Thomas Jefferson University Hospital, Pennsylvania, United States
Background/Case Studies: Organ Procurement and Transplantation Network (OPTN) policy includes requirements for the medical evaluation of potential living liver donors. No mention is made of autologous blood donation. However, local practice encourages autologous whole blood donation at a hospital-based blood donor center prior to living liver donation.
Study
Design/Methods: Living liver donors presenting to an academic medical center for liver donation between 2018 and 2024 were reviewed retrospectively. Sex, age, date of liver donation, number of autologous blood units donated, and number of autologous and allogeneic blood units transfused were recorded. All surgical procedures were overseen by one of three different transplant surgeons.
Results/Findings: Fourteen living liver donors were identified, including six males and eight females. The average donor age was 37 years (range 27-50 years). Two donors never proceeded to living liver donation. One donation was canceled due to the recipient’s worsening medical condition and another was canceled because the donor was newly diagnosed with chronic liver disease. The remaining twelve donors proceeded to liver donation. One donor did not meet blood donor eligibility criteria and was unable to donate any autologous units prior to liver donation. Six donors each donated one autologous unit prior to liver donation. Five donors each donated two autologous units prior to liver donation. Of the sixteen total units of autologous blood donated, twelve units were discarded (75%). Only four units were ultimately transfused, one to each of four donors, all intra- or perioperatively. One donor donated two autologous units, one of which was transfused. For this donor, an intraoperative hemoglobin (Hgb) of 7.5 g/dL was observed, prompting the intraoperative ordering of the autologous unit.However, a postoperative complete blood count drawn just before the autologous unit was issued showed a Hgb of 9.5 g/dL, and the post-transfusion Hgb was 10.8 g/dL. Another donor donated one autologous unit and this was transfused intraoperatively with no documented pre-transfusion Hgb. In this donor’s entire admission, the lowest documented Hgb was 10.2 g/dL. One donor donated two autologous units and one was transfused intraoperatively with no documented pre-transfusion Hgb. In this donor’s entire admission, the lowest documented Hgb was 10.4 g/dL. One last donor donated one autologous unit and this was transfused immediately post-operatively for an intraoperative Hgb of 8.5 g/dL. Allogeneic transfusion was not required for any living liver donor. Conclusions: In this single-center experience, the majority of autologous blood donations made by living liver donors were discarded. Autologous units used were transfused at Hgb levels higher than patient blood management best practices, and allogeneic transfusion was never required for these donors.
