Glucagon-like peptide-1 agonists usage to widen the living donor pool for liver transplantation: A novel metabolic strategy

Table 1 Comparison between weight loss strategies for living liver donors

Aspect	Strict lifestyle modification (diet + exercise)	GLP-1 receptor agonists (e.g., semaglutide, liraglutide)	Bariatric surgery (sleeve, bypass)
Primary goal in donors	Reduce BMI and hepatic steatosis safely	Pharmacologic weight and fat reduction	Major, durable weight loss
Typical components	Calorie restriction, low-fat or low-carb diet, aerobic + resistance exercise	Weekly injections + diet counselling	Surgical alteration of the stomach/intestine
Speed of weight loss	Moderate	Moderate-rapid	Rapid (after recovery)
Effect on liver fat (steatosis)	Very effective	Effective	Effective
Time to donor eligibility	4-12 weeks	2-6 months	6-12 + months
Reversibility	Fully reversible	Reversible (drug stopped)	Irreversible
Nutritional risk	Low if supervised	Moderate (reduced intake, nausea)	High (malabsorption, deficiencies)
Surgical risk added	None	None	Yes (major surgery)
Impact on donor safety	Safest approach	Uncertain perioperative effects	Increased risk
Transplant centre acceptance	Standard of care	Case-by-case	Uncommon practice
Ethical considerations	Acceptable	Debated	Generally unacceptable
Typical candidates	BMI mildly-moderately elevated, fatty liver	Obese donors failing lifestyle alone	Obesity is too severe for donation anyway

GLP-1: Glucagon-like peptide-1; BMI: Body mass index.