Liver Paired Exchange: Ready for Prime Time in North America?

Baker, Talia

doi:10.1002/lt.25639

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Similarly, in the context of LPE, it is critical that the donor from the ABO‐incompatible pair is comfortable pursuing donation. Some authors have suggested that donors from ABO‐incompatible pairs participating in LPE, particularly living related donors, should be more thoroughly evaluated to rule out coercion since they cannot use ABO incompatibility as a reason to no longer pursue donation 5,9,10 . Our nondirected donor, as well as the other members of the LPE, felt strongly about maintaining anonymity through the exchange process.…”

Section: Discussionmentioning

confidence: 99%

Expanding living donor liver transplantation: Report of first US living donor liver transplant chain

Braun

Torres

Louie

et al. 2021

American Journal of Transplantation

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Living donor liver transplantation (LDLT) enjoys widespread use in Asia, but remains limited to a handful of centers in North America and comprises only 5% of liver transplants performed in the United States. In contrast, living donor kidney transplantation is used frequently in the United States, and has evolved to commonly include paired exchanges, particularly for ABO‐incompatible pairs. Liver paired exchange (LPE) has been utilized in Asia, and was recently reported in Canada; here we report the first LPE performed in the United States, and the first LPE to be performed on consecutive days. The LPE performed at our institution was initiated by a nondirected donor who enabled the exchange for an ABO‐incompatible pair, and the final recipient was selected from our deceased donor waitlist. The exchange was performed over the course of 2 consecutive days, and relied on the use and compliance of a bridge donor. Here, we show that LPE is feasible at centers with significant LDLT experience and affords an opportunity to expand LDLT in cases of ABO incompatibility or when nondirected donors arise. To our knowledge, this represents the first exchange of its kind in the United States.

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Section: Discussionmentioning

confidence: 99%

Expanding living donor liver transplantation: Report of first US living donor liver transplant chain

Braun

Torres

Louie

et al. 2021

American Journal of Transplantation

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“…5 Notably, nondirected anonymous donors significantly facilitate to be a medical match for an intended recipient without their ambivalence being exposed. 19 If, however, an alternative option for exchange is technically possible, care must be taken to ensure that they are advised that ambivalence is a contraindication to donation. 19 Lastly, as a part of informed consent, it is important to ask donors to carefully consider how they would cope if the exchange recipient of their organ had a good outcome whereas their intended recipient had a poor outcome.…”

Section: Discussionmentioning

confidence: 99%

“…19 If, however, an alternative option for exchange is technically possible, care must be taken to ensure that they are advised that ambivalence is a contraindication to donation. 19 Lastly, as a part of informed consent, it is important to ask donors to carefully consider how they would cope if the exchange recipient of their organ had a good outcome whereas their intended recipient had a poor outcome. Specifically, once the procedures commence, issues related to one recipient should not jeopardize the survival of the other.…”

Section: Discussionmentioning

confidence: 99%

“…Living donor candidates who undergo assessment but remain ambivalent about donation pose a distinct challenge in LPE. Typically, these individuals would excuse themselves based on medical considerations if they are not found to be a medical match for an intended recipient without their ambivalence being exposed 19 . If, however, an alternative option for exchange is technically possible, care must be taken to ensure that they are advised that ambivalence is a contraindication to donation 19 .…”

Section: Discussionmentioning

confidence: 99%

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Living donor liver paired exchange: A North American first

Patel

Mohamed

Ghanekar

et al. 2021

American Journal of Transplantation

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Paired organ exchange can be used to circumvent living donor‐recipient ABO incompatibilities. Herein, we present the first case of successful liver paired exchange in North America. This 2‐way swap required 4 simultaneous operations: 2 living donor hepatectomies and 2 living donor liver transplants. A nondirected anonymous living donor gift initiated this domino exchange, alleviating an ABO incompatibility in the other donor‐recipient pair. With careful attention to ethical and logistical issues, paired liver exchange is a feasible option to expand the donor pool for incompatible living liver donor‐recipient pairs.

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Liver transplantation: the recipient

2024

Living Donor Organ Transplantation

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Liver Paired Exchange: Ready for Prime Time in North America?

Cited by 6 publications

References 10 publications

Expanding living donor liver transplantation: Report of first US living donor liver transplant chain

Expanding living donor liver transplantation: Report of first US living donor liver transplant chain

Living donor liver paired exchange: A North American first

Liver transplantation: the recipient

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