Liver transplantation with grafts from donors who die from suicide by hanging: a matched cohort study

Hanging is a common method of suicide globally, and the incidence is increasing at an alarming rate. The purpose of this study was to analyze our experience with the use of liver grafts from donors whose cause of death is suicidal hanging and to evaluate the outcome of the graft recipients.

Twenty-four consecutive patients were transplanted with grafts obtained from suicidal hanging donors. These patients (group A) were case-matched to 24 patients who underwent liver transplantation with a liver graft from a brain-dead donor whose cause of death was not hanging or strangulation (group B). The analysis was focused on postoperative complications, graft, and recipient outcomes.

Donors in group A showed a significantly higher mean [±2 standard deviation] serum aspartate aminotransferase and alanine aminotransferase compared to group B (aspartate aminotransferase, 168[166] vs. 57[67] IU/L; P=0.006; alanine aminotransferase, 151[197] vs. 58[103] IU/L; P=0.049); however, there was no difference in graft failure rates between the two groups [8.3% (n=2) in each group]. Overall 30-day postoperative morbidity, 1-year and 5-year survivals were comparable in both groups (P=0.96, P=0.35, P=0.69, respectively).

The use of grafts from suicidal hanging donors (without hemodynamic instability and with downward trend in the donor transaminases) is not associated with higher post-liver transplantation complication rates and does not negatively influence recipient's outcome.