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. 2023 Jul;37(7):e14955.
doi: 10.1111/ctr.14955. Epub 2023 Mar 23.

Financial, policy, and ethical barriers to the expansion of living donor liver transplant: Meeting report from a living donor liver transplant consensus conference

Anjana Pillai  1 , Elizabeth C Verna  2 , Neehar D Parikh  3 , Matthew Cooper  4 , Carrie Thiessen  5 , Julie Heimbach  6 , Elisa J Gordon  7 , Gonzalo Sapisochin  8 , Nazia Selzner  9 , Amit Mathur  10 , Emily R Perito  11 , Michelle Jesse  12 , AnnMarie Liapakis  13 , Vineeta Kumar  14 ; AST LDLT Consensus Conference Working Group
Affiliations

Financial, policy, and ethical barriers to the expansion of living donor liver transplant: Meeting report from a living donor liver transplant consensus conference

Anjana Pillai et al. Clin Transplant. 2023 Jul.

Abstract

Introduction: In October 2021, the American Society of Transplantation (AST) hosted a virtual consensus conference aimed at identifying and addressing barriers to the broader, safe expansion of living donor liver transplantation (LDLT) throughout the United States (US).

Methods: A multidisciplinary group of LDLT experts convened to address issues related to financial implications on the donor, transplant center crisis management, regulatory and oversight policies, and ethical considerations by assessing the relative significance of issues in preventing LDLT growth, with proposed strategies to overcome barriers.

Results: Living liver donors endure multiple obstacles including financial instability, loss of job security, and potential morbidity. These concerns, along with other center, state, and federal specific policies can be perceived as significant barriers to expanding LDLT. Donor safety is of paramount importance to the transplant community; however, regulatory and oversight policies aimed at ensuring donor safety can be viewed as ambiguous and complicated leading to time-consuming evaluations that may deter donor motivation and program expansion.

Conclusion: Transplant programs need to establish appropriate crisis management plans to mitigate potential negative donor outcomes and ensure program viability and stability. Finally, ethical aspects, including informed consent for high-risk recipients and use of non-directed donors, can be perceived as additional barriers to expanding LDLT.

Keywords: donors and donation: living; ethics; liver transplantation: living donor.

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References

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