Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. May 21, 2026; 32(19): 116837
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.116837
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.116837
Rescue liver transplantation for liver failure with extrahepatic metastases: An ethical and clinical framework informed by two cases
Seoung Hoon Kim, Byoung Ho An, Jin A Lee, Go Woon Jeong, Organ Transplantation Center, National Cancer Center, Goyang 10408, Gyeonggi-do, South Korea
Author contributions: Kim SH conceived and designed the research study, wrote the paper; Kim SH, An BH, Lee JA and Jeong GW collected and analyzed the data, performed the research; all authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of National Cancer Center, Korea (No. NCC2025-0266).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board of the National Cancer Center, Korea, due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data that support the findings of this study are not publicly available due to institutional and ethical restrictions but are available from the corresponding author on reasonable request and with permission from the institution.
Corresponding author: Seoung Hoon Kim, MD, PhD, Senior Researcher, Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Gyeonggi-do, South Korea. kshlj@hanmail.net
Received: November 24, 2025
Revised: January 23, 2026
Accepted: February 27, 2026
Published online: May 21, 2026
Processing time: 178 Days and 6.1 Hours
Revised: January 23, 2026
Accepted: February 27, 2026
Published online: May 21, 2026
Processing time: 178 Days and 6.1 Hours
Core Tip
Core Tip: Rescue liver transplantation (LT) is generally considered futile in patients with extrahepatic metastases, yet in rare situations acute liver failure not tumor progression poses the true immediate threat to life. This study describes two such exceptional cases and proposes a structured ethical-clinical decision framework integrating futility assessment, donor safety, allocation fairness, and values-aligned consent. Our model outlines when rescue LT may be ethically and clinically de