Technology- and policy-based strategies for increasing supply of deceased donor livers

[Extract] Currently, liver transplantation remains the only effective treatment for end-stage liver disease, and living and deceased donor graft (the organ) survival rates are nearly equivalent (82.5 percent and 82.0 percent at 1 year post-transplant; 72.2 percent and 71.9 percent at 3 years after transplant; 65.9 percent and 65.1 percent at 5 years after transplant). According to the Organ Procurement and Transplantation Network, there have been at least 15,000 patients awaiting liver transplant at the start of each year since 2011. The size of the waitlist fluctuates during the year as patients are added or removed (because they received transplants or died), but when patients are listed at more than one hospital, the patient is counted only once. In the United States, between 2006 and 2012, approximately 6,391 liver transplants occurred each year, indicating a consistent shortfall of organs. Living liver donation is a risky elective surgical procedure; thus the ethically optimal way forward is not increasing the number of living donations to facilitate more transplants but increasing the number of deceased donor livers available for transplantation.