The use of marginal heart beating donor livers for transplantation in the United kingdom.
BACKGROUND
This study investigated the use of deceased heart-beating donor livers offered for transplantation during a 10-year period, during which there has been an increasing disparity between organ supply and demand in the United Kingdom.


METHODS
Summary data from the National Transplant Database were analyzed on all 7107 heart-beating cadaveric donor livers offered for transplantation in the United Kingdom between 1996 and 2006, with particular attention to livers that were not retrieved, not transplanted, or that subsequently failed to function after transplantation.


RESULTS
The difference between the number of patients registered for liver transplantation in the United Kingdom and those transplanted increased from 132 in 1996 to 333 in 2006, leading to a 77% increase in the number of waiting list deaths. Mean donor age increased by 6.1 (5.7-6.6) years during the period studied, in part because of a reduction in the proportion of donors arising from road fatalities. Despite this, the rate of primary nonfunction remained low (1.7% during 1996-2006). The absolute risk increase of primary nonfunction arising from receipt of a moderately as opposed to mildly steatotic organ was 2.6%, which translates to a "number needed to harm" of 41 patients.


CONCLUSIONS
The decline in both the number and the quality of livers offered for transplantation in the United Kingdom during the past 10 years has not been associated with a change in the rate of primary nonfunction. In these times of acute donor shortage, these data may justify a more liberal use of marginal grafts.
Devey
Luke R
LR
Institute of Biomedical Research and Liver Unit, Queen Elizabeth Hospital Birmingham, United Kingdom.
Friend
Peter J
PJ
Forsythe
John L R
JL
Mumford
Lisa L
LL
Wigmore
Stephen J
SJ
D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D002543:Cerebral Hemorrhage / Q000401:mortality; D005234:Fatty Liver / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D016031:Liver Transplantation; D008875:Middle Aged; D009200:Myocardial Contraction; D011446:Prospective Studies; D014019:Tissue Donors; D019737:Transplants / Q000592:standards* / Q000706:statistics & numerical data / Q000600:supply & distribution; D006113:United Kingdom