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Liver transplantation: Donor selection

Author
Scott J Cotler, MD
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

The shortage of available donor organs is the major limiting factor in liver transplantation. Optimal deceased donors are generally young, previously healthy persons who develop a fatal brain injury due to causes such as head trauma, intracerebral hemorrhage, or anoxia. The relative paucity of donor organs has led transplant centers to consider organs from marginal donors.

This topic will review the selection process for deceased donors and examine donor characteristics associated with recipient outcomes. Patient selection for liver transplantation, living donor liver transplantation, and ethical issues in liver transplantation are discussed elsewhere. (See "Liver transplantation in adults: Patient selection and pretransplantation evaluation" and "Living donor liver transplantation" and "Ethical issues in liver transplantation".)

DONOR EVALUATION

Donation after neurologic death — The United Network for Organ Sharing (UNOS) provides minimum guidelines for organ procurement. The initial evaluation is typically performed by the local organ procurement organization (OPO). The OPO representative verifies that the prospective donor meets the criteria for brain death. Consent for donation is obtained from the potential donor's next of kin. ABO blood type, height, weight, and chest circumference are obtained because recipient matching is based upon blood type and donor organ size.

Potential donors with contraindications to donation are excluded. These include non-hepatic malignancy (other than primary brain tumor without ventriculoperitoneal shunt). Previously, anti-human immunodeficiency virus (HIV) seropositivity was an absolute contraindication to donation in the United States. The ban was in part due to concern that transplanting HIV-positive organs into patients with HIV that was well controlled could result in the transfer of resistant HIV to the recipient. However, in 2013, a law was passed that ended a ban on transplanting organs from donors with HIV into HIV-positive recipients because of better HIV therapy as well as high waiting list mortality rates for patients with HIV [1]. Although septicemia is usually considered a contraindication to donation, organs from bacteremic donors have been used successfully. A large retrospective study, for example, showed similar 30-day graft and patient survival in recipients of organs from bacteremic and non-bacteremic donors [2].

The OPO representative obtains a medical history, evaluates for a history of substance or alcohol abuse, and performs a physical examination. Laboratory testing generally includes ABO blood type, complete blood count (CBC), chemistries, prothrombin time (PT), activated partial thromboplastin time (PTT), hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antigen (HBc), anti-hepatitis C virus (HCV), anti-HIV, venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR), and anti-cytomegalovirus (CMV). Blood and urine cultures are performed if the prospective donor was hospitalized for more than 72 hours. Many OPOs obtain nucleic acid testing (NAT) for HIV and HCV in all or selected high risk donors to shorten the window period between acquisition of infection and detection by ELISA in order to reduce the risk of transmission to the recipient [3]. Ultrasound imaging or liver biopsy is performed if needed.

                    

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Literature review current through: Nov 2016. | This topic last updated: Tue Mar 01 00:00:00 GMT+00:00 2016.
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