CONTROVERSIES

12. Should liver transplants be performed in individuals with alcoholic liver disease?

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Transplant centers have strict criteria that alcohol-induced liver transplant recipients must undergo extensive psychological testing and abstain from alcohol before being placed on the waiting list. The recidivism rate (i.e., transplant patients who start drinking again) remains low. Financially, the cost is comparable, if not lower, than continued medical management of end-stage liver disease. We currently do provide care for other self-inflicted medical problems, such as cigarette smokers. The public must realize that people are not being pulled off bar stools and taken to the hospital for their transplant.

13. Should patients with hepatic malignancies have liver transplants?

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Patients with hepatocellular carcinoma have had successful transplants, although their survival is considerably lower than recipients transplanted for other causes. Other hepatic malignancies, including cholangiocarcinoma, are generally considered contraindications to transplantation. Whether scarce donor livers should be allocated to these patients continues to be a complex issue.

14. Should adult-to-adult living donors be used?

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The evolving field of adult-to-adult living donor liver transplant (ALDLTx) requires a healthy donor to undergo a major, potentially life-threatening operation. The benefits include a timely, life-saving procedure for a loved one, reducing the recipient’s risk of not having a cadaveric liver available in time. The ethics of whether to subject the donor to major liver resective surgery remains debatable. Even more debatable is whether it is permissible to accept a donor liver for a recipient with liver cancer who already has a poor outlook.

References
WEB SITE
http://www.transplantation-soc.org
BIBLIOGRAPHY
1. Bak T, Wachs M, Trotter JF, et al: Adult-to-adult living donor liver transplant using right lobe grafts: Results and lessons learned from a single center experience. Liver Transpl 7:680-686, 2001. Medline Similar articles Full article
2. Barker CF, Brayman KL, Markmann JF, et al: Transplantation of abdominal organs. In Townsend CM, Beauchamp RD, Evers BM, et al (eds): Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th ed. Philadelphia, W.B. Saunders, 2001.
3. Ginns LC, Cosimi AB, Morris PJ: Transplantation. Malden, MA, Blackwell Science, 1999.
4. Lok ASF, Villamil FG, McDiarmid SV (eds): Liver Transplantation for Viral Hepatitis [entire volume]. Liver Transpl 8(suppl 1), 2002.