Declining liver graft quality threatens the future of liver transplantation in the United States.
National liver transplantation (LT) volume has declined since 2006, in part because of worsening donor organ quality. Trends that degrade organ quality are expected to continue over the next 2 decades. We used the United Network for Organ Sharing (UNOS) database to inform a 20-year discrete event simulation estimating LT volume from 2010 to 2030. Data to inform the model were obtained from deceased organ donors between 2000 and 2009. If donor liver utilization practices remain constant, utilization will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs. If transplant centers increase their risk tolerance for marginal grafts, utilization would decrease to 48%. The institution of "opt-out" organ donation policies to increase the donor pool would still result in 1380 to 1866 fewer transplants. Ex vivo perfusion techniques that increase the use of marginal donor livers may stabilize LT volume. Otherwise, the number of LTs in the United States will decrease substantially over the next 15 years. In conclusion, the transplant community will need to accept inferior grafts and potentially worse posttransplant outcomes and/or develop new strategies for increasing organ donation and utilization in order to maintain the number of LTs at the current level.
Department of Medicine, University of North Carolina, Chapel Hill, NC.|Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN.
Eric S
ES
Orman
Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC.
Maria E
ME
Mayorga
Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC.
Stephanie B
SB
Wheeler
Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC.
Rachel M
RM
Townsley
Department of Industrial Engineering, Clemson University, Clemson, SC.
Hector H
HH
Toro-Diaz
Department of Medicine, University of North Carolina, Chapel Hill, NC.
Paul H
PH
Hayashi
Department of Medicine, University of North Carolina, Chapel Hill, NC.
A Sidney
AS
Barritt
D000328:Adult; D003198:Computer Simulation; D016208:Databases, Factual; D046148:Donor Selection / Q000639:trends*; D005260:Female; D005544:Forecasting; D006085:Graft Survival; D015276:Health Care Rationing / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000639:trends*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D020380:Needs Assessment; D011183:Postoperative Complications / Q000209:etiology; D017064:Process Assessment, Health Care / Q000639:trends*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014481:United States