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Whither living donor liver transplantation?

Whither living donor liver transplantation? To the Editors: The editorial by Dr is a timely illustration of the issues currently facing many liver transplantation programs in Asia. Unlike the West, where there is a substantial cadaveric donor pool of organs, although long waiting lists from excessive demand, the programs in Asia do not have this luxury. With no national programs within Asia, the opportunity for liver transplantation has been quickly diminishing in all other Western and Australian centers for those considered foreign patients at such centers. Accordingly, the only opportunity for these patients to receive a life-saving transplant lies in their own country’s programs or those of a neighboring center, which has a shorter waiting list. For pediatric patients, living donors as an option2 have become routine in our country, and the results bode well for the future. Previously, the wait for cadaveric donors was interminable. With Japan3 and Hong Kong4 leading the way, right-sided liver living donor grafts have now been used successfully for adult recipients. This has also been the experience from the United States.5 This has opened a new era of hope for many adult patients with liver disease, when previously there was precious little. Xenografts and hepatocyte transplantation as a solution remains very much in the future. The issue of donor informed consent and complications is certainly an area of much scrutiny from all concerned, and the utmost care is taken to make sure there is no coercion and that the donor is fully informed of the risk, including death. Whether a consent can be truly unbiased is a philosophical issue that bears comparison to a mother’s love for her child and being willing to sacrifice her life for him or her, as well as a spouse’s wish to save the life of their mate even at a risk to self. It would be foolish to believe that we live in a world without emotions and that they have no weight in our decision making. As John MacMurray once remarked about emotions, ‘‘Not the Cinderella of our inner life, to be kept in her place among the cinders in the kitchen. Our emotional life is us in a way our intellectual life cannot be.’’6 Risk-benefit analysis can certainly be performed Strong1 for such cases, but using separate risk allocation to the recipient appropriate to the country under discussion. For instance, an adult with fulminant liver failure in our country would be extremely unlikely to receive a cadaveric liver in time and thus would die several days later, unlike in Europe or the United States, where an organ is usually available within 48 hours, providing a significant chance of recovery. Our roles as professionals is thus to try our hardest to minimize adverse events by understanding as much as possible about the therapy we propose. We will never eliminate all risk. Thus, we believe it is important to continue the work on right-sided liver donation in Asia, where the cadaveric organ supply remains very low, while fully accepting the onerous reality of our decision, and only then, by grasping the future, we will grow as a transplant community to the next level of endeavor. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Whither living donor liver transplantation?

Lee, Kang H.; Tan, Kai‐Chah
Liver Transplantation , Volume 6 (3) – May 1, 2000
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References (6)

Publisher
Wiley
Copyright
Copyright © 2000 American Association for the Study of Liver Diseases
ISSN
1527-6465
eISSN
1527-6473
DOI
10.1053/lv.2000.6810
pmid
10858082
Publisher site
See Article on Publisher Site

Abstract

To the Editors: The editorial by Dr is a timely illustration of the issues currently facing many liver transplantation programs in Asia. Unlike the West, where there is a substantial cadaveric donor pool of organs, although long waiting lists from excessive demand, the programs in Asia do not have this luxury. With no national programs within Asia, the opportunity for liver transplantation has been quickly diminishing in all other Western and Australian centers for those considered foreign patients at such centers. Accordingly, the only opportunity for these patients to receive a life-saving transplant lies in their own country’s programs or those of a neighboring center, which has a shorter waiting list. For pediatric patients, living donors as an option2 have become routine in our country, and the results bode well for the future. Previously, the wait for cadaveric donors was interminable. With Japan3 and Hong Kong4 leading the way, right-sided liver living donor grafts have now been used successfully for adult recipients. This has also been the experience from the United States.5 This has opened a new era of hope for many adult patients with liver disease, when previously there was precious little. Xenografts and hepatocyte transplantation as a solution remains very much in the future. The issue of donor informed consent and complications is certainly an area of much scrutiny from all concerned, and the utmost care is taken to make sure there is no coercion and that the donor is fully informed of the risk, including death. Whether a consent can be truly unbiased is a philosophical issue that bears comparison to a mother’s love for her child and being willing to sacrifice her life for him or her, as well as a spouse’s wish to save the life of their mate even at a risk to self. It would be foolish to believe that we live in a world without emotions and that they have no weight in our decision making. As John MacMurray once remarked about emotions, ‘‘Not the Cinderella of our inner life, to be kept in her place among the cinders in the kitchen. Our emotional life is us in a way our intellectual life cannot be.’’6 Risk-benefit analysis can certainly be performed Strong1 for such cases, but using separate risk allocation to the recipient appropriate to the country under discussion. For instance, an adult with fulminant liver failure in our country would be extremely unlikely to receive a cadaveric liver in time and thus would die several days later, unlike in Europe or the United States, where an organ is usually available within 48 hours, providing a significant chance of recovery. Our roles as professionals is thus to try our hardest to minimize adverse events by understanding as much as possible about the therapy we propose. We will never eliminate all risk. Thus, we believe it is important to continue the work on right-sided liver donation in Asia, where the cadaveric organ supply remains very low, while fully accepting the onerous reality of our decision, and only then, by grasping the future, we will grow as a transplant community to the next level of endeavor.

Journal

Liver Transplantation – Wiley

Published: May 1, 2000

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