Liver transplantation outcomes using donors after cardiac death
Reddy S., Friend P.
Purpose of review: Livers from non-heart-beating donors are a small but increasing component of organs used for transplantation. This review describes the current status and considers potential developments in this area. Recent findings: The use of non-heart-beating donors in liver transplantation is largely confined to 'controlled' donors with short warm ischemic times, with outcomes which are comparable to transplantation from heart-beating donors. Reports of liver transplantation from 'uncontrolled' non-heart-beating donors, with much longer warm ischemia periods, suggest a much poorer outcome. Summary: Livers retrieved with short warm ischemia times from controlled non-heart-beating donors can be considered an acceptable source of livers for transplantation. Careful donor selection requires an age limit (preferably <60 years), discarding organs with significant steatosis, minimizing cold ischemia (<8 hours) and selection of stable recipients. With longer warm ischemia times from uncontrolled non-heart-beating donor, the risk of primary non-function is still unacceptably high. The results obtained to date do not justify widespread clinical application and use of uncontrolled non-heart-beating donors should probably be restricted to carefully controlled clinical trials. To realise the much greater potential of uncontrolled non-heart-beating donor, new techniques of resuscitation, preservation and viability assessment will be needed. © 2005 Lippincott Williams & Wilkins.