Liver transplantation: is it a sustainable practice?

Despite its widespread diffusion, liver transplantation (LT) still remains one of the most resource consuming surgical procedures. In times of economic constraints, the entire medical community is discussing the strategies necessary to allow a sustainable development of LT. Sustainability is the capacity to endure and, in ecology, the word describes how biological systems remain diverse and productive over time. In clinical practice, sustainability is the potential for long-term maintenance of human well-being, which has environmental, economic and social dimensions. Making LT a sustainable clinical practice entails a multidimensional, multilevel approach balancing patients' needs with those of the entire society. Consumption of resources is pivotal to a sustainable LT practice, and the strategies to adopt should focus on increasing deceased donor availability as well as on reducing current long-term graft attrition rates. It is our duty to rethink the way we are currently performing LT and our major commitment is to transfer our capacities to future generations, without wasting resources and to invest in research. This calls for urgent action to be taken at the care-provider-to-patient, social and political levels, and for networking of all professionals involved in care of liver disease patients.