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=== Living donor transplantation ===
[[File:LDLT volume measure.jpg|thumb|Volume rendering image created with [[computed tomography]], which can be used to evaluate the volume of the liver of a potential donor]]
'''Living donor liver transplantation''' (LDLT) has emerged in recent decades as a critical [[Surgery|surgical]] option for patients with end stage liver disease, such as [[cirrhosis]] and/or [[hepatocellular carcinoma]] often attributable to one or more of the following: long-term [[alcohol use disorder]], long-term untreated [[hepatitis C]] infection, long-term untreated [[hepatitis B]] infection. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human liver and (2) the widespread shortage of [[cadaver]]ic livers for patients awaiting [[Organ transplant|transplant]]. In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient's diseased liver has been entirely removed.{{cn}}
Historically, LDLT began with terminal pediatric patients, whose parents were motivated to risk donating a portion of their compatible healthy livers to replace their children's failing ones. The first report of successful LDLT was by [[Silvano Raia]] at the [[University of São Paulo]] Faculty of Medicine in July 1989.<ref>{{cite book | title=Liver Transplantation | isbn=9788184487701 | url=https://books.google.com/books?id=3t8z7mKHo7UC | ref={{sfnref | Google Books}} | access-date=2020-05-08| last1=Chakravarty | first1=Dilip | last2=Chakravarty | first2=Dilip K. | last3=Lee | first3=W. C. | date=9 October 2010 | publisher=Boydell & Brewer }}</ref>{{Page needed|date=June 2022}}<ref name="Google Books">{{cite book | title=Malignant Liver Tumors | isbn=9781444356397 | url=https://books.google.com/books?id=AOKWsAAIRpUC | access-date=2020-05-08| last1=Clavien | first1=Pierre-Alain | last2=Breitenstein | first2=Stefan | last3=Belghiti | first3=Jacques | last4=Chari | first4=Ravi S. | last5=Llovet | first5=Josep M. | last6=Lo | first6=Chung-Mau | last7=Morse | first7=Michael A. | last8=Takayama | first8=Tadatoshi | last9=Vauthey | first9=Jean-Nicolas | date=23 September 2011 | publisher=John Wiley & Sons }}</ref> It was followed by [[Christoph Broelsch]] at the [[University of Chicago Medical Center]] in November 1989, when two-year-old Alyssa Smith received a portion of her mother's liver.<ref>{{cite web|url=http://www.uchicagokidshospital.org/specialties/transplant/patient-stories/alyssa-liver.html|title=Patient Stories – University of Chicago Medicine Comer Children's Hospital|website=www.uchicagokidshospital.org|access-date=29 March 2018}}</ref> Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor liver transplantation, and also poses the ethical problems underlying the indication of a major surgical operation ([[hemihepatectomy]] or related procedure) on a healthy human being. In various case series, the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are [[biliary fistula]], [[gastric stasis]] and [[infection]]s; they are more common after removal of the right lobe of the liver. Death after LDLT has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure.{{sfn|Umeshita|Fujiwara|Kiyosawa|Makuuchi|2003}} Since the law was changed to permit altruistic non-directed living organ donations in the UK in 2006, the first altruistic living liver donation took place in Britain in December 2012.<ref>{{cite news|title=First UK live liver donation to a stranger takes place.|url=https://www.bbc.co.uk/news/health-21143602|access-date=3 August 2013|newspaper=BBC News|date=23 January 2013}}</ref>
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