Split liver transplantation and living donor liver transplantation (LDLT) commonly use a right liver graft without the middle hepatic vein (MHV). Although tributaries of the MHV are not reconstructed in the majority of cases, the alterations of the microcirculation and its regional functions remain unknown. We addressed these issues by assessing liver tissue indocyanine green (ICG) uptake with near-infrared spectroscopy (NIRS) in 21 donors. After graft procurement, visual inspection (before and after hepatic arterial clamping) and Doppler examination of the veno-occlusive region were performed. Bolus ICG (100 μg/kg) was then administered intravenously. Blood ICG at the finger tip was measured with pulse dye densitometry, whereas the liver ICG concentrations in the veno-occlusive and non–veno-occlusive regions were simultaneously measured for 15 minutes by NIRS. We estimated the hepatic ICG uptake rate constants in the veno-occlusive region (Ku-oc) and non–veno-occlusive region (Ku-non). Changes in sinusoidal perfusion in the veno-occlusive region were expressed by the ratio of Ku-oc to Ku-non (Roc/non). The median value of Roc/non was 0.47, although it ranged from 0.13 to 0.94. Roc/non was related to the extent of liver surface discoloration before and after hepatic arterial clamping (P = 0.03 and 0.01, respectively). In conclusion, sinusoidal perfusion was impaired in the veno-occlusive regions of living donor livers, but the magnitude of the effect varied greatly. Measurement of hepatic ICG uptake by NIRS could become a valuable tool for assessing the indication for venous reconstruction in LDLT and/or split donor liver transplantation. Liver Transpl 14:872–880, 2008. © 2008.