title: Use of a liver from donor after cardiac death: is it appropriate for the sick or the stable?
abstract: OBJECTIVE
  Liver transplantation following donation after cardiac death (DCD) continues to be a subject for heated debate. Opinion is divided in the literature as to who benefits the most from receiving a liver from a DCD donor. This review will focus on some important questions regarding the outcome of transplantation and the selection and matching of donor and recipient.
  
  
  RESULTS
  Liver transplantation with an organ from a donor after cardiac death is becoming an accepted way to treat patients on the waiting list with end-stage liver disease. However, there are still some major issues to address such as ischemic-type biliary lesions, retransplantation rates, criteria for donor and patient selection and whether conversion of donation after brain death to DCD exists. Accepting a DCD liver has the potential for reduced recipient quality of life after transplant. Death on the waiting list must be balanced against the inherent risks of a DCD liver.
  
  
  CONCLUSIONS
  Success of liver transplantation is mostly measured as graft and patient survival. DCD liver transplantation is a potential tool to decrease mortality on the waiting list. Careful selection and matching of donor organ and recipient can lead to good outcomes. However, ischemic-type biliary lesions after DCD liver transplantation remain an important obstacle to overcome and have a serious impact on quality of life after transplantation.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. j.dubbeld@lumc.nl
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dubbeld
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
mesh_terms: D046148:Donor Selection; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality