Donor-recipient matching: myths and realities

Area of Science:

• Transplantation immunology
• Organ transplantation outcomes
• Medical ethics in resource allocation

Background:

• Liver transplant outcomes have significantly improved due to advancements in surgical techniques, immunosuppression, and post-transplant care.
• Increasing demand for liver transplants and a limited organ supply worldwide result in deaths among patients on waiting lists.
• Maximizing the benefit of each available organ is crucial, necessitating effective donor-recipient (D-R) matching strategies.

Purpose of the Study:

• To review and analyze current knowledge regarding donor-recipient matching methods in liver transplantation.
• To categorize D-R matching policies into patient-based, donor-based, and combined donor-recipient systems.
• To discuss the underlying ethical concepts of D-R matching: prioritarianism, utilitarianism, and social benefit.

Main Methods:

• Review of existing literature on donor-recipient matching in liver transplantation.
• Categorization of D-R matching policies based on donor and recipient variables.
• Analysis of the ethical frameworks supporting different D-R matching approaches.

Main Results:

• Current D-R matching policies are based on isolated or combined donor/recipient characteristics.
• Three main categories of D-R matching policies exist: patient-based, donor-based, and combined systems.
• These policies are underpinned by three ethical concepts: prioritarianism, utilitarianism, and social benefit, each with associated advantages and disadvantages.

Conclusions:

• Donor-recipient matching in liver transplantation is a complex and evolving field with significant controversies.
• Existing D-R matching methods and policies are shaped by trial and error, leading to ongoing debate.
• The effectiveness and ethical implications of different D-R matching strategies continue to be a critical area for discussion and research.