3, 18, 19 Although the exact mechanism has not been clarified, the residual capacity for liver regeneration in older patients may be less click here than in younger patients, or older patients may be at greater risk for complications such as infections and multiple organ failure. There may be a concern that the expedited donor evaluation could be associated with poorer donor outcomes. However,

there was no mortality, major morbidity, or reoperation among the donors of our series. Although about 24% of donors suffered from minor complications, all improved spontaneously or with conservative management. The rate of donor complications we observed was lower than that of adult LDLT donors in a multicenter study performed in the United States (38%),20 but higher than that in large LT centers in Asia (12%–16%).21, 22 The differences may be attributable to variation in defining and reporting complications. In general, however, emergency adult LDLT is not likely to be associated with a significantly higher donor complication rate than is elective adult LDLT. Another major ethical consideration has been coercion of potential donors. As indicated previously,14, 23 an element of coercion can always exist between any potential donor and recipient. A complete absence of coercion when making

a decision to donate may be unrealistic, because of the dynamics of the life-threatening condition of the recipient combined with the life-rescuing possibility selleck chemicals llc of LDLT and the familial relationship between donor and recipient. However, we made maximal efforts to guarantee donor autonomy during acquisition of written informed consent.

Freedom of withdrawal was allowed at any stage of the donor evaluation process. A recent systematic review focused on this issue found that nearly all adult LDLT donors reported no coercion to donate,24 and more than 85% of donors reported check details that the information available to them prior to undergoing the procedure was adequate. Although our institution has favored the use of voluntary donors unrelated to recipients, most living donors in this study were family members of recipients. The reasons for this included the limited number of voluntary living donors, the severely limited time in which LT is available for patients with ALF, and the difficulty in guaranteeing the absence of any form of trade between donor and recipient. This study had several limitations. First, it was a single-center study and therefore may not represent the entire ALF patient population in HBV-endemic areas. However, our institution is the largest LT center in Korea and our liver transplant program performs nearly half of all yearly transplants in the country, suggesting that our results may reflect the situation throughout our country.25 Second, it was difficult for us to directly compare patient outcomes by etiology, because of the small numbers of patients with ALF etiologies associated with favorable outcomes.