Birmingham liver unit: use of marginal donors for liver transplantation

There has been an increase in demand for liver transplantation throughout the world. When coupled with static donor rates, this has forced units into adopting strategies to maximise their donor utilisation to minimise waiting list mortality. There have been different approaches to this problem and some centres have adopted living-related liver transplantation as their principal source of organs. In Birmingham the donor pool has been expanded through the liberal use of marginal donors and the splitting of suitable livers to produce 2 grafts, By using marginal grafts, the chance of poor initial liver function is increased and the patient needs to be fit enough to tolerate this insult. For this reason, the use of split livers and marginal donors heightens the importance of recipient selection. Minimising cold ischaemia time is also more critical when dealing with marginal livers. When deciding whether a graft is suitable for splitting, anatomical factors as well as donor characteristics should be taken into account and it is wise to avoid marginal livers for the procedure. When appropriately allocated, marginal livers have been shown to be safe, although their use of will result in increased complications. This increase is probably justifiable given the large number of patients who may benefit from the use of these grafts. There is no ideal marker or scoring system to measure potential donor livers. In the future there may be better markers for predicting out- comes following liver transplantation. For now, the use of marginal donor livers is an important tool in maximising the benefit to patients needing liver transplantation.