After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.

中文翻译：

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活体肝移植的财务毒性：呼吁采取行动实现财务中立


经过 20 年的有限增长后，活体肝移植 (LDLT) 已越来越多地被认为是解决美国日益严重的器官短缺问题的有希望的解决方案。根据经验，LDLT 可提供卓越的移植物和患者存活率以及较低的排斥率。然而，并非所有候补患者都能平等地获得 LDLT，经济负担是一个巨大的障碍。潜在的活体肝脏捐献者面临着与捐献相关的间接、直接和机会成本，以及基于保险的歧视和可变的雇主休假政策。有多种潜在的国家、地方和以患者为中心的解决方案来解决与活体 LDLT 相关的一些成本相关问题。其中包括标准化雇主休假政策、制定联邦和州主导的税收减免计划、优化国家活体捐赠者援助中心的使用、独立活体捐赠者倡导者的参与、创建金融工具包以及鼓励受助者或捐赠者主导的筹款。在这篇文章中，北美活体肝脏捐赠集团（一个由 37 个 LDLT 项目组成的联盟）的成员探讨了这些财务挑战，并讨论了实现财务中立的解决方案，使个人可以在不受财务限制或收益的情况下进行捐赠。作为一个社区，我们必须面对导致经济毒性的因素，以改善公平性和获得 LDLT 的机会。