Liver transplantation in Korea: A living liver donor dominant system shaped by deceased donor scarcity

Korea occupies an unusual position in the transplant world.It sustains one of the largest liver transplant programs in Asia while recovering organs from fewer than eight deceased donors per million population, and the gap is closed almost entirely by living donation, which accounted for 920 of the 1,262 liver transplants performed in 2024 (72.9%).This review draws on the 2024 national statistical yearbook of the Korean Network for Organ Sharing, supplemented by the Korean transplant literature, to describe how that system works and what it has produced.Registry counts refer to transplanted organs rather than to individual patients, and we keep that distinction in the wording throughout.Three features distinguish it.First, the deceased donor pool is small and has been contracting since 2016, so allocation decisions carry unusual weight; roughly two-thirds of deceased donor grafts in 2024 went to patients in the second-highest urgency category.Second, transplantation across the ABO barrier has become ordinary rather than exceptional: 203 living donor procedures in 2024, or 22.1% of the national living donor volume, used an ABO-incompatible graft, with unadjusted 11-year patient survival of 69.9% against 73.0% for identical grafts.Third, activity is concentrated to an unusual degree, with one hospital performing 27.3% of national living donor volume.We also examine the indication profile, in which alcohol-related and hepatitis B-related disease predominate among coded diagnoses, together with living donor demography and registry survival; an unclassified category covering half of all living donor entries means that no diagnosis can be ranked with confidence from these data.Throughout, we are explicit about what an administrative registry can and cannot support, since several of its conventions differ from those familiar to readers outside Korea and are easily misread.The Korean experience is instructive less as a model to copy than as evidence of what a determined living donor program can, and cannot, substitute for.