Financial, policy, and ethical barriers to the expansion of living donor liver transplant: Meeting report from a living donor liver transplant consensus conference

Abstract

Introduction:In October 2021, the American Society of Transplantation (AST) hosted a virtual consensus conference aimed at identifying and addressing barriers to the broader, safe expansion of living donor liver transplantation (LDLT) throughout the United States (US).Methods: A multidisciplinary group of LDLT experts convened to address issues related to financial implications on the donor, transplant center crisis management, regulatory and oversight policies, and ethical considerations by assessing the relative significance of issues in preventing LDLT growth, with proposed strategies to overcome barriers.

CAQ Corner: Evaluation and management of living liver donors

“…[52] NLDAC is means testing based on the recipient income (currently set at 350% of the federal poverty guidelines for household size) for directed donors and without recipient income means testing for nondirected donors. [53] Further support is needed to ensure that a donation is a cost-neutral act.…”

“…The National Living Donor Assistance Center (NLDAC) was created to cover some of these extra expenses, but there are still holes in the coverage 52 . NLDAC is means testing based on the recipient income (currently set at 350% of the federal poverty guidelines for household size) for directed donors and without recipient income means testing for nondirected donors 53 . Further support is needed to ensure that a donation is a cost-neutral act.…”

A perspective and review on nondirected liver donation

“…Nondirected anonymous donations started gaining some momentum after 2000 2 . It is important to emphasize that all living donors should be considered “altruistic” and that terminology should not be used 3 . Altruism applies to all donors; therefore, terminology for living liver donors should be focused on the presence or absence of anonymity and whether the donation is directed or nondirected as stated in the recent consensus statement 3 .…”

Living donor liver transplantation in the United States: The way forward

“…In the paper, “Financial, policy, and ethical barriers to the expansion of living donor liver transplant in the United States: Meeting report from the living donor liver transplant consensus conference,” the authors examine the roles of financial strains, regulatory and oversight policies, and ethical controversies in the growth of LDLT in the US. Proposed strategies to overcome the challenges include the expansion of financial resources and public policy changes that promote financial neutrality for donors, optimization of the informed consent process, and further research into long‐term physical and mental outcomes of non‐directed living liver donors 15 …”

“…Proposed strategies to overcome the challenges include the expansion of financial resources and public policy changes that promote financial neutrality for donors, optimization of the informed consent process, and further research into long-term physical and mental outcomes of non-directed living liver donors. 15 Living donor liver transplantation is a valuable option for patients in need of a liver transplant. However, barriers related to medical, ethical, financial, and psychosocial factors impede its widespread adoption in the US.…”