Ethical perspectives on living donor organ transplantation in Asia

Abstract

Live donors are a continuing source of organ grafts for solid organ transplantation in Asia. Ethical issues surrounding the development of living donor organ transplantation in Eastern countries are different from those in Western countries. Donor safety is still the paramount concern in any donor operation. Issues on organ trafficking remain societal concerns in low-income nations. Religion, cultural background, economic prerogatives, and timely legislation contribute to the social acceptance and maturation of organ donation.

Living Donor Liver Transplantation in Patients 70 Years or Older

“…All of the patients had at least one complication of their liver cirrhosis, such as hepatic encephalopathy, variceal bleeding, or spontaneous bacterial peritonitis. The median model for end-stage liver disease (MELD) score was 13 (interquartile range [IQR], [11][12][13][14][15][16][17] and the median World Health Organization (WHO) performance status was preoperatively three (IQR, 3-3.5). The measured median skeletal muscle area, using preoperative computed tomography scan, was 98 cm 2 (IQR, 95-125) in men and 68 cm 2 (IQR, 61-87) in women.…”

Standard Formulae in Predicting Liver Volumes: A South East Asian Series of Adult Living Donors

“…Due to historical, religious and cultural beliefs in some of these countries, organ transplantation from deceased has not been a widely accepted practice [14]. Although deceased donor organ transplantation was started relatively early in Asia, deceased donor organ rates in this region are among the lowest in the world [15].…”

Why does living donor liver transplantation flourish in Asia?

“…Here, we can see the creativeness of the transplant surgeons who combined their scientific and technical capabilities with religious virtues in convincing patients to undergo liver transplantation. 10 From 2006 to 2010, there was a steady increase in the rates of LDLT in Asia, a slight increase in Europe and a decline in the USA (Figure 2). LDLT comprises >90% of liver transplant activity in Asia, 38 4.3% in Europe, 39 and 5% in the USA; 40 roughly the reverse is true for DDLT.…”

“…Soon brain death laws were adopted elsewhere: in Singapore in 1987, Thailand in 1992, Philippines and India in 1994, Japan in 1997, Hong Kong in 1998, and Korea in 1999. 10 Mainland China has no brain death law but adheres to the idea of 'cardiac death' (that is, stoppage of heart function; often equated with physical or somatic death). However, despite great enthusiasm in this new field of liver transplantation, cases remained few and slow to pick up during the 1980s-1990s.…”