Offer Acceptance Patterns for Liver Donors Aged 70 and Older

Area of Science:

• Transplantation Science
• Organ Donor Management
• Health Services Research

Background:

• Older donor (age ≥70) liver grafts offer survival benefits but face declining utilization.
• Significant center-level variation exists in accepting these valuable grafts.

Purpose of the Study:

• To analyze variations in older donor liver graft offer acceptance across transplant centers.
• To investigate the association between center acceptance rates and patient outcomes.

Main Methods:

• Utilized Scientific Registry of Transplant Recipients (SRTR) data (2009-2017) for 1113 transplanted older donor grafts.
• Employed multilevel logistic regression, Poisson regression, competing risks regression, and Cox regression to analyze outcomes.

Main Results:

• Older donor graft acceptance varied widely across 117 centers (0-95 acceptances), with a median odds ratio of 2.88.
• Centers with higher acceptance rates had greater transplant volume and accepted more nationally shared organs.
• Higher transplant volume centers were more likely to accept older donor grafts; nationally shared offers and higher MELD scores at transplant were less likely to be accepted.

Conclusions:

• Center acceptance of older donor liver grafts significantly impacts transplant rates and waitlist mortality.
• Optimizing organ offer allocation to centers with higher acceptance rates is crucial for improving graft utilization and patient survival.