Living donor liver transplants face infrastructure hurdles despite proven kidney exchange success
The United States has a large potential pool of living liver donors, but a lack of coordinated systems and funding limits widespread use.
Paired kidney exchanges, supported by the National Kidney Registry since 2007, have helped reduce wait times and enable thousands of transplants, yet living liver donation lags behind, representing roughly 6 percent of liver transplants in the United States. Recent multi-pair liver exchanges demonstrate feasibility, but they require multiple surgeons and complex coordination without a centralized registry. Surveys of transplant programs reveal that about 34 percent of centers not performing living donor liver transplants cite institutional barriers such as insufficient funding and limited surgical expertise.
Donors also face logistical challenges, including travel, lodging and time off work, with limited financial assistance available. Experts argue that standardized protocols, algorithmic matching and broader donor protections are needed to expand the living liver donor pool and save more lives.
Why it matters
Improving living liver donation could reduce deaths on the transplant waitlist and ease organ shortages.
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