Commercial Aviation as an Alternative to Charter Flights in Liver Transplantation: A Case Report

The transition to the acuity circle liver allocation system has increased transportation distance, cold ischemia time, and procurement costs. The increase in procurement cost is largely due to a higher reliance on charter flights. Although charter flights are flexible, they are expensive and have a considerable environmental impact. At the same time, advances in controlled hypothermic preservation have extended safe preservation times and may allow broader use of ground and commercial air travel as cost-conscious alternatives to charter flights. We report a case of a donor liver preserved with contemporary hypothermic technology was transported using a commercial airline flight. A 52-year-old donor underwent donation after circulatory death with normothermic regional perfusion. The liver was preserved using the LIVERguard system and transported 356 nautical miles on a commercial flight. Total transportation costs were 14,152 dollars, compared to an estimated 19,000 dollars for a comparable charter flight with ground transfer. LIVERguard preservation time was 9 hours 30 minutes, followed by 4 hours 42 minutes of hypothermic machine perfusion, for a total cold ischemia time of 16 hours 48 minutes. The recipient was a 61-year-old female with metabolic dysfunction associated steatohepatitis and a MELD score of 21. The postoperative course was complicated only by a GI bleed. She had excellent early allograft function and was discharged home on postoperative day 15. This case suggests that commercial flights, paired with advanced hypothermic preservation, can provide a viable, cost effective, and environmentally favorable alternative to charter flights while maintaining organ quality under current allocation practices.