Standardized evaluation protocols for deceased and living liver donors: a practical framework for emerging liver transplant programs

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.