Question: Can doctors be certain that a donor liver is "good" and how can they be sure?

Answer: It is not possible to be certain that a liver will be a good one. However, it is possible in many cases to tell when a liver will be a bad one. By a bad liver, I mean that it will not function immediately in the recipient. If the liver donor has a high serum sodium level, or if the liver has fatty infiltration, it is known that the likelihood that the liver will work well following transplantation is much lower. For this reason if the sodium is high enough or if there is too much fat in the donor liver, it is often not transplanted. The other factor that is known to be associated with poor liver function is the appearance of the donor liver. In other words, the subjective impression of the donor liver by an experienced transplant surgeon is also important. Livers that "don't look good" have rounded edges instead of sharp, distinct ones. They also may have a swollen appearance and/or an abnormal color. Even when none of these factors are present there is a chance that the liver will not work in the recipient. This is called primary non-function. It occurs after about 5% of liver transplants overall. In these cases, an immediate and emergent re-transplant will be required.
-Jeffrey Punch, MD