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.
Departments of Surgery, National Liver Institute, Menofeyia University, Egypt. habdeldayem64@hotmail.com
Hesham M
HM
Abdeldayem
Naglaa A
NA
Allam
Essam
E
Salah
Amr
A
Mostafa Aziz
Samy
S
Kashkoush
Nermine M
NM
Adawy
Hisham
H
Gad
Amr
A
Helmy
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