Ethical issues surrounding adult-to-adult living donor liver transplantation.

1. The ethical principle of utility is enhanced by living donor liver transplantation (LDLT). LDLT carries the potential to optimize efficient use of organs, minimize pretransplant morbidity and mortality, and increase availability of cadaveric organs. 2. The most serious ethical concerns in LDLT focus on the risks to the donor and relate to the principle of nonmaleficence-"do no harm". Although exact risk remains uncertain, there is potential for significant donor morbidity and even mortality. 3. Careful consideration must be given to development of the best approach to obtaining truly informed consent. 4. Specific criteria for LDLT should be developed for transplant centers, donors, and recipients. Informed consent should be standardized. 5. A national registry for donors and recipients of LDLT is needed.