Living donor liver transplant (LDLT) remains under-utilized in the United States. Barriers to LDLT and acceptance of non-directed living liver donation (ND-LLD) and liver paired exchange (LPE) are unclear. The medical and surgical directors of 99 unique transplant programs (56 LDLT programs and 43 non-LDLT programs) were surveyed to gain insight into perceptions and practices of LDLT and types of donors utilized. The response rate was 84%. Most LDLT programs (65%) reported performing ND-LLD, though opinions regarding allocation and the need for additional evaluation of these donors were mixed. Only a minority of LDLT programs reported performing LPE (12%), but most programs (78%), would be open to cross-institutional LPE barring logistical barriers. There were significant differences between LDLT and non-LDLT programs with regard to perceived barriers to LDLT with LDLT programs reporting mainly donor and recipient factors and non-LDLT programs reporting institutional factors (p<0.001).

Understanding perceptions and practices of LDLT, ND-LLD, and LPE is important to aid in the growth of LDLT.