Declining liver graft quality threatens the future of liver ... : Liver Transplantation (original) (raw)

Original Articles: Donor and Liver Allocation

Orman, Eric S.1,3; Mayorga, Maria E.4; Wheeler, Stephanie B.2; Townsley, Rachel M.4; Toro‐Diaz, Hector H.5; Hayashi, Paul H.1; Sidney Barritt, A. IV*,1

1Department of MedicineUniversity of North CarolinaChapel HillNC

2Department of Health Policy and ManagementUniversity of North CarolinaChapel HillNC

3Department of Medicine, School of MedicineIndiana UniversityIndianapolisIN

4Department of Industrial and Systems EngineeringNorth Carolina State UniversityRaleighNC

5Department of Industrial EngineeringClemson UniversityClemsonSC

*Address reprint requests to A. Sidney Barritt IV, M.D., M.S.C.R., University of North Carolina, Campus Box 7584, Chapel Hill, NC 27599. Telephone: 919‐966‐2516; FAX: 919‐966‐1700; E‐mail: [email protected]

Abstract

National liver transplantation (LT) volume has declined since 2006, in part because of worsening donor organ quality. Trends that degrade organ quality are expected to continue over the next 2 decades. We used the United Network for Organ Sharing (UNOS) database to inform a 20‐year discrete event simulation estimating LT volume from 2010 to 2030. Data to inform the model were obtained from deceased organ donors between 2000 and 2009. If donor liver utilization practices remain constant, utilization will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs. If transplant centers increase their risk tolerance for marginal grafts, utilization would decrease to 48%. The institution of “opt‐out” organ donation policies to increase the donor pool would still result in 1380 to 1866 fewer transplants. Ex vivo perfusion techniques that increase the use of marginal donor livers may stabilize LT volume. Otherwise, the number of LTs in the United States will decrease substantially over the next 15 years. In conclusion, the transplant community will need to accept inferior grafts and potentially worse posttransplant outcomes and/or develop new strategies for increasing organ donation and utilization in order to maintain the number of LTs at the current level. Liver Transpl 21:1040‐1050, 2015. © 2015 AASLD.