title: Limits for adult liver donation in Spain.
abstract: BACKGROUND
  Liver donation is the cornerstone for the expansion of liver transplantation. Although big efforts have been performed to release alternatives for increasing the donor pool, only extended-criteria donors have become a feasible option.
  
  
  METHODS
  The success of the Spanish Model for organ transplantation is well known. Approximately 5.4% of all the liver transplants (LT) are performed in Spain, with a rate of 22.9 LT per million people (pmp).
  
  
  RESULTS
  Approximately 70 papers on extended-criteria donors have been reported from Spanish LT teams. Pioneering works in donor steatosis, non-heart-beating donors, donor age-hepatitis C virus, ischemia/reperfusion injury, normothermic extracorporeal membrane oxygenation, and donor steatosis-hepatitis C virus are among the main contributions in the field. Considering data from the Spanish National Registry, it can be observed that an accumulation of donor and recipient factors leads to a continuum of risk for liver transplantation. Donors are not "bad" enough to decline a liver offer per se.
  
  
  CONCLUSIONS
  In Spain, clear efforts should be made to work on more stable and homogeneous criteria for donor acceptance. In this sense, defining a specific Spanish donor risk index would be helpful.
authors.affiliation: Unit of Liver Transplantation, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain. Electronic address: javibriceno@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Briceño
authors.affiliation: Unit of Liver Transplantation, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Ciria
mesh_terms: D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D012042:Registries; D013030:Spain; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014850:Waiting Lists