Live liver donation: a prospective analysis of exclusion criteria for healthy and potential donors

González, Esther; Díaz, Juan Carlos Meneu; García, Ignacio; Segurola, Carmelo Loinaz; Jiménez, Carlos; Gómez, R.; Abradelo, M.; Elola, A. Moreno; Jiménez, Sara; Ferrero, Eduardo; Pulido, Jorge Calvo; Manrique, Alejandro; Herrero, M.L.

doi:10.1016/s0041-1345(03)00666-3

Cited by 10 publications

(1 citation statement)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We must find a way to stimulate living donation. Indeed, the evaluation process itself results in the loss of many a donor (19), primarily because of inadequate volumetry (20) and ABO mismatch (21), and only 9-17% of candidates are eventually accepted (22,23). Hence, an attempt to minimize consequences (physical, psychological, financial) in transplant donors becomes essential.…”

mentioning

confidence: 99%

Liver transplantation from living donor as a sign of social intelligence

Meneu-Diaz

Elola-Olaso

2011

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

From a wide perspective, the general opinion held by the "international transplant community" is that living donor liver transplantation (LDLT) is justified since patients on liver transplantation (LT) waiting lists continue to die (1). Data from the Spanish Registry are telling on-list mortality has leveled out at 8% (it is up to 20% in some centers) whereas the odds of having a transplant (year 2008) never went beyond 50%. LDLT-as well as split (2,3), non-heart-beating donation (4), marginal organs, or domino transplants-represents an option for increasing the donors pool. As our country is a world leader in cadaver donation rates, LDLT has been (and still is) reasonably questioned with arguments for (5) and against (6). This is a simple supply and demand issue that forces complex decisions regarding ethics, equity, and justice. The paper published here by the Murcia University team (Martínez-Alarcón et al.) helps elucidate this controversy (7). Until January 2010, around 246 living-donor transplants had been performed in Spain (53% for adult recipients), with figures becoming more stable on a yearly basis, and representing 1-1.5% of the yearly total (8). When interannual percent growth rates for different organs were compared kidney transplants show a slight increase while the opposite is true for LDLT (9). The reported mortality of living liver donors is 0.15% (0.20% when causes potentially related to living donation are included) (6). To this day no donor deaths have occurred in Spain (5,6), and reoperation rates after donation are estimated around 10%. Survival rates for LDLT, according to data from the European Transplant Registry (10), are better for both patients (85% at 1 year and 76% at five years vs. 82 and 71%, respectively, for cadaver donation) and grafts (80% at 1 year and 70% at five years vs. 78 and 64%, respectively, for cadaver donation). The A2ALL study (11,12) described a higher incidence of grade-4 complications in living donor transplant recipients (16 vs. 9%); this percentage significantly decreases as team experience increases (> 20 transplants/year). Surveys of living donors confirm that only 3.7% are pressured into donation; reasons for donation include saving the recipient's life for 60%, and personal satisfaction for 35% (13). Martínez-Alarcón et al. confirm that, should relatives be properly informed and hence considered living donation favorably, only 44% of recipients would rather stay indefinitely on their waiting list than choose a living donor transplant. Why then are we witnessing a sustained yearly decrease in absolute numbers? Living donation is a singular, complex option to gain access to an organ for transplantation. Some factors condition living donation for the adult (organ scarcity, recipient benefits, donor risks, emotional stress, altruism, autonomy, MELD, etc.). Various (regional) lists exist, and wait times vary from one region to the next. As a consequence, on-list mortality and the odds for transplantation differ between Liver transplantation from living donor as ...

show abstract

mentioning

confidence: 99%