Lost potential and missed opportunities for DCD liver transplantation in the United States

• Type of Material: Article
• Authors: Robert M. Cannon, University of Alabama at Birmingham; Ariann F. Nassel, University of Alabama at Birmingham; Jeffery T. Walker, University of Alabama at Birmingham; Saulat S. Sheikh, University of Alabama at Birmingham; Babak J. Orandi, University of Alabama at Birmingham; Raymond Lynch, Emory University; Malay B. Shah, University of Kentucky; David S. Goldberg, University if Miami; Jayme E. Locke, University of Alabama at Birmingham
• Language: English
• Date: 2022-05-13
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016%2Fj.amjsurg.2022.05.001
• Title of Journal or Parent Work: The American Journal of Surgery
• Volume: 224
• Issue: 3
• Start Page: 990
• End Page: 998
• Grant/Funding Information: This work is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K08DK125769 (PI: Cannon).
• Keywords: Organ donation; Geography; UNOS; DCD; Liver transplant
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery; Health Sciences, Education

Abstract

Background: Donation after cardiac death(DCD) has been proposed as an avenue to expand the liver donor pool. Methods: We examined factors associated with nonrecovery of DCD livers using UNOS data from 2015 to 2019. Results: There 265 non-recovered potential(NRP) DCD livers. Blood type AB (7.8% vs. 1.1%) and B (16.9% vs. 9.8%) were more frequent in the NRP versus actual donors (p < 0.001). The median driving time between donor hospital and transplant center was similar for NRP and actual donors (30.1 min vs. 30.0 min; p = 0.689), as was the percentage located within a transplant hospital (20.8% vs. 20.9%; p = 0.984).The donation service area(DSA) of a donor hospital explained 27.9% (p = 0.001) of the variability in whether a DCD liver was recovered. Conclusion: A number of potentially high quality DCD donor livers go unrecovered each year, which may be partially explained by donor blood type and variation in regional and DSA level practice patterns.