Most liver transplant candidates receive donation offers

Most liver transplant candidates who died or were removed from the transplant list actually received one or more liver donation offers, according to a recent UCSF study.

"What we found challenges the simplistic view that dynamics are driven simply by ," said lead author, Jennifer Lai, MD, assistant clinical professor in the UCSF Division of Gastroenterology and Hepatology. "Efforts to reduce wait-list mortality must target all aspects of mismatch between supply and demand."

The research team analyzed data from 33,389 candidates listed in the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) registry during the time frame of Feb. 1, 2005 to Jan. 31, 2010. Out of the candidates who had died or been delisted, 84 percent received one or more offers prior to death/delisting, indicating that they had an opportunity to undergo transplantation. Reasons for liver offer refusals were reported as donor quality/age or other donor-related factors, size compatibility or recipient readiness.

"Understanding the real-time factors involved in the decisions regarding liver transplant offers is vital to improving the wait-list process," said senior author, John Roberts, MD, professor of surgery and chief of the UCSF Division of Transplantation. "While some of the factors are beyond control, others can be managed."

Simply increasing the availability of deceased or the number of offers may not necessarily reduce wait-list mortality, according to the study. Instead, the study suggests that efforts must be made to understand multiple factors involving candidates, donors and transplant centers to help influence what is often a complex and dynamic decision to accept or decline a liver offer.

More specifically, the study recommends that wait-list candidates efficiently complete their pre-transplant evaluations so they are ready for liver offers as soon as possible. Patients with a Model of End-stage Liver Disease (MELD) score of 15 or higher also should be thoroughly educated about the survival benefit of transplantation with any liver graft, as opposed to continued waiting. The MELD is a scoring system for assessing the severity of chronic and is used by UNOS for prioritizing allocation of liver transplants.

The team also suggests improving efforts within the transplant community to reduce the stigma associated with non-ideal livers and setting realistic expectations for wait-listed candidates regarding the available donor organs.

"The decision to accept a liver offer is not just about minimizing complications after transplant, but about reducing the unpredictability of death before transplant," Lai said.

More information: The paper was published in the leading journal in its field, Gastroenterology.

add to favorites email to friend print save as pdf

Related Stories

Changes to distribution of livers for transplant proposed

Sep 09, 2011

Transplantation specialists have proposed changes to the allocation and distribution of organs used for liver transplants. The recommended policy modifications take into account the scarcity of available organs, ensuring ...

Recommended for you

ALS Ice Bucket Challenge arrives in North Korea

Aug 31, 2014

It's pretty hard to find a novel way to do the ALS Ice Bucket Challenge by now, but two-time Grammy-winning rapper Pras Michel, a founding member of the Fugees, has done it—getting his dousing in the center ...

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

Medtronic spends $350M on another European deal

Aug 27, 2014

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

User comments