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American perspectives for LDLT in 2024.
Jean C Emond1, Stefano Di Sandro2, Elizabeth A Pomfret3
1Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA. je111@cumc.columbia.edu.
Updates in Surgery
|September 20, 2024
Summary
Living donor liver transplantation (LDLT) remains underutilized despite proven safety, hindering its role in addressing organ shortages. Overcoming donor risk aversion and enhancing training are key to expanding this vital procedure.
Area of Science:
- Transplantation Medicine
- Surgical Innovation
- Organ Donation Research
Background:
- Living donor liver transplantation (LDLT) in the US, initiated in 1989, saw limited adult adoption post-2001 due to donor safety concerns.
- Despite ethical validation and demonstrated safety, LDLT constitutes less than 10% of US liver transplants, contrasting with its prevalence in Asia.
- Increased deceased donor liver transplantation (DDLT) and technologies like Normothermic Regional Perfusion (NRP) have improved organ availability, yet LDLT remains crucial for specific patient groups.
Purpose of the Study:
- To analyze the current status and challenges of living donor liver transplantation (LDLT) in the United States.
- To identify barriers to LDLT utilization and explore strategies for its expansion.
- To highlight the critical role of LDLT in mitigating the liver transplant organ shortage.
Main Methods:
- Review of historical data and current trends in LDLT and DDLT in the US.
- Analysis of factors contributing to donor risk aversion and underutilization of LDLT.
- Examination of initiatives aimed at improving LDLT training and expanding donor pools.
Main Results:
- LDLT remains significantly underutilized in the US, primarily due to persistent public and clinician apprehension regarding donor risks.
- Factors such as increased DDLT availability and limited training experience contribute to lower LDLT volumes compared to Asian countries.
- Non-directed donations and social media engagement have positively impacted donor availability, while consortia like A2ALL and training programs are advancing LDLT safety and expertise.
Conclusions:
- LDLT is essential for addressing the critical organ shortage in liver transplantation, particularly for pediatric and select adult populations.
- Overcoming risk aversion through education and enhancing surgical training are paramount for increasing LDLT adoption.
- Despite challenges, ongoing efforts in training and donor recruitment are paving the way for broader LDLT implementation.
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