Comment on “Pure laparoscopic living donor liver transplantation: Dreams come true”,American Journal of Transplantation

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Comment on “Pure laparoscopic living donor liver transplantation: Dreams come true”
American Journal of Transplantation ( IF 8.8 ) Pub Date : 2021-10-03 , DOI: 10.1111/ajt.16863
Mesut Tez ₁

Affiliation

I have read the manuscript entitled “Pure laparoscopic living donor liver transplantation: Dreams come true”,¹ and I congratulate the authors. However, I think that some points must be clarified.

The Oxford dictionary defines “dream”, as “… a wish to have or be something, especially one that seems difficult to achieve.” Is “Pure laparoscopic living donor liver transplantation” a dream? In my opinion, no. The authors stated that “total operative time was 960 min—3/4 day—and this procedure must be performed by a highly experienced surgeon and transplantation team—new learning curve—."¹

I believe the dream of a transplant surgeon or patient would be the following: liver transplantation without rejection, liver transplantation without graft failure, and liver transplantation without immunosuppressants (may be artificial or bioartificial liver).

Thomas Kuhn viewed science historical perspective and observed that it evolves in a circular way similar to a certain extent to the evolution of the seasons of the year, the cycle is known as the Kuhn Cycle. The Kuhn Cycle was described in 1962, according to which scientific evolution has five steps:

Normal Science: Scientific research is not hindered by the model's limits.
Model Drift: At this stage, problems and anomalies start to accumulate (eg, graft rejection); they arise, and the paradigm finds it difficult to address them.
Model Crisis: The paradigm reaches a critical moment and becomes unable to address the new challenges at all. Since the main problem cannot be answered, secondary topics such as the technical details of surgical procedures begin to be discussed more (eg, laparoscopic living donor liver transplantation).
Model Revolution: At this moment, some experts start to promote the idea of the need for a new paradigm to replace the broken one.
Paradigm Shift: These serious attempts will be crowned with a successful paradigm shift, the old is abandoned, and the new one replaces it.²

In conclusion, although I congratulate the researchers for this complex surgery, laparoscopic liver transplantation could not be described as “a dream” nor “a paradigm shift.”

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