Challenging the Traditional Paradigm of Supply and Demand in Pediatric Liver Transplantation Through Nondirected Living Donation: A Case Series

<jats:p>A gap exists between the demand for pediatric liver transplantation and the supply of appropriate size‐matched donors. We describe our center’s experience with pediatric liver transplantation using anonymous nondirected living liver donors (ND‐LLD). First‐time pediatric liver transplant candidates listed at our center between January 2012 and June 2020 were retrospectively reviewed and categorized by donor graft type, and recipients of ND‐LLD grafts were described. A total of 13 ND‐LLD pediatric liver transplantations were performed, including 8 left lateral segments, 4 left lobes, and 1 right lobe. Of the ND‐LLD recipients, 5 had no directed living donor evaluated, whereas the remaining 8 (62%) had all potential directed donors ruled out during the evaluation process. Recipient and graft survival were 100% during a median follow‐up time of 445 (range, 70‐986) days. Of ND‐LLDs, 69% were previous living kidney donors, and 1 ND‐LLD went on to donate a kidney after liver donation. Of the ND‐LLDs, 46% were approved prior to the recipient being listed. Over time, the proportion of living donor transplants performed, specifically from ND‐LLDs, increased, and the number of children on the waiting list decreased. The introduction of ND‐LLDs to a pediatric liver transplant program can expand the benefit of living donor liver transplantation to children without a suitable directed living donor while achieving excellent outcomes for both the recipients and donors.</jats:p>