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Pediatric-Deceased Donor Livers in Mexico: How Current Policy Disadvantages Children
Pilar Leal-Leyte1,2, Mara Medeiros3, Ignacio García-Juárez4
1Department of Organ Transplantation, Navy Medical Center, Mexico City, Mexico.
Insights
In Mexico, 60% of pediatric donor livers go to adults, not children on the waitlist. Older donor age is linked to this trend, highlighting a need for better organ allocation strategies for pediatric liver transplant candidates.
Area of Science:
- Transplant Surgery
- Pediatric Hepatology
- Organ Allocation Policy
Background:
- Minimizing mortality for pediatric liver transplant waitlist patients is crucial.
- Data on pediatric deceased donor liver utilization is scarce.
- Understanding organ allocation patterns is vital for improving outcomes.
Purpose of the Study:
- To describe the allocation of pediatric deceased donor livers in Mexico.
- To analyze factors influencing the use of pediatric donor livers in adult versus pediatric recipients.
Main Methods:
- Descriptive study using the National Center of Transplants database (2014-2024).
- Identified pediatric deceased donors (<18 years), waitlist candidates, and recipients (adult/pediatric).
- Reviewed utilization of pediatric deceased donor liver grafts.
Main Results:
- 278 pediatric donor liver grafts were analyzed.
- 61.5% of pediatric livers were allocated to adult recipients; 38.5% to pediatric recipients.
- 148 pediatric patients died on the waitlist; older donor age predicted allocation to adults.
Conclusions:
- 60% of pediatric deceased donor livers are allocated to adults in Mexico, despite high pediatric waitlist mortality.
- Older donor age is a predictor for allocating pediatric organs to adult recipients.
- National database improvements are needed for accurate analysis of allocation drivers.
Background And Aim:
Strategies to minimize mortality among pediatric patients registered on the liver transplant waitlist are important. There is limited published data on the use of deceased pediatric donor livers. This study aimed to describe the allocation of pediatric-deceased donor livers in Mexico.
Methods:
This descriptive communication used the National Center of Transplants database from 2014 to 2024 to identify pediatric-deceased donors (< 18 years), liver transplant waitlist candidates, and liver transplant recipients (adult and pediatric). Here, we reviewed the use of pediatric-deceased donor livers in pediatric and adult recipients.
Results:
Between 2014 and 2024, we identified 1715 donor-recipient couples. A total of 278 pediatric-deceased donor liver grafts; from the total number of pediatric livers, 107 were allocated to pediatric recipients (38.5%) and 171 to adult recipients (61.5%). During the same study period, 148 pediatric patients died on the waiting list. At least 50% of pediatric livers were allocated to adult recipients annually; multivariate analysis variables associated with this phenomenon were donor age and allocation to private transplant centers.
Conclusions:
Sixty percent of pediatric deceased donor livers are allocated to adult recipients in Mexico, despite the high waitlist mortality rate among pediatric candidates. A higher donor age predicted the allocation of pediatric organs to adult recipients. National Database improvements are required to accurately analyze the factors driving this allocation.
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