A New Lifeline: Feasibility and Outcomes of Altruistic Donor Programs in Living-Donor Liver Transplantation, A Single Saudi Center Experience.

BACKGROUND In regions with limited deceased-donor liver transplantation, living-donor liver transplantation is often the only viable option. Altruistic (unrelated, nondirected) living-donor liver donation offers a novel strategy to expand the donor pool, particularly for patients lacking suitable related donors. MATERIAL AND METHODS This retrospective study analyzed all altruistic liver donors and their recipients at King Fahad Specialist Hospital-Dammam between April 2018 and December 2024. Donors underwent medical, psychosocial, and ethical evaluations, with final approval by an independent multidisciplinary committee. Data on donor demographics, hospital stay, complications, and graft type were reviewed. RESULTS Thirty-two altruistic donors (mean age 34.6 years; 68.8% male) successfully donated left lateral liver grafts. Allocation prioritized pediatric and high-urgency recipients. The average donor hospital stay was 4 days. No major complications (Clavien-Dindo grade ≥III) occurred; 81.2% had no complications, and 18.8% had minor (grade I-II) issues. All donors were alive and well at follow-up. CONCLUSIONS Altruistic liver donation is a safe, ethical, and effective strategy to address organ shortages for liver transplantation. With strong oversight and donor screening, this model enables life-saving transplants in vulnerable populations and represents a replicable innovation in transplant care.