The Ethics of living related liver transplantation when deceased donation is not an option

Schiano, Thomas D.

doi:10.1002/cld.508

Cited by 5 publications

(3 citation statements)

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“…Organ allocation and the decision to perform LT raise numerous ethical and moral issues, and the transplant community has discussed them [192]. A measure of consensus has been achieved on many issues, such as the acceptability of the brain death standard, the use of liver grafts from deceased donors, the allocation of liver grafts based on urgency and need rather than social factors, and the acceptability of living donor transplantation [193]. A wide variety of liver allocation ethical concerns are important, including equity, solidarity, fairness, efficiency, quality of life, maximum benefit, economical responsibility, informed consent, and minimum corruptibility [194].…”

Section: Ethical Issuementioning

confidence: 99%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines. Keywords Living donor liver transplantation • Deceased donor liver transplantation • Multidisciplinary • GradeSpecial consideration: LDLT in ACLF In a study of 112 LDLT recipients with ACLF, defined by the APASL definition, post-LT outcomes were excellent (92.9% at 5 years) [69]. In a study on high-model end-stage liver disease (MELD) (score ≥ 30) LDLT recipients with ACLF (n = 190), defined by the World Congress of Gastroenterology [70], the 5-year survival rate was 72.1% [71]. In a study of 117 LDLT recipients who had ACLF, as defined by the EASL-CLIF definition, post-transplant survival after LDLT was 92.9%, 85.4%, and 75.6% at 1 year, while mortality rate without LT was 28.5%, 77.7%, and 93.4% at 90 days, for ACLF grades 1, 2, and 3, respectively [72]. These data indicate that LDLT can be a life-saving treatment option for patients with ACLF.LDLT differs significantly from DDLT, as the timing of LDLT can be determined by the transplant team. There are advantages and disadvantages of LDLT in the setting of ACLF. The benefit of LDLT in patients with ACLF is its ability to provide rapid transplantation to critically ill patients [73], without waiting for deceased donor allocation. The ideal time for LT can be selected by transplant team when willing living donor is available. If ideal time for LT can be selected in the dynamic course of ACLF, this may improve post-LT outcome. The disadvantages of LDLT include the need for healthy, willing liver donor, and the use of partial grafts for critically ill patients. A graft-to-recipient weight ratio (GRWR) is a factor associated with post-LT outcomes in LDLT [74]. The donor risk index is a factor associated with post-LT outcomes for patients with ACLF who received DDLT [66,75]. This indicates that DDLT, which uses whole liver grafts, might be a better compared to LDLT, which uses partial grafts, in ACLF. In addition, there are uncertainties regarding the criteria for living donor graft quality that is required for critically ill patients with ACLF. In studies that reported...

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Section: Ethical Issuementioning

confidence: 99%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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“…It is to be noted that ethical concerns arise with liver transplantation, such as employing deceased donor organs, transplantation of HCV-infected donor livers into uninfected patients and their subsequent treatment with a direct-acting antiviral regimen, allocation of organs, and living donor transplantation [23,24]. Thus, alternative strategies are urgently required to overcome these problems related to LT. New resolute and lasting interventions need to be implemented to restore correct liver function.…”

Section: Introductionmentioning

confidence: 99%

Evolving Cell-Based and Cell-Free Clinical Strategies for Treating Severe Human Liver Diseases

Cernigliaro

Peluso

Zedda

et al. 2020

Cells

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Liver diseases represent a major global health issue, and currently, liver transplantation is the only viable alternative to reduce mortality rates in patients with end-stage liver diseases. However, scarcity of donor organs and risk of recidivism requiring a re-transplantation remain major obstacles. Hence, much hope has turned towards cell-based therapy. Hepatocyte-like cells obtained from embryonic stem cells or adult stem cells bearing multipotent or pluripotent characteristics, as well as cell-based systems, such as organoids, bio-artificial liver devices, bioscaffolds and organ printing are indeed promising. New approaches based on extracellular vesicles are also being investigated as cell substitutes. Extracellular vesicles, through the transfer of bioactive molecules, can modulate liver regeneration and restore hepatic function. This review provides an update on the current state-of-art cell-based and cell-free strategies as alternatives to liver transplantation for patients with end-stage liver diseases.

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“… Disclosures: In this paper we draw upon our previous publication, expand our discussion of the salient ethical issues, and revise our stance on one controversial issue [1]. We received permission from Clinical Liver Disease to adapt and re-use content from the prior publication. …”

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confidence: 99%

Should living donor liver transplantation be an option when deceased donation is not?

Lieber

Schiano

2018

Journal of Hepatology

Self Cite

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When a liver transplantation candidate is declined for listing to receive a deceased organ, sometimes a loved one comes forward and offers to be a living donor. This raises the ethical question of whether a patient who is not eligible for deceased donor liver transplantation should be eligible for living donor liver transplantation. We compare living organ donation in kidney and liver transplantation and explore key ethical concepts of justice, fairness, and societal trust. Ultimately, because there is no alternative life-preserving therapy in end-stage liver disease, and because transplantation with a living donor organ does not involve removing a resource from the common pool of transplant organs, we argue that a standard of "slightly less benefit" than that required for deceased transplantation should be used to determine the acceptability of living donor liver transplantation.

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The Ethics of living related liver transplantation when deceased donation is not an option

Abstract: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2046-2484/homepage/6-5-reading-schiano.htm a video presentation of this article http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2046-2484/homepage/6-5-interview-schiano.htm the interview with the author

Cited by 5 publications

References 8 publications

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Evolving Cell-Based and Cell-Free Clinical Strategies for Treating Severe Human Liver Diseases

Should living donor liver transplantation be an option when deceased donation is not?

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