# Standardized evaluation protocols for deceased and living liver donors: a practical framework for emerging liver transplant programs

## TL;DR

This paper provides a standardized framework for evaluating deceased and living liver donors to improve transplant safety and outcomes globally.

## Contribution

A unified, evidence-based framework for deceased and living donor liver transplant evaluations is proposed to harmonize practices across healthcare systems.

## Key findings

- Standardized protocols for deceased donor management and neurological death determination improve graft viability.
- Meticulous psychosocial and anatomical assessments in living donor transplants enhance donor safety.
- Adopting global best practices can optimize graft utilization and support sustainable transplant program growth.

## Abstract

Liver transplantation (LT) remains the definitive therapy for end-stage liver disease. However, significant variability in infrastructure, policy, and clinical practice continues to influence the implementation of deceased donor (DDLT) and living donor liver transplantation (LDLT) worldwide, particularly across emerging and expanding programs.

This narrative review synthesizes contemporary guidelines, expert consensus documents, and high-impact clinical studies on donor evaluation. It presents a standardized and pragmatic framework for both DDLT and LDLT, integrating medical, radiologic, ethical, and psychosocial domains. Protocols are designed to be evidence-based, reproducible, and aligned with international standards.

In DDLT, optimal donor management, accurate neurological determination of death, and comprehensive infectious disease screening are essential for graft viability. In LDLT, meticulous psychosocial and anatomical assessments remain critical to donor safety. Advances such as machine perfusion, desensitization protocols, and expanded donor criteria have improved outcomes and broadened transplant opportunities. The proposed framework consolidates global best practices to support program consistency and quality assurance.

This review provides a comprehensive and practical approach to donor evaluation in LT, promoting harmonization of practices across diverse healthcare systems. Its adoption may enhance donor safety, optimize graft utilization, and support the sustainable growth of both DDLT and LDLT programs worldwide.

Infographic comparing deceased donor and living donor evaluation pathways for liver transplantation. Each pathway lists five sequential steps, ending in multidisciplinary approval, highlighting the process differences. A note below states optimized donor selection leads to improved matching and safer transplants.