Aspects of the Legal Regulation of Living Donor Transplantation within Europe

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

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Technical Problems in Living Donor Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2005.06.021 ◽

2005 ◽

Vol 37 (6) ◽

pp. 2449-2450 ◽

Cited By ~ 3

Author(s):

L. Berardinelli

Keyword(s):

Living Donor ◽

Technical Problems ◽

Problems In Living ◽

Living Donor Transplantation

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Economic issues of living donor transplantation in the view of the German health care system

Transplantation Proceedings ◽

10.1016/s0041-1345(03)00190-8 ◽

2003 ◽

Vol 35 (3) ◽

pp. 974-975

Author(s):

H.-D Diste

Keyword(s):

Health Care ◽

Health Care System ◽

Living Donor ◽

German Health Care System ◽

Economic Issues ◽

German Health ◽

Living Donor Transplantation ◽

Care System

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Surgical Aspects of Living-Donor Transplantation

Medical Care of the Liver Transplant Patient ◽

10.1002/9781444398441.ch23 ◽

2012 ◽

pp. 255-265

Author(s):

Kelvin K. C. Ng ◽

Sheung Tat Fan

Keyword(s):

Living Donor ◽

Living Donor Transplantation ◽

Surgical Aspects

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Imaging Techniques for Living Donor Transplantation

Transplantation of the Liver ◽

10.1016/b978-0-7216-0118-2.50051-3 ◽

2005 ◽

pp. 703-712 ◽

Cited By ~ 1

Author(s):

PIYAPORN LIMANOND ◽

STEVEN S. RAMAN ◽

DAVID S.K. LU

Keyword(s):

Living Donor ◽

Imaging Techniques ◽

Living Donor Transplantation

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Analysis of Outcomes in Living Donor Liver Transplants Involving Reconstructive Microsurgeons

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-3401033 ◽

2019 ◽

Vol 36 (03) ◽

pp. 223-227

Author(s):

Jorge Andres Hernandez ◽

Cody L. Mullens ◽

Julien T. Aoyama ◽

Cassandra A. Ligh ◽

Abraham Shaked ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Hepatic Artery ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Liver Transplants ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Surgical Microscope ◽

Living Donor Transplantation

Abstract Background Living donor transplantation is becoming increasingly popular as a modality for patients necessitating liver transplantation. Hepatic artery thrombosis (HAT) remains the most feared acute postoperative complication associated with living-donor liver transplantation. Preoperative planning, including scheduling reconstructive microsurgeons to perform the hepatic artery anastomosis using a surgical microscope or loupes, can decrease HAT rates. Methods A retrospective review of two reconstructive microsurgeons at a single institution was performed to analyze postoperative outcomes of adult and pediatric live donor liver transplants where reconstructive microsurgeons performed the hepatic artery anastomosis. One surgeon utilized the surgical microscope, while the other surgeon opted to use surgical loupes for the anastomosis. Results A total of 38 patients (30 adult and eight pediatric) met inclusion criteria for this study, and average patient age in the adult and pediatric population studied was 48.5 and 3.6 years, respectively. Etiologies of adult patients' liver failure were most commonly cholestatic (43%), followed by alcohol (23%), hepatitis C virus-related cirrhosis (17%), and nonalcoholic steatohepatitis (7%), while etiologies of pediatric liver failure were most commonly cholestatic (62.5%). None of the patients (0%) experienced acute postoperative HAT. On average, 22 and 25 months of postoperative follow-up was obtained for the adult and pediatric cohorts, respectively, and only one adult patient was found to have any liver-related complication. Conclusion A collaborative relationship between reconstructive microsurgeons and transplant surgeons mitigates the risk of HAT and improves patient outcomes in living donor liver transplantation.

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COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic

BioMed Research International ◽

10.1155/2020/5703963 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Gaia Peluso ◽

Silvia Campanile ◽

Alessandro Scotti ◽

Vincenzo Tammaro ◽

Akbar Jamshidi ◽

...

Keyword(s):

Kidney Transplantation ◽

Living Donor ◽

Viral Infections ◽

Elective Surgery ◽

Deceased Donor ◽

Kidney Transplants ◽

Donor Kidney ◽

Transplant Center ◽

Living Donor Transplantation ◽

Donor Kidney Transplantation

Introduction. SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract. Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections. We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era. Patients and Methods. The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic. We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years. Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic. Results. From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors. The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic. All the transplanted patients remained COVID negative during the follow-up. The number of transplants performed has been constant compared to the same months of 2018 and 2019. In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy. Conclusion. Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities. Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients.

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