[Transplant of livers from living relatives: selection of recipients and donors].

Living relative liver transplantation is a valid alternative to cadaver transplantation especially at a time when the availability of organs cannot meet the requests of long waiting lists. This procedure was initially introduced in response to the shortage of organs for pediatric cases, but the rapid growth of demand for liver transplantation has led to its extension to the adult population. The procedure raises a number of ethical, logistic and technical questions. The ethical aspect has been widely debated and in order to be acceptable, the procedure must comply with three critical points: the need for innovation, an acceptable risk-benefit ratio and adequate informed consent. The technical aspect is essential for the success of the procedure. It calls for an extensive experience and know-how of hepatobiliary surgery on one hand, and the use of high-resolution vision on the other, an aspect which is crucial for the success of vascular anastomoses. The indications for living relative transplantation are the same as for standard transplants. The sole exception is for adult patients with 2A status who present advanced hepatic imbalance caused by chronic liver disease, thereby reducing the probability of success, above all because a living donor graft is always smaller compared to the ideal dimensions for the recipient. In view of the severe shortage of organs, living relative transplantation is an important alternative for both pediatric and adult patients. The challenge over the coming decades will be to extend living relative transplantation to a growing number of patients, without jeopardizing the health of the donor.