OLT is known to be associated with a precarious perioperative
hemostatic state due to dysregulation of procoagulant and
anticoagulant factors, endothelial injury, and
inflammation. Transmission of inherited
bleeding and clotting disorders from the liver donor to the recipient may further complicate hemostasis during and after
transplantation. As a result, consideration of congenital coagulation disorders in the liver donor is a practical concern for
donor selection. However, there is no clear consensus regarding the selection of donors with known or suspected
thrombophilia or
bleeding disorders. While multiple case reports and retrospective studies, subject to reporting bias, describe donor-derived thrombophilic and
bleeding disorders, there are no large-scale studies in the adult
liver transplant literature that examine the frequency of transmission, utility of
donor screening, or clinical impact of donor
hemostatic disorders. Based on the reported literature, we summarize our approach for
donor selection with an aim to balance improved organ utility and optimal post-transplant outcomes.