Why are there so many liver transplants from living donors in Asia and so few in Europe and the US?

Abstract

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Liver Transplantation in Developing Countries

“…In most Asian countries, LDLT accounts for more than >90% of the transplantations, in the USA 5%, and in Europe 4.3% of all LT activity. (1,2,15). One reasons LDLT is not being widely adapted in Northern America and in Europe is the risk of morbidity and mortality in living donors.…”

“…In many Asian countries traditions and religious beliefs play a major role in an individual's life and in shaping the decision of organ donation (1). Religions including Buddhism, Taoism, Confucianism, Shintoism, and Islam cautiously approach toward deceased organ donation (1,15,16).…”

“…Among Asian countries, China is the only country with DDLT is more common than LDLT, with 95% of donated livers originating from deceased donors (1,15). This practice stems from China's prior use of organs from non-voluntaries, mainly from executed prisoners, which led to concerns over human rights and organ trafficking.…”

Patients with liver cirrhosis due to nonalcoholic steatohepatitis have lesser chances for liver transplantation

“…The number of deceased liver donors in Japan is increasing but is still insufficient relative to the number of patients who need liver transplants 14,15 . Therefore, the ratio of living donor liver transplantation (LDLT) to deceased donor liver transplantation (DDLT) in Japan is very high compared to that in the United States and Europe 16 . Additionally, the mortality rate while waiting for DDLT is also high 1,17 .…”

“…14,15 Therefore, the ratio of living donor liver transplantation (LDLT) to deceased donor liver transplantation (DDLT) in Japan is very high compared to that in the United States and Europe. 16 Additionally, the mortality rate while waiting for DDLT is also high. 1,17 However, the ratio of undergoing liver transplant to waiting patients according to the underlying liver etiology is unclear.…”