When a liver transplantation candidate is declined for listing to receive a deceased organ, sometimes a loved one comes forward and offers to be a living donor. This raises the ethical question of whether a patient who is not eligible for deceased donor liver transplantation should be eligible for living donor liver transplantation. We compare living organ donation in kidney and liver transplantation and explore key ethical concepts of justice, fairness, and societal trust. Ultimately, because there is no alternative life-preserving therapy in end-stage liver disease, and because transplantation with a living donor organ does not involve removing a resource from the common pool of transplant organs, we argue that a standard of "slightly less benefit" than that required for deceased transplantation should be used to determine the acceptability of living donor liver transplantation.

中文翻译：

---

当死者肝移植不可行时，活体肝移植是否应该成为一种选择？


当肝移植候选人因接受死亡器官而被拒绝时，有时亲人会挺身而出并提出成为活体捐赠者。这就提出了一个伦理问题：不符合死者供体肝移植资格的患者是否应该有资格接受活体供体肝移植。我们比较肾脏和肝脏移植中的活体器官捐赠，并探讨正义、公平和社会信任的关键伦理概念。最终，由于终末期肝病没有替代的挽救生命的疗法，并且由于活体供体器官移植不涉及从共同的移植器官库中移除资源，因此我们认为“获益略少”的标准“应使用比死者移植所需的量来确定活体肝移植的可接受性。