Quality of life of liver donors following donor hepatectomy

Chandran, Biju; Bharathan, Viju Kumar; Mathew, Johns Shaji; Amma, Binoj Sivasankara Pillai Thankamony; Gopalakrishnan, Unnikrishnan; Balakrishnan, Dinesh; Ramachandran, Riju; Dhar, Puneet; Vayoth, Sudheer Othiyil; Sudhindran, S.

doi:10.1007/s12664-017-0743-7

Cited by 18 publications

(35 citation statements)

References 28 publications

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“…Others point out that the urgent context introduces greater opportunities for errors by the transplant team in evaluating the potential donor’s risks . Moreover, research of liver donors in India found that emergency donation was significantly associated with reduced quality of life after donation …”

Section: Case 2: Ldlt In a Patient Under A Time‐sensitive Situationmentioning

confidence: 99%

“…The recipient, the transplant team, and the potential donor must all determine their willingness to accept the risks of adverse events to the recipient (eg, graft failure and HCC recurrence) in light of the risk of donor complications. Donors commonly experience psychological distress when their recipient’s graft fails or if the recipient dies . Accordingly, information about the recipient’s higher risks of recurrence and death should be disclosed to the potential donor as part of the informed consent process.…”

Section: Case 3: Ldlt In a Patient With Hepatocellular Carcinoma Outsmentioning

confidence: 99%

“…(19) Moreover, research of liver donors in India found that emergency donation was significantly associated with reduced quality of life after donation. (20) In such a time-constrained circumstance, we question the quality of a potential donor's decision-making process. Living liver donors are commonly motivated to donate primarily to help a loved one survive.…”

Section: Case 2: Ldlt In a Patient Under A Time-sensitive Situationmentioning

confidence: 99%

“…Donors commonly experience psychological distress when their recipient's graft fails or if the recipient dies. (20,28) Accordingly, information about the recipient's higher risks of recurrence and death should be disclosed to the potential donor as part of the informed consent process. Transplant teams might not respect a potential donor's autonomy if the recipient's risk of recurrence is too high or if the prognosis is too poor.…”

Section: Case 3: Ldlt In a Patient With Hepatocellular Carcinoma Outsmentioning

confidence: 99%

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Living Donor Liver Transplantation When Deceased Donor Is Not Possible or Timely: Case Examples and Ethical Perspectives

Levitsky¹,

Gordon²

2020

Liver Transpl

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This article analyzes the ethical soundness of living donor liver transplantation (LDLT) in situations where the transplant team does not consider deceased donor liver transplantation (DDLT) a clinical or timely option. Given that patients with end‐stage liver disease have a high risk of death without DDLT, the option of LDLT becomes compelling and may save lives. We present 3 representative cases from our center that raise concerns over social behavior, limited time constraints for decision making, and high potential for disease recurrence that render DDLT an unlikely option. Thereafter, we discuss ethical issues for each patient, which predominantly pertain to compromises to the living donor informed consent process and the feasibility of LDLT. We conclude with recommendations regarding whether LDLT is an acceptable ethical option for those patients, which may inform clinical practice in the broader transplant community.

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Section: Case 2: Ldlt In a Patient Under A Time‐sensitive Situationmentioning

confidence: 99%

Section: Case 3: Ldlt In a Patient With Hepatocellular Carcinoma Outsmentioning

confidence: 99%

Section: Case 2: Ldlt In a Patient Under A Time-sensitive Situationmentioning

confidence: 99%

Section: Case 3: Ldlt In a Patient With Hepatocellular Carcinoma Outsmentioning

confidence: 99%

See 2 more Smart Citations

Living Donor Liver Transplantation When Deceased Donor Is Not Possible or Timely: Case Examples and Ethical Perspectives

Levitsky¹,

Gordon²

2020

Liver Transpl

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“…The recipient, transplant team, and potential donor must all determine their willingness to accept the higher risks for posttransplant HCC recurrence given the risks to donors. 14,15 Furthermore, in cases of predicted poor posttransplant prognosis, providers must consider a cutoff point where the risks of transplantation outweigh the benefits to the recipient and donor. This line must be individualized for each case based on tumor biology, imaging findings, and laboratory markers.…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

Ethical Issues When Considering Liver Donor Versus Deceased Donor Liver Transplantation

Nizamuddin

Gordon

Levitsky

2021

Clinical Liver Disease

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Deceased donors remain the primary source of organs for patients wait-listed for liver transplantation (LT). In 2019, 8372 deceased donor liver transplants (DDLTs) were performed, compared with 524 living donor liver transplants (LDLTs) (Fig. 1). 1 The number of LDLTs has not significantly increased over time in the United States because of local surgical expertise, programmatic decisions, and risks to healthy living donors. 2 Given the organ shortage, the patient and the transplant team may opt to pursue LDLT over DDLT. This practice raises several concerns regarding the ethical soundness of LDLT. Our group's review in LT discusses various ethical concerns based on actual cases, as well as potential approaches to optimize the informed consent process.

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Long‐term risk of a fatty liver in liver donors

Goto

Kawamura

Watanabe

et al. 2023

Annals of Gastroent Surgery

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Aim Approximately 30 years have passed since the first experience of living donor liver transplantation. The time to evaluate the long‐term safety of living donors has been fulfilled. Meanwhile, nonalcoholic fatty liver disease is increasingly common and a critical problem. The aim of this study was to evaluate the safety of living donor, focusing on fatty liver postdonation hepatectomy. Methods Living donors (n = 212, 1997–2019) were evaluated by computed tomography (CT) at >1‐year postdonation. A liver to spleen (L/S) ratio of <1.1 was defined as fatty liver. Results Among 212 living liver donors, 30 (14.2%) detected fatty liver at 5.3 ± 4.2 years postdonation. The cumulative incidence rates of fatty liver were 3.1%, 12.1%, 22.1%, and 27.7% at 2, 5, 10, and 15 years postdonation, respectively. Of 30 subjects who developed fatty liver, 18 (60%) displayed a severe steatosis (L/S ratio <0.9). Five (16.7%) had a prior history of excessive alcohol abuse. More than 30% developed metabolic syndrome including obesity, hyperlipidemia, and diabetes. Although six (20%) had a Fib‐4 index of >1.3, which included a case with a Fib‐4 index of >2.67, no significant increased Fib‐4 index was observed in the subjects with fatty liver as compared to those without fatty liver (p = 0.66). The independent predictive risk factors for developing fatty liver were male sex, pediatric recipient, and higher body mass index (>25) at donation. Conclusion Living donors with risk factors for developing fatty liver should be carefully followed‐up for the prevention and management of metabolic syndrome.

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Quality of life of liver donors following donor hepatectomy

Abstract: Recipient death, donation in emergency setting, age above 50, higher BMI, and prolonged hospital stay are factors that lead to impaired HRQOL following live liver donation. Despite this, 99% donors did not repent the decision to donate.

Cited by 18 publications

References 28 publications

Living Donor Liver Transplantation When Deceased Donor Is Not Possible or Timely: Case Examples and Ethical Perspectives

Living Donor Liver Transplantation When Deceased Donor Is Not Possible or Timely: Case Examples and Ethical Perspectives

Ethical Issues When Considering Liver Donor Versus Deceased Donor Liver Transplantation

Long‐term risk of a fatty liver in liver donors

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