ABSTRACT
The shortage of deceased donor allografts and improved outcomes in partial organ transplantation have led to widespread application of adult-to-adult living donor liver transplantation. Donor selection limits overall utilization of this technique and predictors of candidate maturation have been inadequately studied to date. We therefore collected data on 237 consecutive potential donors including their age, sex, ethnicity, relationship to the recipient, education, employment and religious beliefs and practices. Of these 237 candidates, 91 (38%) were excluded for medical and psychosocial reasons, 53 (22%) withdrew from the process predonation and 93 (39%) underwent partial liver donation. In multivariate analyses, the relationship between the donor and the recipient was highly predictive of successful donation. For pediatric recipients, no parents voluntarily withdrew from the evaluation process. For adult recipients, spouses are the most likely to donate, followed by parents, children and siblings. Additional predictors for donation included self-description as religious but not regularly practicing, part-time employment and higher education. Race, ethnicity, gender and age did not predict donation in multivariate analysis. Further understanding of the complex decision to donate may improve donation rates as well as permit more efficient and cost-effective donor evaluation strategies.
Subject(s)
Liver Diseases/therapy , Liver Transplantation/methods , Living Donors/psychology , Organ Transplantation/methods , Adolescent , Adult , Aged , Cost-Benefit Analysis , Decision Making , Decision Support Techniques , Family , Female , Humans , Male , Middle Aged , Multivariate Analysis , Patient Selection , Time Factors , Tissue and Organ Harvesting/methods , Tissue and Organ Procurement/methods , Treatment Outcome , Waiting ListsABSTRACT
The shortage of cadaver livers and improved outcomes in partial liver transplants has led to an increase in adult living donor liver transplantation (LDLT). Only a fraction of potential liver recipients have donors. The characteristics of candidates who have volunteers for living donation may be different than those without donors. We compared adult patients on the waiting list who had potential living donors with those who did not have living donors. Two-hundred and four consecutive patients were listed for transplantation. During evaluation, all were informed and educated about LDLT. To avoid coercion, we did not solicit a living donor. Sixty (29%) potential recipients had at least one living donor volunteer for evaluation. Twenty-eight (14%) patients from the entire cohort and 46% of the 60 patients who had potential living donors underwent LDLT. Compared with Caucasians, Hispanics were more likely to have living donors (P =.006). No patient with alcoholic liver disease (ALD) had a donor come forward (P =.006). Patients with living donors were twice as likely to have cancer (P =.08). Systematic differences exist between patients who have potential living donors versus those without donors. Candidates with potential donors are more likely to be Hispanic and have cancer and less likely to have ALD compared with cadaveric recipients. Only a minority of patients listed for orthotopic liver transplantation (OLT) will lead to LDLT. Further understanding of the cultural differences and motivating factors for why people volunteer for evaluation and subsequently choose to donate may help improve cadaveric and living donor transplant rates.
