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Safety and Care for Donors in the Living Related Liver Transplant ProgramThe introduction of a living related donor (LRD) component to the URMC Liver Transplant Program presents substantial challenges to the anesthesiology team. The appreciation that the donor has real and tangible risks of morbidity and mortality adds an ethical dimension to caring for these patients that is complex and profound, affecting numerous individuals including their families, the recipient, and members of the liver transplant program. The need to develop a protocol for patient selection and intra-operative anesthetic management in collaboration with our surgical colleagues that reduces morbidity and minimizes risks of mortality will in large part define whether LRD liver transplantation will become an ethically acceptable standard of care. The Department of Anesthesiology's Liver Transplantation group headed by Dr. Ashwani Chhibber, is now analyzing the results of 100 consecutive LRD liver donations without a mortality in preparation for publishing their results. The group has evolved an approach to the management of the donor patients that combines the conventional with paradoxically unconventional physiological goals that address the unique set of problems arising from removing almost 2/3 of the liver with the attendant ischemia - reperfusion injury, while providing regional post-operative pain relief. The consistent success they have in evolving an optimal management strategy suggests their protocol may become the standard of care for other such programs.
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