Working Groups
- Working Group I: Pre-operative Aspects to Living Liver Donation
- Working Group II: Intra-operative Considerations in Living Liver Donation
- Working Group III: Early Post-operative Considerations in Living Liver Donation
- Working Group IV: Post-Living Liver Donation: Long- Term Considerations
Working Group Chair: Nazia Selzner, Abhinav Humar & Susan Abbey
Working Group Members: Tiffany Wong, Mettu Srinivas Reddy, Yaman Tokat, Tomoharu Yoshizumi, Gokhan Kabacam, Anjana Pillai, Vicky Ng, Francois Durand, Pooja Bhangui, Erik Yeo, Kartik Jhaveri, Heather Bedanoch, Mark Cattral, Jed Gross, Ashish Malik, Taizo Hibi, Henrik Petrowsky, Sezai Yilmaz, Muhammed Kahn, Silvio Nadalin
Vanguard Committee: Madhukar Patel, Paolo Magistri, Qasim Khan
TOPICS for Working Group I
1. Who’s an ideal donor?
A. Age, ABO, BMI, etc.
B. What are the acceptable comorbidities?
a. Medical contraindications for donation?
b. Drug history? – neurological, allergies etc.
C. Assessment of liver quality
a. LFT
i. Acceptable limits – derangements before donation?
D. Assessment of steatosis in the donor? (MRI, Fibroscan, LAI, biopsy etc)
a. Acceptable limits
b. Interventions – to improve liver status
E. Procoagulant work-up? Mandatory, what should be done? Family history? Etc.
F. Disease specific work-up and extended tests?
a. Anatomical considerations
i. Mandatory radiological work-up.
ii. Is MRI is it mandatory?
b. Absolute contraindication to donation
c. Implications for donor outcome / for recipient outcome
d. Safe remnant
i. Absolute contraindication
ii. Relative contraindications
iii. Optimizing remnant
e. Previous surgery – previous donations
i. Acceptability consideration
Working Group Chair: Kim Olthoff, Deniz Balci & Yuji Soejima
Panelists: Ki-Hun Kim, Subash Gupta, James Pomposelli, Seisuko Sakamoto, Qiang Xia, Alfred Kow, Rajesh Rajalingam, Stuart McCluskey, Jim Findlay, Avi Soin, Swaytha Ganesh, Wojchiech Polak, Gonzalo Sapisochin, Yee Lee Cheah, Amar Gupta, Michael Spiro
Vanguard Committee: Abdul Hakeem, Alexandra Shingina, Tommaso Di Maira
TOPICS for Working Group II
1. Anesthesia
A. Standardized access and what should be minimal monitoring? (Central venous access, arterial line)
B. Loco-regional pain control: may reference prior ERAS conference work
2. Surgery
A. Training requirements for ODH, PLDH and RDH. Centre volume – ideal number.
B. What are the standard surgical techniques? Incision – ideal for ODH
C. Inflow control, parenchymal transection techniques- best/preferred, bile duct visualization -ICG, IOC, bile duct division, drain placement?
D. MIS utilization: robotic vs lap? Bile duct division in MIDH
E. Standardized intra-op disaster pathway: in open/lap/robotic – uncontrolled hemorrhage or severe HD instability
Working Group Chair: Julie Heimbach, Anand Ghanekar & Mureo Kasahara
Panelists: Olivier Scatton, Mark Ghobrial, Tarunjeet Klair, Akila Rajakumar, Dimtri Bezinovir, Gary May, Tess Bitterman, Caitlin Don, Sudhindran, Dong-Sik Kim, Roberto Hernandez Alejandro, Carla Luzzi, Cynthia Tsien, Fabrizio Di Benedetto
Vanguard Committee: Ryan Chadha, Manikandan Kathirvel, Tommy Ivanics, Marta Tejedor
TOPICS for Working Group III
1. Anesthesia & Hepatology
A. Requirements for 24 Monitoring, pain control, diet advancement, fluid management, ERAS pathway – applications
B. Mandatory protocols – Blood tests (LFTs, lactate) imaging USG-frequency, Triggers for CT
C. Prophylaxis: Antibiotics, DVT, Ulcer—what and for how long
2. Surgery
A. Management of early complications
B. Biliary – Drain bilirubin, Indications & timing of ERCP Reexploration,
C. Management of Bleed
D. Triggers for reexploration
E. Management of insufficient functional liver remnant – criteria for PHLF, threshold for consideration of LT
F. Management of other serious medical complications: PE, pancreatitis,
G. Standardized post-op disaster plan – Donor mortality
3. Psychiatry & Ethics
A. Timing of Return to work, exercise, driving, sexual health
B. Donors with Post-operative depression or anxiety
C. Sharing news of poor recipient outcome with donors
Working Group Chair: Mohamed Rela, Dong-Hwan Jung & Kym Watt
Panelists: Zhi-jun Zhu, Elizabeth Pomfret, Nicolas Goldaracena, Markus Selzner, Jongman Kim, Bijan Eghtesad, Daniel Maluf, Annmarie Liapakis, Nancy Kwan Man, Sudha Kodali, Paul James, John Roberts, Susumu Eguchi, Albert Chan
Vanguard Committee: Sadhana Shankar, Johns Shaji Mathew, Nicholas Syn
TOPICS for Working Group IV
1. Hepatology & Surgery
A. Defining standard long-term follow-up benchmarks
B. Review protocols- Minimum requirement
a. Mandatory frequency, blood tests, imaging etc.
C. Management of Late Complications
a. Biliary strictures
b. Diaphragmatic Hernia
c. Wound complications
d. Chronic pain
2. Psychiatry & Ethics
A. Quality of Life, Body Image, Sexual & Reproductive health
B. Long term psychosocial support – suicides, recipient deaths etc
C. Istanbul declaration
D. International LDLT donor registry