Marginal donors in liver transplantation

The use of marginal donors has become very common in many liver transplantation units due to the increase in the number of possible recipients. Experience has shown that previous donor protocols were too restrictive. Meanwhile, formerly unknown factors influence current donor evaluation. Different donor factors affecting the outcome of transplantation have been studied. Current absolute contraindications are severe macrosteatosis, long ischemia, sepsis, some viral infections and extra-CNS malignancy. Old age, mild to moderate steatosis, long ICU stay, altered liver function tests, hypernatremia, hypotension and pressors, moderately prolonged ischemia and sex mismatch are usually considered relative contraindications. The result of this wider acceptance policy has been an increasing number of usable livers without deleterious influences on graft and patients survival.