Liver transplantation in China: Achievements over the past 30 years and prospects for the future

Abstract

Primary liver cancer is the seventh most common malignant tumor according to the World Health Organization and the fourth leading cause of cancerrelated mortality. It has soared to the second leading cause of cancer-related mortality in China, after lung cancer. In 2020, the number of cases surpassed 410,000, with more than 390,000 deaths, placing a huge burden on China's health system (1). Hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and other uncommon liver cancers are types of primary liver cancer. HCC accounts for a sizable chunk of the total therein. The main etiological factors for HCC are liver cirrhosis, hepatitis, and aflatoxins, while the high incidence of HCC in China is attributed to the high prevalence of the hepatitis B virus. HCC treatment options include hepatectomy, trans arterial chemoembolization (TACE), radiofrequency ablation (RFA), liver transplantation (LT), and conservative therapy. However, only LT can eliminate the tumor and underlying liver disease at the same time. Accordingly, LT is the treatment of choice for end-stage liver disease and early-stage HCC (2).China has seen remarkable progress in orthotopic LT since 1977, when it was first performed on the Chinese mainland. According to the China liver Transplant Registry (CTLR), LT cases in China account for more than a third of all LT cases worldwide (3). As of June 2015, a total of 29,360 cases of LT were performed, about 50% of which were performed to treat HCC (2). With economic and technological advances, LT in China is no longer constrained by the procedure but rather by a scarcity of donors and a high rate of postoperative recurrence. Under such conditions, efforts are being made to address the issue of a donor shortage and to improve the prognosis for transplant patients. The legal framework for government oversight in 2007 was the initial step to regular organ transplantation. However, several ethical and legal issues remained. The pilot

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“…Another reason that deters people from giving consent for post-mortem donation is the imperfection of legal regulation. In China, for example, "deceived donors account for a substantial portion of organ donations, but brain death was not adopted as a standard until now" (Mi et al, 2022). Furthermore, the main problems with…”

Analysis of international experience in the legal regulation of posthumous consent for donation and its implementation in Ukraine

“…Another reason that deters people from giving consent for post-mortem donation is the imperfection of legal regulation. In China, for example, "deceived donors account for a substantial portion of organ donations, but brain death was not adopted as a standard until now" (Mi et al, 2022). Furthermore, the main problems with the transplantation system in China are "the lack of publicity and education and the difficulty of standardizing legislation about ethical issues arousing ethical problems" (Wu et al, 2022).…”

Hepatectomy versus transcatheter arterial chemoembolization for resectable BCLC stage A/B hepatocellular carcinoma beyond Milan criteria: A randomized clinical trial

“…Liver transplantation and hepatectomy are the current curative treatments for HCC but only HCC patients who meet the Milan/ UCSF criteria are eligible for liver transplantation and those beyond the Milan/UCSF criteria are at higher risk of recurrence after hepatectomy (14,15). In China, few patients receive successful liver transplantation due to a shortage of donors and high incidence of HBV, which is exclusionary according to the Milan criteria (16). Further, patients may progress beyond the Milan criteria while waiting for liver transplantation.…”