TY - JOUR
T1 - Financial, policy, and ethical barriers to the expansion of living donor liver transplant
T2 - Meeting report from a living donor liver transplant consensus conference
AU - AST LDLT Consensus Conference Working Group
AU - Pillai, Anjana
AU - Verna, Elizabeth C.
AU - Parikh, Neehar D.
AU - Cooper, Matthew
AU - Thiessen, Carrie
AU - Heimbach, Julie
AU - Gordon, Elisa J.
AU - Sapisochin, Gonzalo
AU - Selzner, Nazia
AU - Mathur, Amit
AU - Perito, Emily R.
AU - Jesse, Michelle
AU - Liapakis, Ann Marie
AU - Kumar, Vineeta
N1 - Publisher Copyright:
© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
PY - 2023/7
Y1 - 2023/7
N2 - Introduction: In October 2021, the American Society of Transplantation (AST) hosted a virtual consensus conference aimed at identifying and addressing barriers to the broader, safe expansion of living donor liver transplantation (LDLT) throughout the United States (US). Methods: A multidisciplinary group of LDLT experts convened to address issues related to financial implications on the donor, transplant center crisis management, regulatory and oversight policies, and ethical considerations by assessing the relative significance of issues in preventing LDLT growth, with proposed strategies to overcome barriers. Results: Living liver donors endure multiple obstacles including financial instability, loss of job security, and potential morbidity. These concerns, along with other center, state, and federal specific policies can be perceived as significant barriers to expanding LDLT. Donor safety is of paramount importance to the transplant community; however, regulatory and oversight policies aimed at ensuring donor safety can be viewed as ambiguous and complicated leading to time-consuming evaluations that may deter donor motivation and program expansion. Conclusion: Transplant programs need to establish appropriate crisis management plans to mitigate potential negative donor outcomes and ensure program viability and stability. Finally, ethical aspects, including informed consent for high-risk recipients and use of non-directed donors, can be perceived as additional barriers to expanding LDLT.
AB - Introduction: In October 2021, the American Society of Transplantation (AST) hosted a virtual consensus conference aimed at identifying and addressing barriers to the broader, safe expansion of living donor liver transplantation (LDLT) throughout the United States (US). Methods: A multidisciplinary group of LDLT experts convened to address issues related to financial implications on the donor, transplant center crisis management, regulatory and oversight policies, and ethical considerations by assessing the relative significance of issues in preventing LDLT growth, with proposed strategies to overcome barriers. Results: Living liver donors endure multiple obstacles including financial instability, loss of job security, and potential morbidity. These concerns, along with other center, state, and federal specific policies can be perceived as significant barriers to expanding LDLT. Donor safety is of paramount importance to the transplant community; however, regulatory and oversight policies aimed at ensuring donor safety can be viewed as ambiguous and complicated leading to time-consuming evaluations that may deter donor motivation and program expansion. Conclusion: Transplant programs need to establish appropriate crisis management plans to mitigate potential negative donor outcomes and ensure program viability and stability. Finally, ethical aspects, including informed consent for high-risk recipients and use of non-directed donors, can be perceived as additional barriers to expanding LDLT.
KW - donors and donation: living
KW - ethics
KW - liver transplantation: living donor
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U2 - 10.1111/ctr.14955
DO - 10.1111/ctr.14955
M3 - Article
C2 - 36880375
AN - SCOPUS:85150892710
SN - 0902-0063
VL - 37
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 7
M1 - e14955
ER -