The rapid expansion of machine perfusion technologies in the west and increasing utilization of donation after circulatory death (DCD) with normothermic regional perfusion (NRP) are reshaping liver transplantation worldwide. While these innovations have significantly expanded the donor pool, they have also introduced new logistical complexities and substantial acquisition costs. At the same time, living donor liver transplantation (LDLT) continues to provide excellent clinical outcomes, immediate organ availability, sustainable and efficient resource utilization, yet its economic value is often overlooked in discussions of modern transplant practice. This webinar will bring together international leaders in LDLT and MP/NRP transplantation to critically examine the financial, clinical, and societal value of these complementary strategies. Rather than positioning them as competing approaches, the discussion will focus on how each contributes to maximizing access, improving outcomes, and ensuring long-term sustainability of liver transplantation programs.
Webinar Objectives:
✅ Review the major drivers of costs associated with living donor liver transplantation and DCD transplantation utilizing machine perfusion and NRP.
✅ Compare the short- and long-term economic value of LDLT versus DCD/NRP, including recipient outcomes, waitlist impact, and healthcare utilization.
✅ Discuss how reimbursement models and healthcare policies influence adoption of both strategies across different healthcare systems.
✅ Explore how transplant centers can optimize resource allocation by integrating living donation and machine perfusion within a value-based transplant program.
Presentations & Speakers:
The Value Proposition of Living Donor Liver Transplantation
Prof. Dieter E. Broering, MD
King Faisal Specialist Hospital & Research Centre, Saudi Arabia
Prof. Dieter E. Broering is an internationally recognized expert in living donor liver transplantation. His work focuses on expanding access to transplantation, improving surgical outcomes, and advancing the clinical and programmatic value of living donation. His experience provides an important perspective on the economic, clinical, and societal benefits of LDLT within modern transplant programs.
Presentation Topics:
- Direct and indirect costs of LDLT
- Impact on waitlist mortality and time-to-transplant
- Recipient outcomes and long-term cost-effectiveness
- Can living donation become the best option?
- Programmatic investment versus societal value
- Future opportunities to improve efficiency and value in living donation
The Value Proposition of Machine Perfusion Preservation (NRP and MP types):
The Economics of Expanding the Donor Pool with Deceased Donors
Prof. Umberto Cillo, MD
Professor of Surgery, University of Padua, Italy
Prof. Umberto Cillo is Professor of Surgery at the University of Padua and Chief of the HPB and Liver Transplant Unit. His expertise includes hepatobiliary surgery, liver transplantation, organ allocation, and machine perfusion preservation, with extensive clinical and academic experience in the field.
Presentation Topics:
- Cost drivers of graft recovery, NRP, and machine perfusion
- Acquisition costs versus improved organ utilization
- Economic impact of reduced graft dysfunction and improved outcomes
- Financial sustainability of advanced preservation technologies
- Future directions in value-based DCD transplantation
Discussants and Discussion Points:
David Axelrod, MD
Professor of Surgery, University Hospitals Cleveland
Dr. David Axelrod is a transplant surgeon and health services researcher with expertise in kidney and liver transplantation, transplant economics, and healthcare management. His clinical interests include end-stage liver and kidney disease, hepatic malignancy, portal hypertension, and complex transplant surgery. He also serves in national leadership roles, including the ASTS Standards Committee and the UNOS Board.
Discussion Question: Cost to Value: Are Living Donation and Machine Perfusion Competitors or Complementary Strategies?
Simone Strasser, MD
Transplant Hepatologist, Royal Prince Alfred Hospital
Prof. Simone Strasser is Head of Department and Senior Staff Specialist at the AW Morrow Gastroenterology and Liver Centre and Medical Co-Director of the Australian National Liver Transplantation Unit. She has extensive expertise in hepatology and liver transplantation and holds leadership roles across several national and international transplant organizations, including TSANZ and ILTS.
Discussion Question: Which approach provides the greatest value under different healthcare systems?
Andrea Schlegel
Transplant Surgeon, Cleveland Clinic
Dr. Andrea Schlegel is a transplant and hepatobiliary surgeon at Cleveland Clinic with expertise in liver transplantation and organ preservation. Her research focuses on experimental and clinical transplantation, graft viability, and strategies to improve the safe utilization of donor organs.
Discussion Question: Should reimbursement evolve to reward patient outcomes rather than acquisition cost?
Moderators and Opening Remarks:
Daniel Maluf, MD
Director, Transplantation Unit, University of Maryland Medical System
Daniel Maluf is a transplant surgeon-scientist with more than two decades of experience in liver and renal transplantation. As Director of the Transplantation Unit at the University of Maryland Medical System, his work focuses on improving organ utilization, advancing living donation, and optimizing outcomes in liver transplantation. His research includes donor selection, marginal organ assessment, transplant immunology, and molecular markers associated with graft performance. He has contributed to more than 170 scientific publications and has led research supported by NIH grants and clinical trials.
Markus Selzner, MD
Surgical Director, Ajmera Liver Transplant Program, University Health Network
Markus Selzner is Surgical Director of the Ajmera Liver Transplant Program at the University of Toronto and Associate Director of the Toronto Abdominal Organ Transplant Fellowship. He completed his surgical training in Germany and Switzerland, followed by clinical and research fellowships in liver and pancreas transplantation in Zurich and Toronto. His research focuses on abdominal organ preservation and perfusion, including strategies to improve graft quality and transplantation outcomes.
Xiao Xu, MD, PhD
Professor, Zhejiang University
Xiao Xu is a physician-scientist specializing in organ transplantation and a professor at Zhejiang University in Hangzhou, China. He is a Changjiang Scholar, recipient of the National Science Fund for Distinguished Young Scholars, and Chair-Elect of the Organ Transplantation Branch of the Chinese Medical Association. He also serves as Head of the Liver Transplantation Group and Chief Scientist of the National Key Research and Development Program “Organ Repair and Stem Cell Research.”
Presented by
