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World J Gastroenterol. Dec 28, 2013; 19(48): 9183-9188
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9183
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9183
Transplant benefit for patients with hepatocellular carcinoma
Alessandro Vitale, Umberto Cillo, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, 35128 Padova, Italy
Michael Volk, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
Author contributions: Vitale A, Volk M and Cillo U wrote, edited and revised the manuscript.
Correspondence to: Alessandro Vitale, MD, PhD, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, Via Giustiniani 2, 35128 Padova, Italy. alessandro.vitale@unipd.it
Telephone: +39-49-8212211 Fax: +39-49-8211816
Received: October 1, 2013
Revised: November 13, 2013
Accepted: November 28, 2013
Published online: December 28, 2013
Revised: November 13, 2013
Accepted: November 28, 2013
Published online: December 28, 2013
Core Tip
Core tip: Deciding upon the best option for a patient with hepatocellular carcinoma is complicated, involving numerous ethical principles including: urgency, utility, intention-to-treat survival, transplant benefit, harm to candidates on waiting list, and harm to living donors. In this paper we suggest that allocating organs by transplant benefit could help balance these competing principles, and also introduce equity between patients with hepatocellular carcinoma and those with nonmalignant liver disease. We also propose a triangular equipoise model to help decide between deceased donor liver transplantation, living donor liver transplantation, or alternative therapies.