The foremost priority in liver transplantation preparation is ensuring that the procedure does not cause any harm to either the donor or the recipient. The goal of the operation is to conclude with two healthy individuals. If there is even a slight possibility that the donor could be harmed by the surgery, the preparation process is immediately cancelled, and another donor candidate is identified.

When a donor volunteers to donate part of their liver, detailed medical examinations and advanced imaging studies are performed before surgery to ensure that the remaining liver will be sufficient for the donor. These evaluations also confirm that the anatomical structures of the hepatic artery, portal vein, hepatic vein, and bile ducts are suitable for safe surgical division.

If, during the operation, a condition arises that poses a risk to the donor—even if rare—the procedure may be aborted for safety reasons. As a general rule, the remnant liver volume in the donor should not be less than 30%. However, in young and healthy donors, this threshold can be safely reduced to 25%.

Recipient Evaluation

Before liver transplantation, which represents the only definitive treatment for liver failure, the recipient must undergo comprehensive preoperative evaluation—just like the donor. This evaluation aims to ensure that the patient can tolerate surgery, to identify and treat correctable problems beforehand, and to detect potential post-transplant complications early. If any findings suggest that transplantation may pose significant risks, the operation is cancelled and the patient is informed accordingly.

Transplantation is not performed in the following situations:

• Advanced portal vein thrombosis
• Hepatocellular carcinoma invading major vessels or spreading beyond the liver
• Insufficient donor liver volume for the recipient
• Donor liver vascular or bile duct structures posing surgical risk

As a general rule, the transplanted liver graft must weigh at least 1% of the recipient’s body weight. In stable patients with good health and young donors, this ratio can be reduced to 0.8%.

Examinations for Donor and Recipient

1. Physical Examination
2. Detailed Blood and Urine Tests and evaluation of all system functions, including:
   • Blood group determination
   • Complete blood count, biochemistry, coagulation profile
   • Hepatitis markers, EBV and CMV IgM/IgG
   • TSH, PTH, HbA1c, B-HCG, PSA, AFP, and tumor markers
   • Complete urine analysis and etiology-specific tests for the recipient
3. Microbiological Examinations – catheter, urine, ascitic fluid, and blood cultures when necessary
4. Radiological Examinations:
   • Recipient: abdominal ultrasound, portal vein Doppler, thoracic CT, triphasic abdominal CT, and contrast-enhanced MRI if needed
   • Donor: abdominal ultrasound, thoracic CT, and triphasic abdominal CT
5. Consultations – from Cardiology, Pulmonology, Psychiatry, Gynecology, and other specialties as required
6. Additional Tests – electrocardiography, echocardiography, pulmonary function testing, endoscopy, colonoscopy, and, when appropriate, mammography, breast and thyroid ultrasound