Living donor liver transplantation: A multi‐disciplinary collaboration towards growth, consensus, and a change in culture

Abstract

Introduction Living donor liver transplantation (LDLT) reduces liver transplant waitlist mortality and provides excellent long‐term outcomes for persons with end stage liver disease. Yet, utilization of LDLT has been limited in the United States (US). Methods In October 2021, the American Society of Transplantation held a consensus conference to identify important barriers to broader expansion of LDLT in the US, including data gaps, and make recommendations for impactful and feasible mitigation strategies to overcome these barriers. Domains addressed encompassed the entirety of the LDLT process. Representation from international centers and living donor kidney transplantation were included for their perspective/experience in addition to members across disciplines within the US liver transplantation community. A modified Delphi approach was employed as the consensus methodology. Results The predominant theme permeating discussion and polling results centered on culture; the beliefs and behaviors of a group of people perpetuated over time. Conclusions Creating a culture of support for LDLT in the US is key for expansion and includes engagement and education of stakeholders across the spectrum of the process of LDLT. A shift from awareness of LDLT to acknowledgement of benefit of LDLT is the primary goal. Propagation of the maxim "LDLT is the best option" is pivotal.

Living donor liver transplant candidate and donor selection and engagement: Meeting report from the living donor liver transplant consensus conference

“…Complete information including the list of consensus conference workgroup domains, the process regarding consensus conference participant selection, development and refinement of consensus statements, and modified Delphi methodology, are reported elsewhere. 19 As part of the process, literature searches were developed with terms related to living liver donor and candidate selection and engagement, performed by two librarians with expertise in systematic reviews. The literature searches were distributed to workgroup members for review and selection.…”

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

“…A modified Delphi approach was utilized as the consensus methodology. Complete information including the list of consensus conference workgroup domains (and subtopics noted below), and process regarding consensus conference participant selection, development and refinement of consensus statements, and modified Delphi methodology including consensus polling, are reported in Liapakis et al 7 …”

Advances and innovations in living donor liver transplant techniques, matching and surgical training: Meeting report from the living donor liver transplant consensus conference

“…For the definition of consensus, minimum consensus participant response rate to each poll was set at 70% and minimum consensus across statements was again conservatively set at no greater than 30% of respondents’ rankings outside of the central interquartile range (IQR). Analyses of polling responses were simple descriptives using IBM SPSS V.27 software 18 …”

“…2021, the Living Donor Community of Practice (LDCOP), Liver and Intestinal Community of Practice (LICOP), and the Psychosocial and Ethics Community of Practice (PSECOP) of the AST outlined goals to (1) collaboratively bring together United States and International leaders in LDLT to exchange experience and knowledge, (2) identify barriers and data gaps to broaden expansion of LDLT in the United States, and (3) develop consensus recommendations to address barriers and data gaps to promote the safe expansion of LDLT. Complete information including the list of consensus conference workgroup domains, the process regarding consensus conference participant selection, development and refinement of consensus statements, and modified Delphi methodology including consensus polling, are reported elsewhere 18. …”