Donor liver selection. The South-Eastern Organ Procurement Foundation Liver Committee

Area of Science:

• Transplantation Medicine
• Organ Procurement
• Hepatology

Background:

• Donor variables significantly influence patient and graft survival post-liver transplant.
• Current donor organ selection relies heavily on surgeon experience rather than standardized protocols.
• Limited understanding of hepatic ischemia/reperfusion molecular biology hinders informed donor preparation.

Purpose of the Study:

• To identify variations in donor liver assessment practices among South-Eastern Organ Procurement Foundation liver transplant centers.
• To highlight discrepancies in surgeon decision-making regarding donor organ acceptance.
• To explore potential areas for improving donor organ utilization through consensus.

Main Methods:

• Survey of liver transplant centers within the South-Eastern Organ Procurement Foundation.
• Data collection on donor acceptance criteria, including serum sodium, vasopressor use, biopsy, fat content, hospitalization, and hepatitis C status.
• Analysis of responses from 16 out of 25 participating centers.

Main Results:

• Upper limit for donor serum sodium acceptance was 170 mEq/L.
• Inconsistent criteria were observed for donor vasopressor use.
• Preimplantation donor liver biopsy was used selectively; maximum acceptable fat content was generally 30%.
• Donor hospitalization exceeding 7 days was universally considered a negative factor.
• Five centers reported not using donor livers positive for hepatitis C.

Conclusions:

• Significant variability exists in the assessment and selection of liver organ donors.
• Lack of consensus in donor assessment practices may limit organ utilization.
• Establishing greater consensus could enhance organ use and decrease retransplantation, improving overall organ economy.