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

Changes in donor liver allotment will not generate more organs. At this time, diverse training and experience are all that guide donor organ selection. Donor variables are now recognized to influence patient and graft survival at 1 year and beyond. Little is known about the molecular biology of hepatic ischemia/reperfusion that might enable informed donor preparation and selection. This study of South-Eastern Organ Procurement Foundation liver transplant centers identifies differences among liver transplant surgeons in donor assessment as issues for further consideration. Sixteen of 25 centers responded. A 170 mEq/L donor serum sodium was the upper limit for acceptance. Selection based on donor vasopressor use lacked uniformity. Preimplantation donor liver biopsy was used selectively, and the maximum acceptable fat content was 30 per cent for most centers. Donor hospitalization for more than 7 days was considered a negative factor by all groups. Surprisingly, five centers were not using donor livers testing positive for hepatitis C. This study points to the great variability in the assessment of organ donors. Greater consensus in this area could lead to increased organ use and/or less retransplantation, a net gain in organ economy.