Liver transplantation: When to say yes or no? Based on a case report

Abstract

Background: Liver transplantation (LT) is the gold standard therapy for end-stage liver diseases (ESLD) worldwide. Over the past decades, multiple strategies have been developed in order to optimize allograft/recipient outcomes and decrease patient morbidity/mortality. However, maintaining an appropriate balance between “using a limited resource” (i.e. available organs) and “reducing waitlist mortality” arises multiple ethical concerns. Aim: In this report we aimed to address some ethical issues related to a case that occurred in our institution in which liver re-transplantation was performed in a patient with cirrhosis and hepatocellular carcinoma (HCC) as an emergent life-saving therapy. Conclusions: We conclude that expanding the donor pool (e.g. living donor LT, use of extended criteria donors, donation after cardiac death, bridging therapies to delay the necessity of transplantation) is a way to compensate the growing discrepancy between donors and recipients; however, this needs to be evaluated in each individual patient in order to obtain the maximum benefit. Keywords: Liver transplantation, Hepatocellular carcinoma, Metastasis