title: Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update.
abstract: BACKGROUND
  The critical shortage of transplantable organs necessitates utilization of unconventional donors. We describe a successful experience of controlled non-heart-beating donor (NHBD) liver transplantation.
  
  
  METHODS
  Controlled NHBDs had catastrophic head injury, prognosis for no meaningful recovery, decision to withdraw life support, and subsequent consent for donation. After stopping mechanical ventilation in the operating room, death determination by a nontransplant caregiver, and rapid aortic cannulation, liver and kidneys were recovered.
  
  
  RESULTS
  Controlled NHBDs contributed 5% of hepatic allografts (8/164) from August 1996 through June 1999 (9% in 1998). Sixteen NHBDs afforded 8 livers and 24 kidneys. Liver donors (n=8) were 11-66 years old; half were >50 years old. Premortem alanine aminotransferase was 25-157 U/L. Arrest occurred 3-27 min after stopping ventilation. Perfusion started 3-5 min after incision, and <22 min after hypotension (mean arterial pressure: <50 mmHg). Patient and graft survivals are 100% at 18+/-12 months follow-up. There was no intraoperative complication, reperfusion syndrome, poor graft function, primary nonfunction, arterial thrombosis, biliary complication, or serious infection. Postoperative day 2 prothrombin time was 13+/-1 sec. Peak alanine aminotransferase was 980+/-601 U/L. Intensive care unit and posttransplant lengths of stay were 2+/-2 and 10+/-7 days, respectively. Soon after transplantation there was frequent temporary hyperbilirubinemia (five of eight recipients; bilirubin peak: 7-29 mg/dl, 2-3 weeks after transplantation) and rejection (4/8 recipients, <3 weeks after transplantation).
  
  
  CONCLUSIONS
  NHBDs significantly and safely expanded our donor pool. NHBD surgeons must be capable of rapid procurement. Cautious liberalization of criteria for accepting livers from NHBDs with confounding risk factors is justified. Refined ethics guidelines would broaden approval of NHBDs.
authors.affiliation: Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA. reichd@aehn2.einstein.edu
authors.forename: D J
authors.initials: DJ
authors.lastname: Reich
authors.forename: S J
authors.initials: SJ
authors.lastname: Munoz
authors.forename: K D
authors.initials: KD
authors.lastname: Rothstein
authors.forename: H M
authors.initials: HM
authors.lastname: Nathan
authors.forename: J M
authors.initials: JM
authors.lastname: Edwards
authors.forename: R D
authors.initials: RD
authors.lastname: Hasz
authors.forename: C Y
authors.initials: CY
authors.lastname: Manzarbeitia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012121:Respiration, Artificial; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome