Anonymous Living Liver Donation: Literature Review and Case Series Report

Abstract

Supplemental Digital Content is available in the text.

Practices and Perceptions of Living Donor Liver Transplantation, Nondirected Donation, and Liver Paired Exchange: A National Survey

“…It has also been suggested that centers could partner with regional organ procurement organizations to reduce the burden of additional screening on individual programs. (9) In addition to ND-LLD, LPE is an attractive option to increase organ availability, but it is rarely practiced in the United States to date. It is estimated that 2%-17% of donors are rejected in the United States for ABO incompatibility, inadequate hepatic mass, or vascular or biliary anatomic variations (5) and LPE is a way to potentially address these incompatibilities.…”

“…In practice, many centers, including several in our study, prefer to use nondirected donors for pediatric recipients given that many pediatric recipients may be underserved by current allocation practices or because donors only need to donate a left lateral segment, which is a safer procedure and poses fewer risks of complications. (9,15) Standardizing a process that minimizes risk to the donor may help to alleviate some programs' concerns regarding the ethics of ND-LLD. Yet, questions remain as to whether there is a need for standardization of organ allocation or whether this is better left to the discretion of each institution.…”

“…( 14 ) Washington University Medical Center in St. Louis published their use of psychometric testing, including the Minnesota Multiphasic Personality Inventory‐2 for all potential nondirected liver or kidney donors. ( 9 ) Additional psychosocial screening appears to be a relatively common practice across institutions and can potentially be adopted by all programs to ensure donor motivations are sound. It has also been suggested that centers could partner with regional organ procurement organizations to reduce the burden of additional screening on individual programs.…”

“…(4,8) We were also interested in investigating perceptions of ND-LLD given ethical concerns that have been raised. (9) For LPE, we were interested in perceived barriers and where they should be performed (within the institution or across institutions as currently done with kidney paired exchange). Because there is no central organizing process for LPE currently, we also assessed opinions regarding an organizing body (United Network for Organ Sharing [UNOS] versus institution versus private).…”

Anonymous Nondirected Living Liver Donation in the United States

“…We read with great interest this recent article from the University of Virginia group titled “Anonymous Living Liver Donation: Literature Review and Case Series Report.” 1 We congratulate the authors for discussing this very important topic and highlighting the experience of 3 centers.…”