The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance

Abstract

Interest in anonymous nondirected living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding nondirected donation in living donor liver transplantation. Herein, we review current transplant policy, discuss emerging data, draw parallels from nondirected kidney donation, and examine relevant considerations in nondirected living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of nondirected living liver donors and a schema for just allocation of nondirected grafts.

Can non‐directed living liver donation help improve access to grafts and correct socioeconomic disparities in pediatric liver transplantation?

“…ND-LLDs are most often allocated to candidates with the highest medical urgency that are without an eligible directed living donor. 16 Therefore, while ND-LLDs are not actively allocated to adjust for disparities in LDLT, our analysis demonstrates they "passively" do so because disadvantaged groups, such as those with public insurance, are less likely to have a directed living donor and therefore have a higher likelihood of receiving an ND-LLD. 11 While recipients with public insurance were more likely to receive an ND-LLD than a D-LLD, the same pattern was not seen with racial and ethnic minorities, who have also been shown to have lower rates of directed LDLT.…”

“…ND‐LLD is uniquely situated to address disparities in LDLT as their evaluation and donation process is independent of the recipient, as is their financial situation and social support system. ND‐LLDs are most often allocated to candidates with the highest medical urgency that are without an eligible directed living donor 16 . Therefore, while ND‐LLDs are not actively allocated to adjust for disparities in LDLT, our analysis demonstrates they “passively” do so because disadvantaged groups, such as those with public insurance, are less likely to have a directed living donor and therefore have a higher likelihood of receiving an ND‐LLD 11 .…”

“…Since 2000, pediatric LDLT from anonymous ND‐LLD has been increasingly performed across North America 13 . Although there is no formal policy regulating the allocation of ND‐LLDs, the majority of programs performing LDLT from ND‐LLD have reported allocating these unique donors based on blood type compatibility and medical urgency, with preference given to pediatric candidates 14–16 . The impact of ND‐LLDs on access to LDLT among pediatric candidates with public insurance has not been explored.…”

“…13 Although there is no formal policy regulating the allocation of ND-LLDs, the majority of programs performing LDLT from ND-LLD have reported allocating these unique donors based on blood type compatibility and medical urgency, with preference given to pediatric candidates. [14][15][16] The impact of ND-LLDs on access to LDLT among pediatric candidates with public insurance has not been explored. The aim of this study was to compare types of living donors (ND-LLD vs. D-LLD), by recipient insurance type among pediatric LDLT recipients.…”

A qualitative systematic review of anonymous/unspecified living kidney and liver donors’ perspectives

“…Currently, the Organ Procurement and Transplantation Network (OPTN) policy requires transplant centres in the United States to follow up with living donors for 2 years with mandated reporting every 6 months(3). Besides proposals of wellbeing programs for living donors [46,47], further recommendations have been made for unspecified donors to be followed by the transplant community in a formalized registry. One such model is the Living Donor Collective Pilot Registry which currently enrols 6 liver and 10 kidney transplantation programs in the United States [48].…”