REVIEW article
Front. Transplant.
Sec. Abdominal Transplantation
This article is part of the Research TopicOvercoming Barriers and Enhancing Strategies in Organ Transplantation SystemsView all articles
Standardized Evaluation Protocols for Deceased and Living Liver Donors: A Practical Framework for Emerging Liver Transplant Programs
Provisionally accepted
Pablo Coste Murillo1,2,3*
Rodrigo Álvarez Buitrago3
Vanessa López Jara2
Maria Lynch-Mejia2,3
Francisco Vargas Navarro2,3
Wagner Ramírez Quesada2,3
Christie Perello4
Jose Luis Calleja5- 1University of Costa Rica, San Jose, Costa Rica
- 2Hospital Rafael Angel Calderon Guardia, San José, Costa Rica
- 3Liver Lab CR, San José, Costa Rica
- 4Hospital Metropolitano de Santiago, Santiago De Los Caballeros, Dominican Republic
- 5Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
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Background: Liver transplantation (LT) remains the definitive therapy for end-stage liver disease. However, significant variability in infrastructure, policy, and clinical practice continues to influence the implementation of deceased donor (DDLT) and living donor liver transplantation (LDLT) worldwide, particularly across emerging and expanding programs. Methods: This narrative review synthesizes contemporary guidelines, expert consensus documents, and high-impact clinical studies on donor evaluation. It presents a standardized and pragmatic framework for both DDLT and LDLT, integrating medical, radiologic, ethical, and psychosocial domains. Protocols are designed to be evidence-based, reproducible, and aligned with international standards. Key content and findings: In DDLT, optimal donor management, accurate neurological determination of death, and comprehensive infectious disease screening are essential for graft viability. In LDLT, meticulous psychosocial and anatomical assessments remain critical to donor safety. Advances such as machine perfusion, desensitization protocols, and expanded donor criteria have improved outcomes and broadened transplant opportunities. The proposed framework consolidates global best practices to support program consistency and quality assurance Conclusions: This review provides a comprehensive and practical approach to donor evaluation in LT, promoting harmonization of practices across diverse healthcare systems. Its adoption may enhance donor safety, optimize graft utilization, and support the sustainable growth of both DDLT and LDLT programs worldwide.
Keywords: Deceased donor, Donor evaluation, emerging programs, Extended criteria donor, Liver Transplantation, Living donor, transplant protocol
Received: 05 Nov 2025; Accepted: 22 Jan 2026.
Copyright: © 2026 Coste Murillo, Álvarez Buitrago, López Jara, Lynch-Mejia, Vargas Navarro, Ramírez Quesada, Perello and Calleja. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Pablo Coste Murillo
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.