title: Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience.
abstract: We report our experience with potential donors for living donor liver transplantation (LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors (n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion (n = 792). Most of the transplant candidates (82.3%) had an experience with more than one excluded donor (median = 3). Some recipients travelled abroad for a deceased donor transplant (n = 12) and some died before finding a suitable donor (n = 14). The evaluation of an excluded donor is a time-consuming process (median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD (range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed Abdel
authors.initials: MA
authors.lastname: Wahab
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Elsarraf
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elshobary
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ahmed Mohamed
authors.initials: AM
authors.lastname: Sultan
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shehta
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Omar
authors.initials: O
authors.lastname: Fathy
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Helmy
authors.initials: H
authors.lastname: Ezzat
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Yassen
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elmorshedi
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elsaadany
authors.affiliation: Mohamed Abdel Wahab, Hosam Hamed, Tarek Salah, Ahmed Mohamed Sultan, Ahmed Shehta, Omar Fathy, Mohamed Elsaadany, Gatrointestinal Surgery and Liver Transplantation Unit, Gastrointestinal Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Usama
authors.initials: U
authors.lastname: Shiha
mesh_terms: D000293:Adolescent; D000328:Adult; D004534:Egypt; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D019520:Living Donors / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000191:economics / Q000331:legislation & jurisprudence; D014850:Waiting Lists; D055815:Young Adult
keywords: Deceased donor; Excluded donors; Liver disease; Liver transplantation; Living donor