{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:24:10Z","timestamp":1790706250090,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre\u2010transplant evaluation, transplant surgery and post\u2010transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low\u2010 and middle\u2010income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non\u2010alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post\u2010transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people.<\/jats:p>","DOI":"10.1002\/puh2.162","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T07:15:47Z","timestamp":1708499747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Challenges of liver transplantation programs in low\u2010 and middle\u2010income countries: An experience from Sri Lanka"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4716-290X","authenticated-orcid":false,"given":"M. J. S.","family":"Jayarathna","sequence":"first","affiliation":[{"name":"Department of Anatomy Faculty of Medicine University of Peradeniya  Kandy Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1402-3364","authenticated-orcid":false,"given":"B. K.","family":"Dassanayake","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medicine University of Peradeniya  Kandy Sri Lanka"},{"name":"Teaching Hospital Peradeniya  Kandy Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-8704","authenticated-orcid":false,"given":"Thinley","family":"Dorji","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Central Regional Referral Hospital  Gelephu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2179-6365","authenticated-orcid":false,"suffix":"III","given":"Don Eliseo","family":"Lucero\u2010Prisno","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6388-8537","authenticated-orcid":false,"given":"S.","family":"Samarasinghe","sequence":"additional","affiliation":[{"name":"Teaching Hospital Peradeniya  Kandy Sri Lanka"},{"name":"Department of Anaesthesiology and Critical Care Faculty of Medicine University of Peradeniya  Kandy Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6938-248X","authenticated-orcid":false,"given":"Vasanthi","family":"Pinto","sequence":"additional","affiliation":[{"name":"Teaching Hospital Peradeniya  Kandy Sri Lanka"},{"name":"Department of Anaesthesiology and Critical Care Faculty of Medicine University of Peradeniya  Kandy Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. D.","family":"Lamawansa","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medicine University of Peradeniya  Kandy Sri Lanka"},{"name":"Teaching Hospital Peradeniya  Kandy Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"e_1_2_17_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.1061"},{"key":"e_1_2_17_3_1","unstructured":"World Health Organization (WHO).Leading causes of death and disability[Internet].WHO.2020.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/the\u2010top\u201010\u2010causes\u2010of\u2010death#:\u223c:text=In high\u2010incomecountries%2C deaths or 205 000 deaths respectively"},{"key":"e_1_2_17_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.09.014"},{"key":"e_1_2_17_5_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010018\u20101217"},{"key":"e_1_2_17_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1526924816677996"},{"key":"e_1_2_17_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1756\u20100500\u20104\u2010513"},{"key":"e_1_2_17_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101746.2009.05831.x"},{"key":"e_1_2_17_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.05.071"},{"key":"e_1_2_17_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575\u2010023\u201000760\u20109"},{"key":"e_1_2_17_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10173867"},{"key":"e_1_2_17_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2013.88"},{"key":"e_1_2_17_13_1","unstructured":"Transplant\u2010Observatory.org.Global observatory on donation and transplantation. [Internet].Transplant\u2010Observatory.org;2023. [cited 8 Aug 2023]https:\/\/www.transplant\u2010observatory.org\/summary\/"},{"key":"e_1_2_17_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20294"},{"key":"e_1_2_17_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664\u2010011\u20100159\u20108"},{"key":"e_1_2_17_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.05.062"},{"key":"e_1_2_17_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010015\u20101296\u20109"},{"key":"e_1_2_17_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.03.039"},{"key":"e_1_2_17_19_1","doi-asserted-by":"publisher","DOI":"10.14744\/hf.2022.2022.0014"},{"key":"e_1_2_17_20_1","doi-asserted-by":"publisher","DOI":"10.20529\/IJME.2014.037"},{"key":"e_1_2_17_21_1","doi-asserted-by":"publisher","DOI":"10.4038\/sljs.v39i3.8894"},{"key":"e_1_2_17_22_1","doi-asserted-by":"publisher","DOI":"10.4038\/cmj.v56i2.2381"},{"key":"e_1_2_17_23_1","doi-asserted-by":"publisher","DOI":"10.4038\/sljs.v39i3.8901"},{"key":"e_1_2_17_24_1","unstructured":"Ministry of Health Government of Sri Lanka.Annual health bulletin 2019 [Internet].Ministry of Health Government of Sri Lanka;2019.http:\/\/www.health.gov.lk\/moh_final\/english\/public\/elfinder\/files\/publications\/AHB\/2020\/AHB2019.pdf"},{"key":"e_1_2_17_25_1","unstructured":"Ministry of Justice. Transplantation Of Human Tissues Act No. 48 of 1987.Government of Sri Lanka."},{"key":"e_1_2_17_26_1","unstructured":"Ministry of Health.Implementation of the national organ donor programme for deceased donor organ transplantation[Internet].Government of Sri Lanka;2010[cited 5 Dec 2023].https:\/\/nationaltransplant.health.gov.lk\/docs\/01\u201037\u20102010\u2010eng.pdf"},{"key":"e_1_2_17_27_1","unstructured":"Ministry of Health.National strategic plan on organ tissue and cell transplantation 2022\u20132026[Internet].Colombo: Government of Sri Lanka;2019.http:\/\/www.health.gov.lk\/moh_final\/english\/public\/elfinder\/files\/publications\/publishpolicy\/2022\/NationalStrategicPlanonOrganTissueandCellTransplantation2022\u20132026.pdf"},{"key":"e_1_2_17_28_1","unstructured":"Ministry of Health.National transplant programme: Streamlining deceased donor organ transplantation[Internet].Government of Sri Lanka;2015[cited 5 Dec 2023].https:\/\/nationaltransplant.health.gov.lk\/docs\/01\u201009\u20102015\u2010eng.pdf"},{"key":"e_1_2_17_29_1","first-page":"40","article-title":"A cross\u2010sectional study of knowledge and attitudes of medical professionals towards end\u2010of\u2010life decisions in teaching hospitals of Kandy district (Sri Lanka)","volume":"17","author":"Pinto MVG","year":"2013","journal-title":"Anaesthesia, Pain and Intensive Care"},{"key":"e_1_2_17_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12910\u2010021\u201000631\u20105"},{"key":"e_1_2_17_31_1","volume-title":"Practice guidelines in end\u2010of\u2010life care","author":"Sri Lanka Medical Association","year":"2021"}],"container-title":["Public Health Challenges"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/puh2.162","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T17:57:15Z","timestamp":1749232635000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/puh2.162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/puh2.162"],"URL":"https:\/\/doi.org\/10.1002\/puh2.162","archive":["Portico"],"relation":{},"ISSN":["2769-2450","2769-2450"],"issn-type":[{"value":"2769-2450","type":"print"},{"value":"2769-2450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"assertion":[{"value":"2023-08-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e162"}}