Transplant Without Borders: Clinical Outcomes and Challenges in Transborder Living Donor Pediatric Liver Transplantation in Jordan
Bibliographic record
Abstract
Purpose: To describe the clinical outcomes, complications, and logistical challenges of pediatric living donor liver transplantation (LT) in Jordanian children referred abroad, in the absence of a national transplant program. Patients and Methods: This retrospective study reviewed all pediatric cases referred to the Jordanian Center for Organ Transplantation (JCOT) for LT between 2019 and 2023. Data were collected from JCOT records and follow-up interviews with caregivers. Variables included patient demographics, indications for transplantation, donor-recipient relationships, post-operative complications, survival outcomes, and financial aspects. Results: A total of 31 children were referred for LT, of whom 20 (64.5%) successfully underwent living donor liver transplantation abroad—primarily in Turkey—while 11 (35.5%) remained on the waiting list. Biliary atresia (25%) was the most common indication, followed by Alagille syndrome and progressive familial intrahepatic cholestasis (each 20%). Primary hyperoxaluria, Crigler-Najjar syndrome, and maple syrup urine disease were also observed. Parents were the most frequent donors (70%). The most common complications were bile duct leakage (35%), portal vein thrombosis (20%), and infections (15%). The 5-year post-transplant survival rate was 90%. Among the waiting list group, four children (36.4%) died before receiving a transplant. No children underwent transplantation for pediatric acute liver failure during the study period. The average cost per transplant covered by the Ministry of Health was $61,071, excluding out-of-pocket expenses borne by families. Conclusion: This study highlights the feasibility and challenges of transborder pediatric liver transplantation in Jordan. While clinical outcomes for transplanted children were favorable, significant barriers remain, including delayed referrals, financial strain, and mortality among waitlisted patients. These findings underscore the urgent need to establish a national pediatric liver transplant program to improve timely access and long-term care for children with end-stage liver disease in Jordan. Plain Language Summary: In Jordan, children who need liver transplants do not have access to a transplant center within the country. Instead, they must travel abroad—usually to Turkey—for this life-saving surgery. This study looked at how this process works, what challenges families face, and how children do after their transplants. The researchers reviewed the records of all Jordanian children referred for liver transplantation between 2019 and 2023. They found that 20 children successfully received a transplant abroad, while 11 others were still waiting. The most common reason for needing a liver transplant was a condition called biliary atresia, which blocks bile flow from the liver and can cause liver failure in infants. All transplants were done using living donors, usually a parent. Although most children who received a transplant survived and did well, many faced serious complications after surgery, such as bile leakage or infections. Sadly, four children on the waiting list died before they could get a transplant. Families also faced financial and emotional stress due to the travel, paperwork, and long hospital stays. This study is the first to describe how pediatric liver transplantation works in Jordan under the current system. It shows that while the overseas model can save lives, it also has major challenges. The researchers highlight the urgent need for a national transplant center in Jordan, along with better coordination, earlier referrals, and long-term follow-up care for these children. Keywords: pediatric hepatology, cross-border healthcare, living donor surgery, organ transplant outcomes, health system barriers, Jordan
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".