This manuscript discusses the safety and feasibility of donor right liver resection (DRLR) in individuals with a body mass index (BMI) of 30 kg/m² or higher in the context of living donor liver transplantation (LDLT) [1]. With the global rise in obesity, there is an increasing number of potential liver donors with higher BMIs. However, the effect of donor obesity on both donor safety and recipient outcomes has not been extensively studied. Using data from a high-volume center in Asia, this study provides valuable evidence by comparing obese and normal-weight donors, focusing on key perioperative outcomes.

The authors should be commended for their rigorous methodology, including the use of matching to minimize bias. Their findings reveal no significant differences in major postoperative complications, length of hospital stay, or readmission rates between obese and normal-weight donors. This suggests that with appropriate donor selection and thorough preoperative evaluation, DRLR can be safely performed in selected high-BMI donors, potentially expanding the donor pool in a time of critical organ shortages globally.

However, it is important to note the study’s limitations, including its retrospective nature and the relatively small sample size after matching. Moreover, while the findings suggest that obese donors can be safely incorporated into LDLT programs, the study highlights the importance of strict preoperative assessments, particularly regarding liver steatosis and metabolic health, to manage the technical challenges posed by obesity. Future research, especially prospective and multi-center studies, will be essential in solidifying these results and helping to establish more comprehensive guidelines for the inclusion of obese donors in LDLT.