Declined Organs for Liver Transplantation: A Right Decision or a Missed Opportunity for Patients with Hepatocellular Carcinoma?

Liver transplantation is the only promising treatment for end-stage liver disease and patients with hepatocellular carcinoma. However, too many organs are rejected for transplantation. We analyzed the factors involved in organ allocation in our transplant center and reviewed all livers that were dec...

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Bibliographic Details
Published in:Cancers 2023-02, Vol.15 (5), p.1365
Main Authors: Lozanovski, Vladimir J, Adigozalov, Said, Khajeh, Elias, Ghamarnejad, Omid, Aminizadeh, Ehsan, Schleicher, Christina, Hackert, Thilo, Müller-Stich, Beat Peter, Merle, Uta, Picardi, Susanne, Lund, Frederike, Chang, De-Hua, Mieth, Markus, Fonouni, Hamidreza, Golriz, Mohammad, Mehrabi, Arianeb
Format: Article
Language:English
Subjects:
Blood & organ donations
Body mass index
Candidates
Care and treatment
Decision making
Disease transmission
Evaluation
Health aspects
Hepatocellular carcinoma
Hepatoma
Liver
Liver cancer
Liver diseases
Liver transplantation
Methods
Patient safety
Patients
Risk assessment
Transplantation
Transplants & implants
Trends
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Summary:Liver transplantation is the only promising treatment for end-stage liver disease and patients with hepatocellular carcinoma. However, too many organs are rejected for transplantation. We analyzed the factors involved in organ allocation in our transplant center and reviewed all livers that were declined for transplantation. Reasons for declining organs for transplantation were categorized as major extended donor criteria (maEDC), size mismatch and vascular problems, medical reasons and risk of disease transmission, and other reasons. The fate of the declined organs was analyzed. 1086 declined organs were offered 1200 times. A total of 31% of the livers were declined because of maEDC, 35.5% because of size mismatch and vascular problems, 15.8% because of medical reasons and risk of disease transmission, and 20.7% because of other reasons. A total of 40% of the declined organs were allocated and transplanted. A total of 50% of the organs were completely discarded, and significantly more of these grafts had maEDC than grafts that were eventually allocated (37.5% vs. 17.7%, < 0.001). Most organs were declined because of poor organ quality. Donor-recipient matching at time of allocation and organ preservation must be improved by allocating maEDC grafts using individualized algorithms that avoid high-risk donor-recipient combinations and unnecessary organ declination.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers15051365