Moral and ethical issues in living-donor liver transplant in Egypt.
OBJECTIVE
Since brain-death criteria are not accepted in Egypt, only organs acquired from living donors can be used for transplant. Our objective was to highlight the ethical issues raised by living-donor liver transplant.


METHODS
The study was conducted by reviewing publications from centers performing living-donor liver transplant in Egypt and by consulting with a group of experts in the fields of liver transplantation, clinical ethics, and religious scholarship.


RESULTS
The first successful living-donor liver transplant in Egypt was performed at the National Liver Institute in 1991; however, this program did not continue because of poor early results. In August 2002, transplants began at Dar-Al-Foaud Hospital; since then, almost 500 cases of living-donor liver transplant have been performed at 9 centers. Although the donor risk is estimated to be low, 2 donors died (0.4%). The ethical principle that best applies to living-donor liver transplant is primum non nocere (first, not to harm), as the donor derives emotional benefit fromdonation and the opportunity to save a life. It is important to stress that the alternative to living-donor liver transplant in Egypt is not deceased-donor liver transplant. There are no doubts that this is a beneficial procedure for the recipient with acceptable risks to the donor.


CONCLUSIONS
It is ethically appropriate to perform liver transplant using living donors.
Abdeldayem
Hesham M
HM
Departments of Surgery, National Liver Institute, Menofeyia University, Egypt. habdeldayem64@hotmail.com
Allam
Naglaa A
NA
Salah
Essam
E
Mostafa Aziz
Amr
A
Kashkoush
Samy
S
Adawy
Nermine M
NM
Gad
Hisham
H
Helmy
Amr
A
D000533:Altruism; D001291:Attitude of Health Personnel; D004534:Egypt; D005195:Family Relations; D037921:Gift Giving / Q000941:ethics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D016031:Liver Transplantation / Q000009:adverse effects / Q000941:ethics* / Q000523:psychology; D019520:Living Donors / Q000941:ethics* / Q000523:psychology; D009014:Morals; D009042:Motivation; D012068:Religion and Medicine; D018570:Risk Assessment; D014838:Volunteers