Korean J Transplant.  2021 Sep;35(3):161-167. 10.4285/kjt.21.0015.

Use of minor donors for living donor liver transplantation and associated ethical issues

• Hwang S
• Song GW
• Jung DH
• Ha TY
• Park GC
• Ahn CS
• Moon DB
• Lee SG

• KMID: 2520677
• DOI: http://doi.org/10.4285/kjt.21.0015

Abstract

Background
Living liver donation by minors is regarded as justifiable only if minors possess the capacity to consent to donation and the procedure is in their best interests. This study analyzed the incidence of and reasons for living donor liver transplantation (LDLT) by minor donors in Korea, and discussed ethical issues regarding liver donation by minors.
Methods
The databases of the Korean Network for Organ Sharing (KONOS) and Asan Medical Center (AMC) from 2010 to 2019 were retrospectively reviewed to determine the incidence of LDLT by minor donors.
Results
From 2010 to 2019, 590 (4.1%) of 14,243 liver donors in the KONOS database and 276 (7.5%) of 3,401 liver donors in the AMC database were minors. The proportions of minor donors in the KONOS and AMC databases were highest in 2012, at 4.1% and 12.6%, respectively, and lowest in 2019, at 1.1% and 3.0%, respectively. Because most LDLT recipients had relatively low model for end-stage liver disease scores and hepatocellular carcinoma, they were unlikely candidates for deceased-donor liver transplantation and were highly likely to drop out of LDLT if they waited for 1–2 years. The donor-recipient relationship of minor donors in the AMC database was first-degree in 256 (92.8%) and second- or third-degree in 20 (7.2%).
Conclusions
Liver donation by minors is limitedly acceptable only when the minor proves informed, well‐considered, and autonomous consent to the procedure and the procedure is in the minor's best interests. We suggest that minors be allowed to donate only to first-degree family members.

Keyword

Donor age; Adolescent; Donor shortage; Hepatocellular carcinoma; Coercion

Figure

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  Fig. 1 Age distribution of all living solid organ transplant donors from January 2010 to December 2019 in Korea.

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  Fig. 2 Annual proportions of minor donors to all living solid organ transplant donors in the Korean Network for Organ Sharing (KONOS) database and Asan Medical Center (AMC) database during 2010–2019.

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  Fig. 3 Relationships between living donors and recipients in the first 5,000 cases of adult living donor liver transplantation (LDLT); because of dual-graft donors, the actual number of donors was 5,223. (A) Overall relationships. (B) Degrees of kinship.

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