Combined liver with other solid organ transplants: Promises, pitfalls and ethical dilemmas, an expert opinion

In this expert opinion, we explore the growing practice of multi-organ transplantation (MOT) in which liver transplantation is combined with another solid organ transplantation, such as heart, lung or kidney transplantation. There is an increasing demand for MOT as a lifesaving treatment for patients with multi-organ failure, despite societal challenges like donor shortage and complex logistics. MOT recipients, when well-chosen, demonstrate favourable survival outcomes, although the procedures involve significant risks and require close coordination among specialised teams. Patient selection and resource allocation require careful ethical consideration to balance equity and utility. Ethical dilemmas arise regarding prioritisation, particularly when organs are allocated to one patient over several others. In this opinion paper, we emphasise the need for global standardisation of protocols and robust multidisciplinary care. Immunological advantages, advanced risk assessments, and novel technologies, such as machine perfusion, improve success rates. This opinion piece calls for harmonised policies to address disparities in organ allocation while maintaining equitable access and optimised outcomes.