Benefits and ethical issues in domino liver transplant

Abstract

Due to the permanent discordance between the number of available liver grafts and the number of cases on the waiting lists, attention was focused on developing different solutions in order to increase the number of grafts. Once the technique of living donor has been proposed, the number of grafts increased but the gap between the number of available grafts and the cases on the waiting list is still significant. Therefore attention was focused on finding out other solutions such as splitting the graft or performing a domino liver transplant. The procedure of domino transplant consists of harvesting a graft from a young patient with metabolic disorders in which a healthy graft will be used and implants it to a marginal receiver. The method seems to associate minimal risks for the marginal donor to develop the metabolic disorder especially if the donor suffers from familial amyloid polyneuropathy; however, ethical issues in such cases are obvious. The aim of this paper is to analyse both the benefits of domino liver transplant and the ethical issues of the procedure.