiting, abdominal or rib pain, and scar discomfort. Emotional symptoms, including fear (29%) and anxiety (27%), were reported but resolved spontaneously.

All donors resumed physical activity and social lives within 2 months. Among the 87% of those who took leave from work, all returned to work within the same period. Ninety-three percent of the participants said that they would recommend organ donation to others.

Ethical Considerations

Fernando Cairo, MD, head of the Solid Organ Transplant Service at Hospital El Cruce de Florencio Varela, Buenos Aires, Argentina, who was not involved in the study, described the findings as clinically relevant because they directly address the experience and QoL of LDs.

“In Argentina and Latin America, where LD transplantation can be an important alternative in selected scenarios, this evidence helps to make better decisions and design safer, more ethical and sustainable programs,” he said.

Fernández stated that the study findings were expected.

“This reflects not only the strength of the multidisciplinary team working in the service but also the awareness among donors of the situation facing individuals with liver failure. Donors understand the delays associated with the waiting list and the risk for not receiving an organ in time compared with the progression of disease, and they are willing to help as much as possible.” Fernández said.

Expanding Access

In 73% of cases of liver transplants, procedures from LDs were adult to pediatric transplants, with parents accounting for 83% of donors in that group. In adult-to-adult transplants, adult children were the most frequent donors (91% of cases).

“In the consultation room, each individual receives detailed information about the physical and emotional risks of surgery and still chooses to proceed to give a family member the opportunity for a better quality of life. This act reflects both a commitment to the health of a loved one and a profound sense of solidarity and generosity,” Fernández said.

She stated that she often reflects on the donors she has cared for. She personally met the participants and accompanied them throughout the perioperative period, when anxiety and uncertainty were most intense, or during the immediate postoperative phase, when physical pain frequently triggered fear. The patients were followed up through the later postoperative stages once recovery was complete.

“Being present during those difficult moments, watching them confront the challenges of surgery and then seeing them recover, healthy and satisfied, while their family member regains health and daily life, is simply priceless,” Fernández said.

Cairo described mixed reactions upon reviewing the study. He noted favorable outcomes and testimonials that highlighted the human aspect of the process, including the support donors received and the meaning they attributed to the act of giving. Simultaneously, he emphasized that the findings highlighted the importance of not minimizing the physical, emotional, or social effects donors may experience.

“The LD is not a companion. The patient was healthy and underwent major surgery. Focusing on his experience reinforces a key concept: the donor must be treated as a patient, with comprehensive evaluation, robust informed consent, psychosocial support, and follow-up,” Cairo said.

He added that this principle is critical for several reasons: “First, for safety, to identify complications or long-term effects. Second, for ethical reasons, consent must be informed and freely given. Third, for quality, since measuring experience and quality of life allows improvements in processes, communication and follow up, all of which form part of the transplant outcome,” he said.

When asked why it is important to care for those who decide to donate, Fernández said that his interest in research emerged from clinical practice. Many individuals in need of a liver assume that waiting for a deceased donor is their only option and are unaware that living-donor liver transplantation is feasible.

“In Argentina, in particular, and in Latin America more broadly, organ availability is very limited. Depending on their position on the waiting list, many individuals would not receive a transplant. Publishing this reference article helps raise awareness of this alternative, promotes knowledge, and may increase transplant opportunities in the region,” said Fernández.

In their publication, the authors noted that the widespread acceptance of living organ donation in Argentina remains limited. Cultural opinions limited public education on the topic, and persistent misconceptions about the risks of donation contributed to reluctance, particularly for procedures involving adults. In contrast, adult-to-pediatric transplantation tends to gain broader acceptance because of the urgent need to save a child’s life.

“Improving the donor experience not only safeguards physical and emotional well-being but also builds trust in the transplant process. When potential donors and their families know that follow-up protocols, psychological support, and careful risk management are in place, they are more likely to consider donation,” said Fernández.

He added that in “Argentina and Latin America, where more than 10,000 people are on waiting lists for organ and tissue transplantation, this could translate into a higher number of successful liver transplants.”

According to Fernández, medical professionals play a significant role in achieving this goal. In routine consultations, they can inform and educate individuals about the possibility of living donation, address questions about the procedure, and refer candidates and potential donors to specialized centers with established evaluation and follow-up protocols, thereby strengthening trust in the healthcare system.

Cairo agreed that prioritizing the donor experience increases trust. When donors are known to be supported and followed up with long-term, the healthcare system inspires confidence. If donors are perceived to be unprotected, this form of transplantation is discouraged.

“If living donation is to become a feasible and safe strategy in the region, the path forward is to strengthen ethics, quality and donor protection,” Cairo said.

“Caring for the donor is not only an ethical and medical obligation. This is also a strategy for expanding opportunities to save life. Many individuals die while waiting for an organ, and in some cases, the solution may be within reach: a healthy family member is willing to donate,” Fernández said.

All authors of the study, Fernández, and Cairo, reported having no relevant conflicts of interest.

This story was translated from Medscape’s Spanish edition.