Journal article
Anonymous living donation expands access and enhances equity in pediatric liver transplantation: A retrospective cohort study
Liver transplantation, Vol.32(6), pp.830-839
06/2026
DOI: 10.1097/LVT.0000000000000753
PMID: 41104559
Abstract
Living donor liver transplantation (LDLT) confers the best survival to children with end-stage liver disease, yet racial and socioeconomic barriers often preclude access to a biologically or emotionally related donor. Anonymous nondirected LDLT (A-LDLT), whereby altruistic strangers donate, could close this gap and diminish reliance on deceased-donor LT (DDLT), but its equity and efficacy have not been fully quantified. We therefore analyzed all 422 consecutive pediatric liver transplants at a large Canadian center from January 2005 to March 2023. In this retrospective cohort study, we compared recipient demographics, clinical characteristics, waitlist duration, and survival outcomes across A-LDLT (n=62), directed living donor liver transplantation (n=174), and DDLT (n=186) groups. Children who underwent A-LDLT were disproportionately Black or Indigenous, more often lived in single-parent households, and more frequently spoke a non-English primary language, indicating that anonymous donation reached sociodemographically disadvantaged groups. After adjusting for age, diagnosis, era, and pediatric end-stage liver disease/MELD score, median wait time for cholestatic disease was 104 days with A-LDLT versus 138 days with DDLT-a 20% reduction-while operative complexity, vascular or biliary complication rates, and intensive-care stay were comparable to directed LDLT. One-, 5-, and 10-year patient survival rates after A-LDLT were 100%, 98% and 98%, respectively, mirroring directed living donor liver transplantation and exceeding DDLT (96%, 94%, and 93%). Graft survival showed the same pattern. Integrating anonymous nondirected donors enlarges the living donor pool, decreases time to transplantation for vulnerable children, and preserves the superior long-term outcomes achieved with living donor organs. Embedding A-LDLT alongside DDLT can reduce disparities and enable timely, life-saving transplantation for children without directed donors while maintaining the advantages associated with living donor grafts.
Details
- Title: Subtitle
- Anonymous living donation expands access and enhances equity in pediatric liver transplantation: A retrospective cohort study
- Creators
- Toshifumi Yodoshi - Hospital for Sick ChildrenJennifer Stunguris - University of TorontoMaria De Angelis - University of TorontoKrista Van Roestel - University of TorontoJulia Hensley - University of TorontoYaron Avitzur - University of TorontoRobert H. J. Bandsma - Hospital for Sick ChildrenNicola Jones - University of TorontoBinita Kamath - University of TorontoMar Miserachs - University of TorontoChantal Wiggins - University Health NetworkNazia Selzner - University of TorontoAnand Ghanekar - University Health NetworkMark Cattral - University Health NetworkBlayne A. Sayed - Trakya UniversityVicky L. Ng - University of Toronto
- Resource Type
- Journal article
- Publication Details
- Liver transplantation, Vol.32(6), pp.830-839
- DOI
- 10.1097/LVT.0000000000000753
- PMID
- 41104559
- NLM abbreviation
- Liver Transpl
- ISSN
- 1527-6465
- eISSN
- 1527-6473
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Language
- English
- Date published
- 06/2026
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9985214100902771
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