A new study predicts an expected decline in liver transplants due to the non-use of lower quality donor livers.
The study published in the January 2013 issue of the journal Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), found that the non-use of donor livers climbed through 2010 due to a worsening of donor liver quality, primarily from donation following cardiac death. Diabetes, donor age, and body mass index (BMI) were also linked to a decrease in use of organs.
“For patients with end-stage liver disease, transplantation is the only option for extending life, but organ availability places constraints on the transplant community.”
“For patients with end-stage liver disease, transplantation is the only option for extending life, but organ availability places constraints on the transplant community,” explains study first author Eric S. Orman, MD, currently a fellow in the division of gastroenterology & hepatology at the University of North Carolina School of Medicine. “One of the methods to increase the donor pool is to include donors with less than ideal health status—those with fatty livers, older donors, and donation after cardiac death.”
Funded in part by the National Institutes of Health (NIH) and Health Resources and Services Administration, the study notes that in an attempt to increase available livers for transplant, the transplant community has gradually extended donation criteria. However, previous research shows that poor outcomes may occur following transplant of more inferior organs. Other studies have shown an increased recipient disease and death risk with donation after cardiac death (when circulation ceases) than with standard donation following brain death in which donor circulation is sustained.
For the present study researchers used data from the Organ Procurement and Transplantation Network (OPTN) to indentify 107,259 deceased donors in U.S. between 1988 and 2010. Donors were 18 years of age and older who had a least one organ (liver, heart, intestine, kidney, lung or pancreas) used for transplantation. Average donor age was 44 years.
Analysis indicates that 41,503 donations occurred after June 30, 2004 with 82 percent of livers used for transplant and 18 percent unused. The number of unused livers decreased from 1,958 (66 percent of donors) in 1988 to 841 (15 percent) in 2004, and then increased to 1,345 (21 percent) in 2010. Liver non-use was independently linked to older donor age, greater BMI, diabetes prevalence and donation after cardiac death—all of which are on the rise in the U.S.
Researchers reported a four-fold increase in the odds of non-use of livers from donation following cardiac death donors between 2004 and 2010, with the proportion of nonuse climbing from 9 percent to 28 percent during the same time period. “Our findings show nonuse of livers for transplantation is steadily rising, and is primarily due to donation after cardiac death,” Orman concludes. “If these trends continue, a significant decline in liver transplant availability would be inevitable.”