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Solid organ transplantation (SOT) has revolutionized the treatment of end-stage organ failure, offering recipients improved survival and quality of life. The two primary sources of organs for transplantation are living donors and deceased donors. Living donor transplantation (LDT) involves the surgical removal of an organ or a part of an organ from a living person for transplantation into a recipient. Deceased donor transplantation (DDT) utilizes organs from individuals who have been declared brain dead or have experienced circulatory death. Both LDT and DDT have contributed significantly to expanding the pool of available organs and improving access to transplantation. However, these two approaches differ considerably in their logistics, risks, and benefits [1]. Understanding these differences is crucial for informing clinical decision-making, developing effective transplant policies, and optimizing patient outcomes. The persistent shortage of deceased donor organs has driven the growth of LDT, particularly for kidney and liver transplantation [2]. LDT offers several potential advantages, including shorter waiting times, planned surgical procedures, and the potential for preemptive transplantation before the recipient’s condition deteriorates significantly.

Description

Studies have consistently shown that recipients of living donor kidneys generally experience superior graft survival rates compared to recipients of deceased donor kidneys [3]. This advantage is particularly pronounced in the early post-transplant period. Similar trends have been observed in liver transplantation, although the magnitude of the difference may vary depending on the specific liver disease and transplant center experience. LDT offers a significant advantage in terms of waiting time, as recipients can receive a transplant as soon as a suitable living donor is identified and evaluated. In contrast, recipients awaiting deceased donor organs face unpredictable waiting times, which can be influenced by factors such as blood type, tissue compatibility, and organ availability.

The superior graft survival observed in LDT, particularly for kidney transplantation, is likely attributable to several factors, including shorter cold ischemia time (the time the organ is outside the body), planned surgical procedures, and better matching of donor and recipient characteristics. The shorter waiting time associated with LDT can also lead to improved recipient outcomes by preventing further deterioration of the recipient’s health while awaiting transplantation. However, LDT involves inherent risks for the living donor, including surgical complications, pain, and potential long-term health consequences [4]. Careful donor selection and comprehensive pre-donation evaluation are crucial to minimize these risks. The ethical considerations surrounding LDT are also important to address. Ensuring that the donation is truly altruistic and free from coercion is paramount. Independent donor advocacy and rigorous informed consent processes are essential to protect the well-being of living donors [5]. Deceased donor transplantation plays a crucial role in providing organs for patients who do not have a suitable living donor or who are not candidates for LDT. Expanding the deceased donor pool through public awareness campaigns and effective organ donation programs is essential to meet the growing demand for organs. The use of extended criteria donors (ECD) and donation after circulatory death (DCD) donors has helped to increase the availability of deceased donor organs [6]. However, these types of donors may be associated with slightly lower graft survival rates compared to standard criteria donors. The allocation of deceased donor organs is a complex process that aims to balance considerations of medical urgency, waiting time, and other factors such as blood type, tissue compatibility, and age. Different allocation systems exist, and their effectiveness in achieving equitable organ distribution and maximizing graft survival is an ongoing area of research and policy debate [7]. The cost-effectiveness of LDT compared to DDT is also an important consideration. While LDT involves the costs associated with donor evaluation and surgery, the potential for improved graft survival and reduced need for long-term dialysis or re-transplantation can lead to significant cost savings in the long run [8]. The psychological impact of both LDT and DDT on recipients and their families should not be overlooked. Both types of transplantation can be associated with significant emotional stress and adjustment challenges [9]. Providing adequate psychosocial support and counseling is essential for promoting the well-being of recipients and their families. The development of new technologies, such as ex-vivo organ perfusion and machine perfusion, has the potential to improve the quality of deceased donor organs and expand the donor pool [10]. These technologies can help to reduce ischemia-reperfusion injury and improve graft function.

Discussion

This review is limited by the heterogeneity of the included studies, which varied in study design, patient populations, and outcome measures. Further research is needed to specifically compare LDT and DDT in different organ types and transplant settings. Future research should focus on developing strategies to optimize donor selection and minimize donor risks in LDT. Further research is also needed to improve the quality of deceased donor organs and expand the deceased donor pool. Comparative effectiveness research is needed to directly compare LDT and DDT in different patient populations and to assess the long-term outcomes of both approaches.

Conclusion

Both living and deceased donor transplantation play crucial roles in addressing the organ shortage and providing life-saving therapy for patients with end-stage organ failure. LDT offers advantages in terms of graft survival and waiting time, while DDT provides an essential source of organs for patients who do not have a suitable living donor. Continued research and policy development are needed to optimize both approaches and ensure equitable access to transplantation for all patients in need.

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