Living Donor Liver Transplant Programs in the United States Need to Be Carefully Nurtured Amidst Expanding Use of Perfusion Technology.

Living donor transplantation constitutes a small portion of total transplants in the United States as compared Southeast Asia and Middle East. Recent consensus meeting has identified reluctance on the part of transplant providers and donor financial concerns as the major hindrance in increasing the Living donor liver transplants in US. There is a need to carefully analyze the recent outcome data from across the globe and from large volume North American centers that clearly establishes the benefit of Living donor transplants for both adults and children and reducing wait list mortality. LDLT also provides an opportunity for expanding the indications to offer transplant for indications like colorectal metastasis and intrahepatic cholangiocarcinoma without reducing the number of livers available for traditional indications. Recent expansion of perfusion technology has demonstrated significant increase in utilization of Non heart beating donor livers over the last few years. However, with simultaneous increase in patients being added to the wait list, the wait list mortality and dropouts have been persistently high. In this opinion piece, the authors have looked at the transplant trends in the US in the last few years and advocate for adopting a complementary rather than a singular approach for expansion of LDLT along with new perfusion technologies for increasing the number of liver transplants in the US.