Clinical and ethnic differences in candidates listed for liver transplantation with and without potential living donors

Abstract

The shortage of cadaver livers and improved outcomes in partial liver transplants has led to an increase in adult living donor liver transplantation (LDLT). Only a fraction of potential liver recipients have donors. The characteristics of candidates who have volunteers for living donation may be different than those without donors. We compared adult patients on the waiting list who had potential living donors with those who did not have living donors. Two-hundred and four consecutive patients were listed for transplantation. During evaluation, all were informed and educated about LDLT. To avoid coercion, we did not solicit a living donor. Sixty (29%) potential recipients had at least one living donor volunteer for evaluation. Twenty-eight (14%) patients from the entire cohort and 46% of the 60 patients who had potential living donors underwent LDLT. Compared with Caucasians, Hispanics were more likely to have living donors (P =.006). No patient with alcoholic liver disease (ALD) had a donor come forward (P =.006). Patients with living donors were twice as likely to have cancer (P =.08). Systematic differences exist between patients who have potential living donors versus those without donors. Candidates with potential donors are more likely to be Hispanic and have cancer and less likely to have ALD compared with cadaveric recipients. Only a minority of patients listed for orthotopic liver transplantation (OLT) will lead to LDLT. Further understanding of the cultural differences and motivating factors for why people volunteer for evaluation and subsequently choose to donate may help improve cadaveric and living donor transplant rates.