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Liver Paired Exchange: Ready for Prime Time in North America?

The evolution of Kidney Paired Exchange (KPE) in the United States has expanded transplant options for ABO incompatible (ABOi) and human leukocyte antigen (HLAi) incompatible living donor pairs.(1) The success of KPE has prompted consideration of liver paired exchange (LPE). Although the idea seems promising its application has been limited to a handful of centers in Asia. (2-4) The indications, logistical issues, and ethics for establishing a LPE program in the United States was recently explored by Mishra et al (5.).