Is laparoscopic live donor hepatectomy justified ethically?

Live donor liver transplant (LDLT) was first reported in the 1990s and quickly raised ethical considerations, mainly related to the risk brought to the donor. The question of donor safety was even more accurate with the occurrence of laparoscopy, a technique which could allegedly increase the risk of severe intraoperative complications. Besides the questions of justice and autonomy, donor safety remains the main ethical debate of LDLT. Considering the lack of comparative assessment of postoperative outcomes, the Jury of the last Consensus meeting held in Japan in 2014 called for the creation of international registries to help to determine the benefit/risk ratio of laparoscopic donor hepatectomy. Since randomized studies are very unlikely to occur, benchmarking comparisons, between liver and kidney donors for instance, may also help to define standard practice. At last, donors' points of view should also be taken into account in the evaluation of those innovative procedures. Highlight Olivier Soubrane, a pioneer of laparoscopic live donor hepatectomy, and colleagues describe the history and the ethical questions in laparoscopic live donor hepatectomy and give insights to these ethics in comparison with open live donor hepatectomy. The authors emphasize to create an international registry to conduct a relevant and methodologically consistent comparison between these two techniques.