Purpose: LDLT reduces waitlist mortality, improves access to transplantation and has post-transplant outcomes that are equivalent to or better than deceased donor transplant. Despite these benefits, LDLT continues to be a small fraction of liver transplants in the US. This study explores barriers to the wider utilization of LDLT.

Methods: Two separate Likert-scale questionnaires were developed and separately administered to potential liver donors and potential recipients at a single center. Questionnaires asked patient perspectives on donor health risks, financial strain and concerns about approaching potential donors.

Results: From 5/15-11/15, 58 potential recipients and 23 potential donors completed the questionnaires. Recipients were mostly male (65.5%) while more donors were female (52.2%). Recipients were older than donors (57.4,+/-11.4 vs. 37.6+/-7.6, p<0.01). Potential recipients were much more likely to express concerns about a long/painful recovery for the donor (44.8% agreed or strongly agreed, compared to 21.7% of potential donors). Recipients were also more likely to have concerns about the donor developing post-operative complications (82.8% of recipients, compared to 21.7% of donors). Recipients were also significantly more concerned about the financial impact of donation than donors (81.0% of recipients, compared to 13.0% of donors). A majority of recipients and donors expressed support for a national living donor fund to minimize the financial impact of donation. 78.3% of potential donors agreed or strongly agreed they would be more likely to donate if the surgery could be done laparoscopically. 72.4% of potential recipients agreed or strongly agreed that they would be more likely to approach a family member about donation if the surgery could be done laparoscopically and 56.9% agreed or strongly agreed that they would be more likely to approach a friend. A high percentage of recipients were concerned about coercion and the emotional impact of donation (63.8% agreed or strongly agreed).

Conclusions: A majority of potential recipients are concerned about adverse outcomes including surgical complications and financial strain. In fact, recipients were more likely to express concerns than potential donors. Recipient hesitation is likely the major barrier to the utilization of LDLT. Minimally invasive donation may increase recipient interest in approaching potential donors, even unrelated donors.

CITATION INFORMATION: Yegiants A, Przybyszewski E, Fox A, Emond J, Samstein B. Barriers to the Wider Utilization of Living Donor Liver Transplantation (LDLT). Am J Transplant. 2016;16 (suppl 3).

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