What are the advantages and disadvantages of a living donor versus a deceased donor (cadaveric donor) for organ transplantation?

From the Guidelines

Living donor liver transplantation should be considered for selected patients, as it offers several advantages over deceased donor transplantation, including decreased waitlist dropout rate and comparable post-transplant outcomes. The advantages of living donor transplants include:

• Decreased waitlist dropout rate, as living donor LT can be performed when the availability of grafts from deceased donors is scarce [ 1 ]
• Comparable post-transplant outcomes after LT with living or deceased donors, particularly in intention-to-treat analysis considering waitlist dropout [ 1 ]
• The ability to schedule surgery in advance, allowing for optimal timing for both donor and recipient However, living donation also carries risks for the donor, including:
• Surgical complications and recovery time
• Potential long-term health effects
• Financial burdens from time off work
• Psychological impacts On the other hand, deceased donor transplantation has its own set of disadvantages, including:
• Longer waiting times, often years
• Organs that may have suffered damage before retrieval
• Sometimes delayed function after transplantation
• Typically shorter survival times
• Transplantation must occur immediately when an organ becomes available, regardless of the recipient's current health status The choice between living and deceased donation involves weighing these medical outcomes against the ethical considerations of asking someone to undergo surgery and organ removal for another's benefit, with the goal of minimizing waitlist dropout/mortality and maximizing outcomes [ 1 ].

From the Research

Advantages of Living Donor

• Living donor transplantation can shorten the waiting time for a recipient and provide a healthy organ for transplant, increasing recipient survival 2
• The use of living donors can help alleviate the shortage of deceased donor organs, which is a limiting factor in transplant 3
• Living donors can be carefully evaluated and selected to minimize complications and provide adequately functional grafts 3

Disadvantages of Living Donor

• Living organ donation is a unique procedure where healthy patients undergo a major surgical operation without any direct functional benefit to themselves, and donors may experience complications or risks 4, 5
• The evaluation and selection process for living donors must be careful and thorough to minimize harm, and donors must be fully informed of the risks and benefits as a donor 6, 2
• Living donors may experience simple, moderate, or severe complications, including organ failure or death, although severe complications are rare 5, 3

Comparison with Deceased Donor

• Deceased donor organs may have a higher risk of graft failure or other complications compared to living donor organs, although outcomes for recipients of repeat living donors are similar to recipients of comparison donors 5
• The use of living donors can provide a more timely and reliable source of organs for transplant, although the long-term safety of repeat living donation is unknown 5
• The selection and evaluation process for living donors is critical to ensuring the safety and well-being of both the donor and the recipient, and to minimizing the risks associated with living donation 6, 2, 3