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

John P Roberts, Hyosun H Han, Dianne LaPointe Rudow, Elizabeth C Verna, Vineeta Kumar, Anjana Pillai, Adam D Griesemer, Gerald Scott Winder, James Trotter, Carrie Thiessen, Alisha Mavis, Michelle T Jesse, Daniela P Ladner, Elizabeth A Pomfret, David Mulligan, Josh Levitsky, Nicolas Goldaracena, Abhinav Humar, Swaytha Ganesh, AnnMarie Liapakis, Whitney E Jackson

Journal: Clinical transplantation 2023;37(7):e14954

PMID: 36892182

Abstract

INTRODUCTION

Living donor liver transplantation (LDLT) is a promising option for mitigating the deceased donor organ shortage and reducing waitlist mortality. Despite excellent outcomes and data supporting expanding candidate indications for LDLT, broader uptake throughout the United States has yet to occur.

METHODS

In response to this, the American Society of Transplantation hosted a virtual consensus conference (October 18-19, 2021), bringing together relevant experts with the aim of identifying barriers to broader implementation and making recommendations regarding strategies to address these barriers. In this report, we summarize the findings relevant to the selection and engagement of both the LDLT candidate and living donor. Utilizing a modified Delphi approach, barrier and strategy statements were developed, refined, and voted on for overall barrier importance and potential impact and feasibility of the strategy to address said barrier.

RESULTS

Barriers identified fell into three general categories: 1) awareness, acceptance, and engagement across patients (potential candidates and donors), providers, and institutions, 2) data gaps and lack of standardization in candidate and donor selection, and 3) data gaps regarding post-living liver donation outcomes and resource needs.

CONCLUSIONS

Strategies to address barriers included efforts toward education and engagement across populations, rigorous and collaborative research, and institutional commitment and resources.

© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Address: Transplant Institute, Henry Ford Health System, Detroit, Michigan, USA.; Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA.; Yale School of Medicine and Yale New Haven Transplant Center, New Haven, Connecticut, USA.; Thomas E Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; Division of Transplant Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.; Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Division of Transplant Surgery, Yale University, New Haven, Connecticut, USA.; Transplant Surgery, University of Colorado, Aurora, Colorado, USA.; UCSF Department of Surgery, San Francisco, California, USA.; Pediatric Gastroenterology, Hepatology, and Nutrition, Duke University Health, Durham, North Carolina, USA.; University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.; Transplant Hepatology, Baylor University Medical Center, Dallas, Texas, USA.; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.; Department of Surgery, NYU Langone Heath, New York, New York, USA.; Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA.; Department of Medicine, Division of Nephrology/Transplant, University of Alabama at Birmingham, Birmingham, Alabama, USA.; Center for Liver Disease and Transplantation, Columbia University, New York, New York, USA.; Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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