D Yoeli et al. Liver Transplantation 2021; 27: 1392-1400. Challenging the Traditional Paradigm of Supply and Demand in Pediatric Liver Transplantation Through Nondirected Living Donation: A Case Series
This case series of 13 nondirected liver donors (ND-LLDs) (from 2012-2020) helps highlight this increasing trend of motivated donors who do not have a predetermined recipient. The Scientific Registry of Transplant Recipients documented 105 patients who underwent a living donor liver transplantation (LDLT) from ND-LLDs 2000-2019, with 39 in 2019 alone.
- While the article states that carefully selected ND-LLDs at high volume centers have excellent outcomes, the associated editorial (pg 1373-74) notes that there is a 0.2% living donor operative mortality. And, a significant number experience negative physical and socioeconomic effects of donation
- The authors advocate more use of SPLIT livers to increase the donor pool (currently at 10 centers) to lower pediatric deaths on the waitlist
- The authors note that the likelihood of receiving a LT is increased at high-volume pediatric centers (85%) compared to low-volume centers (41%). “Center expertise and volume is an important consideration…especially true for pediatric liver transplantation, which is relatively infrequent…551 [in 2019]” compared to 8345 adult liver transplants.
The commentary places some context regarding the donors.
- 70% had previously donated a kidney (“Repetitive donor disorder?”)
- Yet, “in some sense, nondirected donors may be the best qualified donors, as they are free of coercion”
- The authors advocate for a “safe, well-informed” process and for national guidelines to address risks and the components of evaluation, medical and psychosocial
My take: It is amazing how much some individuals are willing to sacrifice to help others, especially in age when some react so harshly to being asked to consider the needs of their community.
Related blog posts:
- Surprised This Study Was Published: Liver Transplantation and Undocumented Immigrants
- How Does USA Compare to Other Countries in Pediatric Liver Transplantation | gutsandgrowth
- More on Time to Split (2018)
- Pediatric Livers Bypassing Needy Children
- More Acceptance (of livers), Better Outcomes
- Should Younger Transplant Patients Receive Better Organs? | gutsandgrowth
- Picking winners and losers with liver transplantation allocation
- Pediatric Liver Transplantation: Past Time to Split
- More on its Past Time to Split