Here's a review of liver exchange in the transplant literature, with some comparisons to kidney exchange.
Paired exchange Living donor Liver Transplantation: Indications, stumbling blocks, and future considerations by Dhiraj Agrawal, Subhash Gupta, and Sanjiv Saigal, Journal of Hepatology, In Press, Pre-proof https://doi.org/10.1016/j.jhep.2022.10.019
Abstract: "The last decade has seen Liver Paired exchange (LPE) as an increasingly used modality across the transplant community by which pairs of incompatible living Liver donors and their intended recipients swap Livers resulting in compatible transplants. The feasibility and benefit of LPE in providing excellent recipient outcomes and robust donor safety have been proven in uncomplicated swaps. Began initially as single-centre two-way or three-way exchanges, LPE has tremendous potential to grow into more complicated chains over days and over multiple centres. Also, LPE is associated with unique technical, logistical, ethical and legislative challenges. This review discusses the indications, potential types of LPE, unique solutions to stumbling blocks in performing LPE, and future considerations on how LPE can expand the living donor liver pool and the armamentarium of living donor liver transplantation (LDLT)".
"The published literature on LPE has nine reports (5 original articles and 4 case reports), including 74 LPEs from Asia and North America.1), 2), 3), 4), 5), 6), 7), 8), 9) LPE constitutes approximately 1.2 to 8.3 % of the total LDLTs performed at the individual centre1), 2), 3), 4), signifying a substantial potential of this form of LDLT to mitigate the liver allograft shortage."
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