Organizational and ethical aspects of living donor liver transplantation

The well-known shortage of organs for transplantation can partly be managed with organs (or parts of them) from living donors. This form of organ donation is hampered by two important drawbacks: the harm to the donor and the lack of certainty that the donation is free of coercion. As often happens in medicine, both aspects have no clear solution. Therefore, all guarantees must be built into the processes leading to transplantation, under the control of peers. Also, the transplantation centers as the organ providers (in the large sense, the donor family and eventually an intermediate agency) must undergo this peer review. Eventually, a local ethical committee could perform an initial screening if there is a legal background for its competence in this matter. Alternatives for living donation are to be expected in the future, but this cannot circumvent the actual problems.