Patients who need a new liver usually face a long wait. Some die before a suitable donor is found. Living liver donation is offered routinely in some countries. Should the United Kingdom follow suit?

Liver transplantation has become an accepted form of treatment for patients with end stage liver disease and those with an unacceptable quality of life because of liver disease. Despite government initiatives to increase donor rates and surgical innovations to maximise the use of existing donor livers, the number of donor organs is insufficient to meet the existing demand. Living liver donation has the potential to help mitigate the deficit and is offered routinely in many countries in North America, Asia, and continental Europe. Living liver donation is not routinely available in the United Kingdom, although a few living transplant operations have been done led by Roger Williams and Nigel Heaton.1 We believe that living liver donation should be available on the NHS, although it should not be adopted without full public debate and agreement because of the risks to donors.

Current practice

The United Kingdom has no reliable information on requirements for liver transplantation. Although we have data on the number accepted for transplantation,2 not everyone who might benefit from transplantation is referred.3 The rate of transplantation is relatively low compared with other European countries (11.6/million population compared with 19.3/million in France and 24.3/million in Spain). However, we do not know the requirement for transplantation because the burden of liver disease in these countries may differ. Donor rates also vary between countries, but the proportion of potential donors who are offered for transplantation is not known. The number of patients dying from liver disease in England is increasing.4

Liver transplant operation

Credit: J L MARTRA/PUBLIPHOTO DIFFUSION/SPL

To be accepted on the transplant list in …