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Hepatobiliary Disease

Launching Liver Exchange and the First 3-Way Liver Paired Donation

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1 Credit CME

JAMA Surgery

Published Online: December 7, 2022

Surgical Innovation

Article Information and Disclosures

Saad Salman, MD, MPH¹;

Muhammad Arsalan, MBBS²;

Faisal Saud Dar, MBBS²

Author Affiliations

¹Harvard School of Public Health, Harvard University, Boston, Massachusetts
²Pakistan Kidney and Liver Institute, Lahore, Pakistan

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There is a shortage of transplantable organs almost everywhere in the world. In the US, about 6000 transplant candidates die waiting each year.¹ In Pakistan, 30% to 50% of patients who needed a liver transplant are unable to secure a compatible donor, and about 10 000 people die each year waiting for a liver.² Kidney paired donations, supported by Nobel Prize–winning kidney exchange (KE) algorithms,³ have enabled living donor kidneys to become an important source of kidneys. Exchanges supported by algorithms that systematically identify the optimal set of paired donations has yet to take hold for liver transplant.

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Article Information

Corresponding Author: Saad Salman, MD, MPH, Harvard School of Public Health, Harvard University, 665 Huntington Ave, Boston, MA 02115 (saad.salman@mail.harvard.edu).

Published Online: December 7, 2022. doi:10.1001/jamasurg.2022.5440

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patients for granting permission to publish this information. We thank Alex Chan, MPH (Stanford University, Palo Alto, California), whose initiative and expertise in economics were the key driving forces for launching liver exchange. We thank Ihsan Ul Haq, MBBS, Sohail Rashid, MBBS, M. Yasir Khan, MBBS, and Siraj Haider, MBBS (Pakistan Kidney and Liver Institute, Lahore, Pakistan), who led the procedures as part of the 3-way liver paired donations reported here. Contributors were compensated for their work.

References

Chan A , Roth AE . Regulation of organ transplantation and procurement: a market design lab experiment. Accessed April 28, 2022. https://www.alexchan.net/_files/ugd/a47645_99b1d4843f2f42beb95b94e43547083b.pdf

Salman S , Gurev S , Arsalan M , Dar F , Chan A . Liver exchange: a pathway to increase access to transplantation. Accessed April 1, 2022. http://www.hhpronline.org/articles/2021/1/14/liver-exchange-a-pathway-to-increase-access-to-transplantation

Henderson D . On marriage, kidneys and the Economics Nobel. Wall Street Journal. October 15, 2012. Accessed March 5, 2022. https://www.wsj.com/articles/SB10000872396390443675404578058773182478536

Chan A . Optimal liver exchange with equipoise. Accessed April 23, 2022. https://www.alexchan.net/_files/ugd/a47645_36e252f4df0c4707b6431b0559b03143.pdf

Hwang S , Lee SG , Moon DB , et al. Exchange living donor liver transplantation to overcome ABO incompatibility in adult patients. Liver Transpl. 2010;16(4):482-490. doi:10.1002/lt.22017 PubMed Google Scholar Crossref

Patel MS , Mohamed Z , Ghanekar A , et al. Living donor liver paired exchange: a North American first. Am J Transplant. 2021;21(1):400-404. doi:10.1111/ajt.16137 PubMed Google Scholar Crossref

Braun HJ , Torres AM , Louie F , et al. Expanding living donor liver transplantation: report of first US living donor liver transplant chain. Am J Transplant. 2021;21(4):1633-1636. doi:10.1111/ajt.16396 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.