Rescue liver transplantation for liver failure with extrahepatic metastases: An ethical and clinical framework informed by two cases

BACKGROUND Liver transplantation (LT) is traditionally contraindicated in patients with active extrahepatic metastases due to concerns regarding futility, donor risk, organ allocation fairness, and limited post-transplant survival. However, in rare and extreme situations, acute hepatic failure becomes immediately life-threatening and no alternative life-saving therapy exists. AIM To report two rescue LT cases undertaken for end-stage hepatic failure despite persistent extrahepatic metastases, an