Liver transplantation in Italy and the scarcity of donors: Causative factors and ethical considerations

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Abstract
Summary We analyze the current state of liver transplantation (OLTx) in Italy that in the last few years had reached approximately 150 OLTx per year for a population of 58 millions of inhabitants. The need for OLTx in Italy is high and mainly due to the incidence of post-hepatitis and post-alcoholic liver cirrhosis, which are the prevalent indication for OLTx. On the contrary the availability of donor organs in Italy is very low as compared with other European countries, and as a consequence the gap between need and performed OLTx is widening. The reasons for poor donations are multifactorial among which; lack of organization, insufficient ICU care beds, poor knowledge of health personnel. General attitudes of the society and brain death concepts are also involved as a recent survey has demonstrated. Under certain circumstances the patient who cannot be transplanted on time in Italy is allowed to seek for care abroad under the local government economical assistance. Finally some ethical considerations and the proposal for better education of both population and health care providers are advocated.