Case Report
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World J Gastroenterol. Oct 7, 2014; 20(37): 13607-13614
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13607
Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience
Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Waleed Elsarraf, Mohamed Elshobary, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Helmy Ezzat, Amr Yassen, Mohamed Elmorshedi, Mohamed Elsaadany, Usama Shiha
Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt
Waleed Elsarraf, Amr Yassen, Mohamed Elmorshedi, Anesthesia and Intensive Care Department, Gastrointestinal Surgical Center, Mansoura Faculty of Medicine, Mansoura University, Daqahlia 35516, Egypt
Mohamed Elsaadany, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia 35516, Egypt
Usama Shiha, Radiology Department, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt
Author contributions: Wahab MA and Hamed H contributed to conception and design, analysis and interpretation of data, drafted the article and revised it; Salah T, Elsarraf W, Elshobary M, Sultan AM, Shehta A, Fathy O, Yassen A, Elmorshedi M, Elsaadany M and Shiha U contributed to acquisition, analysis and interpretation of the data; all authors made final approval of the manuscript.
Correspondence to: Mohamed Abdel Wahab, Professor, Chair of Liver Transplantation Unit, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Gehan Street, Mansoura University, Republic Street, Daqahlia 35516, Egypt. wahab_m_eg@yahoo.com
Telephone: +2-12-23134160 Fax: +2-50-2243220
Received: January 25, 2014
Revised: April 3, 2014
Accepted: May 19, 2014
Published online: October 7, 2014
Processing time: 254 Days and 19.7 Hours
Abstract

We report our experience with potential donors for living donor liver transplantation (LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors (n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion (n = 792). Most of the transplant candidates (82.3%) had an experience with more than one excluded donor (median = 3). Some recipients travelled abroad for a deceased donor transplant (n = 12) and some died before finding a suitable donor (n = 14). The evaluation of an excluded donor is a time-consuming process (median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD (range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.

Keywords: Living donor; Liver transplantation; Excluded donors; Deceased donor; Liver disease

Core tip: This is the first case series from a country where a deceased donor liver transplantation program is not available and the shortage of living liver donors is high. We report our experience regarding the problem of excluded donors and possible strategies to overcome this problem. We hope that this experience will be of benefit to the readers of the World Journal of Gastroenterology.