Does living donation have advantages over deceased donation in liver transplantation?

Liver transplantation (LT) is the best treatment option for patients with end-stage liver disease. Living donor LT (LDLT) has developed as an alternative to deceased donor LT (DDLT) in order to overcome the critical shortage of deceased organ donations, particularly in Asia. LDLT offers several advantages over DDLT. The major advantage of LDLT is the reduction in waiting time mortality. Especially among patients with hepatocellular carcinoma (HCC), LDLT can shorten the waiting time and lower the dropout rate. The Hong Kong group reported that median waiting time was significantly shorter for LDLT than for DDLT. Intention-to-treat survival rates of HCC patients with voluntary live donors were significantly higher than those of patients without voluntary live donors. In contrast, a multicenter adult-to-adult LDLT retrospective cohort study reported that LDLT recipients displayed a significantly higher rate of HCC recurrence than DDLT recipients, although LDLT recipients had shorter waiting times than DDLT recipients. The advantage of LDLT involves the more liberal criteria for HCC compared with those for DDLT. Various preoperative interventions including nutritional treatment can also be planned for both the donor and recipient in LDLT. Conversely, LDLT has marked unfavorable characteristics in terms of donor risks. Donor morbidity is not infrequent and the donor mortality rate is estimated at around 0.1-0.3%. In conclusion, living donation is not necessarily advantageous over deceased donation in LT. Taking the advantages and disadvantages of each option into consideration, LDLT and DDLT should both be used to facilitate effective LT for patients requiring transplant.