Noneligible Donors as a Strategy to Decrease the Organ Shortage

Area of Science:

• Transplantation Medicine
• Organ Donation Policy
• Public Health

Background:

• Current organ procurement organization (OPO) performance metrics primarily focus on eligible deaths (donation after brain death donors <70 years).
• Noneligible deaths, encompassing donation after cardiac death donors and donation after brain death donors >70 years, are not consistently tracked.
• This oversight represents a potential underutilization of valuable organ resources.

Purpose of the Study:

• To investigate the variability in the utilization of noneligible liver donors across 58 donor service areas (DSAs).
• To compare liver transplants (LTs) from noneligible versus eligible donors.
• To identify potential strategies for increasing the use of noneligible liver donors.

Main Methods:

• Utilized data from the United Network for Organ Sharing Standard Transplant Analysis and Research file for LTs performed between 2011 and 2015.
• Analyzed the proportion of noneligible liver donors used within each DSA and by individual transplant programs.
• Employed linear regression to assess the correlation between DSA-specific match Model for End-Stage Liver Disease scores and noneligible donor utilization.

Main Results:

• Significant variability was observed in the proportion of noneligible liver donors used across DSAs, ranging from 0% to 19.6%.
• Transplant programs reported using noneligible liver donors at rates from 0% to 35.3%.
• No correlation was found between DSA-specific match Model for End-Stage Liver Disease scores and the proportion of noneligible donors utilized (p = 0.14).

Conclusions:

• Noneligible donors represent an underutilized resource in many OPOs.
• Implementing policy changes to track noneligible donors is crucial.
• Learning from OPOs with high noneligible donor usage can inform strategies to enhance awareness and pursuit of these organs, ultimately increasing liver graft availability.