Meeting the demand: Incorporating living donor liver transplantation into the deceased donor liver transplantation landscape

Liver transplantation (LT) has for decades been a well-established treatment for end-stage liver disease and malignancy, becoming the standard of care for select patients with these life-limiting conditions. Due to a limited pool of high-quality deceased donor organs, there is an existing and growing disparity between those in need of and those able to access LT. Living donor liver transplantation (LDLT) has emerged as one way to mitigate this disparity. Despite Australia’s place in history as the first reported LDLT from mother-to-child in 1987, living donation for adults is rare, in part due to perceived lack of need due to the historically low waitlist mortality data. This Perspective reviews the history of LDLT and utilises Australia as a case-study for exploring the necessity for LDLT in existing deceased donor liver transplant programs, the ethical considerations, risks and benefits of the procedure, and the means to implement LDLT.