title: Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers 'that nobody wants'.
abstract: BACKGROUND
  There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received 'livers that nobody wants' (LNWs) in Argentina.
  
  
  METHODS
  Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival.
  
  
  RESULTS
  We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups.
  
  
  CONCLUSIONS
  Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence.
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina. lmccormack@hospitalaleman.com
authors.forename: Lucas
authors.initials: L
authors.lastname: McCormack
authors.forename: Emilio
authors.initials: E
authors.lastname: Quiñonez
authors.forename: María Martha
authors.initials: MM
authors.lastname: Ríos
authors.forename: Pablo
authors.initials: P
authors.lastname: Capitanich
authors.forename: Nicolás
authors.initials: N
authors.lastname: Goldaracena
authors.forename: Javier Kerman
authors.initials: JK
authors.lastname: Cabo
authors.forename: Margarita
authors.initials: M
authors.lastname: Anders
authors.forename: Javier
authors.initials: J
authors.lastname: Osatnik
authors.forename: Pablo
authors.initials: P
authors.lastname: Comignani
authors.forename: Norberto
authors.initials: N
authors.lastname: Mezzadri
authors.forename: Ricardo Cesar
authors.initials: RC
authors.lastname: Mastai
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D046148:Donor Selection; D017558:Elective Surgical Procedures; D005260:Female; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult