Should living donor liver transplant selection be subject to the same restrictions as deceased donor transplant?

PURPOSE OF REVIEW: In the United States, most of the liver allografts come from deceased donors, and our current liver recipient selection process is heavily centered on the ethical principle of utility to maximize the net benefit to the liver recipient community as a group rather than individuals due to the organ scarcity. Although living donor liver transplantation contributes less than 5% of total liver transplant in the United States, these living donor recipients are being subjected to the same selection process designed to benefit the group as a whole rather than the individuals. We would like to examine if these recipients who have living donors should be subjected to the same selection process.

RECENT FINDINGS: There are several disease processes where liver transplantation is the only curative option, and recent studies have shown clear survival benefits with liver transplantation.

SUMMARY: For those who have living donors, different selection criteria based on their specific disease, not based on the principle of utilization should be used to evaluate their candidacy.