Living donor liver transplant candidate and donor selection and engagement: Meeting report from the living donor liver transplant consensus conference
Michelle T. Jesse, Whitney E. Jackson, AnnMarie Liapakis, Swaytha Ganesh, Abhinav Humar, Nicolás Goldaracena, Josh Levitsky, David C. Mulligan, Elizabeth A. Pomfret, Daniela P. Ladner, John P. Roberts, Alisha Mavis, Carrie Thiessen, James F. Trotter, Gerald Scott Winder, Adam Griesemer, Anjana Pillai, Vineeta Kumar, Elizabeth C. Verna, Dianne LaPointe Rudow, Hyosun Han, the AST LDLT Consensus Conference Working Group
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.