Related Experiment Video
Updated: Jan 14, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Utilization of liver grafts obtained from donation after medical assistance in dying: A Canadian multicenter
Alessandro Parente1, Kevin Verhoeff2, Samrat Ray3
1Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, T6G 2J3, Canada; Institute of Liver Studies, King's College Hospital, Denmark Hill, SE59RS, London, United Kingdom; Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, The Roger Williams Institute of Liver Studies, King's College London, SE59NT, London, United Kingdom.
Background & Aims:
Given country-specific variance in legislation, limited information is available regarding outcomes of liver transplantation (LT) using medical assistance in dying (MAiD) donation after circulatory death (DCD type-V) grafts. We compared outcomes following LT using DCD type-V vs. conventional DCD type-III grafts.
Methods:
We reviewed all LTs using DCD-V and DCD-III donors performed across Canadian provinces between 2016 (MAiD legalization) and 2023. Primary outcomes were patient and graft survival at 1, 3, and 5 years. Secondary outcomes included early allograft dysfunction, length of stay, postoperative complications, and biliary complications.
Results:
Among 313 recipients, 56 (17.9%) received DCD-V and 257 (82.1%) DCD-III grafts. DCD-V donors were older (56 vs. 38 years, p <0.0001), and had similar warm ischemic time (20 vs. 23 min, p = 0.190). Patient survival for DCD-V was 89.3%, 85.7%, and 85.7% at 1, 3, and 5 years, with graft survival of 82.1%, 78.6%, and 78.6%, comparable to DCD-III. DCD-V was not associated with graft loss (odds ratio 1.64; 95% CI 0.66-4.08), which was confirmed by multivariable Cox regression analysis (hazard ratio 1.53; 95% CI 0.74-3.15). Early allograft dysfunction occurred more frequently with DCD-III (57.5% vs. 42.9%, p = 0.047), whereas length of stay was longer with DCD-V (21.5 vs. 15 days, p = 0.011). Overall complication rates were similar; biliary complications were more common in DCD-V, but this was not statistically significant (32.1% vs. 23.1%, p = 0.153).
Conclusions:
Liver grafts from MAiD donors provide outcomes comparable to DCD-III and increased Canadian DCD activity by 21.8%. These findings support MAiD as a valuable additional source of liver grafts, though larger studies are needed to validate long-term safety and efficacy.
Impact And Implications:
Liver transplantation using grafts from donors following medical assistance in dying (MAiD) achieves satisfactory patient and graft survival, with complication rates comparable to those following conventional donation after circularly death. MAiD donation increased donation after circularly death liver transplant activity in Canada by 21.8% over 7 years. These findings support MAiD as a valuable additional source of grafts, while also honoring the wishes of patients who choose to donate their organs.
