Increasing living donor liver transplantation: liver exchange and other options

 Here's an early online paper from the journal Liver Transplantation.

Can living donor liver transplant in the United States reach its potential?  by Alyson Kaplan, Russell Rosenblatt, Benjamin Samstein, Robert S. Brown Jr., 

First published: 26 June 2021 https://doi.org/10.1002/lt.26220   

Abstract: Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end-stage liver disease. LDLT still only makes up a very small proportion of all liver transplants performed each year, but there are many innovations taking place in the field that may increase its acceptance amongst both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through non-directed donation, paired exchange, transplant chains, transplant of ABO-incompatible donors, and transplant in high MELD patients. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center-level behavior, such as ensuring surgical expertise and providing culturally competent education, will help towards LDLT expansion. While it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the last two years.