Ethical considerations and rationale of adult-to-adult living donor liver transplantation

Adult-to-adult living donor liver transplantation (ALDLT) is a reality, sho rtly after its introduction into clinical practice, it is being performed i n approximately 50 centers throughout the United States and Europe. The qui ck development of ALDLT and some deaths among donors repropose old ethical dilemmas and confront the transplant community with new urgent problems. To minimize risks for recipients and, especially, donors, two key questions a re addressed: (1) who can or should perform the procedure, and (2) what pat ient should undergo the procedure. The high risks taken by live donors unde rgoing a hemihepatectomy seem to be justified by the steadily increasing mo rtality of adult recipients waiting for transplantation. A comprehensive co nsent procedure is at the base of responsible decision making for both dono rs and recipients. In adherence to basic medical criteria, the autonomy of decision of donors and recipients, may allow the extension of indications t o patients not suitable to undergo transplantation with cadaveric grafts. T he broadening of indications is appropriate only in centers with adequate e xperience and proven expertise in ALDLT. The medical community faces the du ty of regulating ALDLT before external influences force undesired policy ch anges, particularly if not based on medical grounds. Individual centers and patients are ultimately responsible for the correct use of LDLT.