A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States

IntroductionA successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders. MethodsWe conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021-October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference. ResultsResponses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non-LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non-LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers. ConclusionFindings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access.

Automated summary

This study aimed to explore the attitudes, barriers, and facilitators of living donor liver transplant (LDLT) in US liver transplant centers. The findings showed that there is a strong interest in expanding LDLT, with a high level of agreement that it mitigates donor shortage and should be offered to suitable candidates. However, barriers such as institutional factors and surgical expertise were identified at non-LDLT centers, while waitlist candidate and donor factors were the main barriers at LDLT centers.