“It never rains it pours!”

The most effective therapy for end stage liver disease is transplantation. Immunosuppression and surgical techniques have improved the long term survival of patients following liver transplantation; this had led to an increase in demand for organs (1). The liver has remarkable regenerative properties and because of this it is possible to transplant part of a liver into an individual. This can be either as a " split " liver, where a cadaveric liver is split in two and transplanted into two individuals or as a live donor liver transplant (LDLT) (2). It has been shown that within 7 days of surgery for an LDLT, both a transplanted right lobe and a remnant left lobe will have increased in size by approximately 100% (3, 4). Subsequent studies however have shown that functional recovery occurs more gradually than the recovery of liver volume and tends to occur over around 6 months (5). Historically there has been a shortage of donor livers for paediatric patients awaiting transplantation (3). Split liver transplantation has had a dramatic effect on paediatric waiting list mortality, reducing it to almost zero (6). The situation is different in adults and LDLT is currently the most effective way of overcoming the organ shortages for adults (1). When it was first introduced LDLT was a way in which parents with children with liver disease could donate part of their healthy liver to their child. The first report of a successful LDLT was in 1989 when a 2 year old girl received a portion of her mother's liver (7, 8). Since then LDLT has become increasingly common. Donor recipients tend to come from a patients family or close friends. In January 2013, the first live liver donation to a complete stranger took place in the UK (9). The benefit of using a living donor is the ability to perform a transplant when it is clinically indicated, the complications associated with organ preservation are minimised and primary non function is rare (3). If a patient is critically unwell it may even be possible to conduct the two operations simultaneously and the transplant to occur very quickly (10). There has been a vast difference uptake around the world with the uptake in the east being much greater than in the west. According the Japanese Transplant Society, the number of LDLT's in adults has increased each year (5) whereas in the US and Europe the …