Donor outcomes in anonymous live liver donation

Abstract

Background: Death rates on liver transplant waiting lists range from 5%-25%.Herein, we report a unique experience with 50 anonymous persons who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship (A-LLD).Methods: Candidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated selfreported questionnaires assessed personality traits and psychological impact.Results: 50 A-LLD liver transplants (LT) were performed between 2005 and 2017.Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59 yrs.). Thirtythree (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal supports in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was six days. There was one Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision.Conclusions: This is the first and only report of the motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability. Highlights• Anonymous liver donors can successfully contribute to the donor organ pool.• Social media can be used to educate communities about this opportunity.• Anonymous donors are motivated by their values and beliefs and are very satisfied with their experience.

Global experience and perspective on anonymous nondirected live donation in living donor liver transplantation

“…In 2019, the University of Toronto published their experience with 50 anonymous living liver donations . Of these donors, 35 patients were nondirected and 15 were directed (donating to a specified recipient without the recipient's knowledge).…”

Living donor liver paired exchange: A North American first

“…1-year recipient survival was 91% in adults and 97% in children. 5 Further, none of the surveyed donors regretted their decision. 5 Notably, nondirected anonymous donors significantly facilitate to be a medical match for an intended recipient without their ambivalence being exposed.…”

“…We have previously discussed our selection process for recipients of anonymous living liver donor grafts. 5 In brief, priority is given to patients on the deceased organ donor waiting list thought to be disadvantaged under current allocation practices, and who are likely to have a good outcome. In review of our experience over a 12-year period, 50 anonymous adult living liver donor transplants were performed with excellent outcomes.…”

“…In review of our experience over a 12-year period, 50 anonymous adult living liver donor transplants were performed with excellent outcomes. 5 Specifically, only 1 donor had a Dindo-Clavien Grade 3 complication that resolve;…”

“…Motivated by the opportunity to maximize the benefits of her donation, she agreed to participate and underwent a living donor right hepatectomy excluding the middle vein. 5,6 Postoperatively, her liver function normalized; however, she had…”