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Global liver transplantation: emerging trends and ethical challenges

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Abstract

Purpose

Liver transplant (LT) is the only definitive treatment for end-stage liver disease (ESLD). This review aims to explore current global LT practices, with an emphasis on challenges and disparities that limit access to LT in different regions of the world.

Methods

A detailed analysis was performed of present-day liver transplant practices throughout the world, including the etiology of liver disease, patient access to transplantation, surgical costs, and ongoing ethical concerns.

Results

Annually, only 10% of the patients needing a liver transplant receive an organ. Currently, the USA performs the highest volume of liver transplants worldwide, followed by China and Brazil. In both North America and Europe, nonalcoholic fatty liver disease is becoming the most common indication for LT, compared to hepatitis B and C in most Asian, South American, and African countries. While deceased donor liver transplant remains the most performed type of LT, living donor liver transplant is becoming increasingly popular in some parts of the world where it is often the only option due to a lack of well-developed infrastructure for deceased organ donation. Ethical concerns in liver transplantation fundamentally revolve around the definition of a deceased donor and the exploitation of living donor liver donation systems.

Conclusion

Globally, liver transplant practices and outcomes are varied, with differences driven by healthcare policies, inequities in healthcare access, and ethical concerns.

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Data availability

The authors declare that the data supporting the findings of this study are available within the paper and cited within the bibliography.

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Funding

The research reported in this publication was supported by the Washington University School of Medicine Surgical Oncology Basic Science and Translational Research Training Program grant T32CA009621 from the National Cancer Institute (NCI).

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Authors and Affiliations

  1. Washington University in St. Louis, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA

    Angela L. Hill MD, MPHS, Amen Z. Kiani MBBS, Jessica D. Lindemann MD, PhD, Neeta Vachharajani BS, Majella B. Doyle MD, MBA, William C. Chapman MD & Adeel S. Khan MD, MPH

  2. CMH Lahore Medical and Dental College, Lahore, Pakistan

    Maryam Khan

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  1. Angela L. Hill MD, MPHS
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  2. Maryam Khan
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  3. Amen Z. Kiani MBBS
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Contributions

Hill—acquisition, analysis and interpretation of data, drafting of manuscript; Khan, M—study conception and design, acquisition and analysis of data; Lindemann—critical revision of manuscript; Doyle—critical revision of manuscript; Chapman—critical revision of manuscript; Khan, A—study conception and design, analysis and interpretation of data, critical revision of manuscript.

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Correspondence to Adeel S. Khan MD, MPH.

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Dr. William Chapman is a board member of Mid-America Transplant. Dr. Adeel Khan is a consultant for Intuitive Surgical.

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Hill, A.L., Khan, M., Kiani, A.Z. et al. Global liver transplantation: emerging trends and ethical challenges. Langenbecks Arch Surg 408, 418 (2023). https://doi.org/10.1007/s00423-023-03144-4

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