title: Impact of a Full-Time Donor Management Protocol on Donors' Liver Biopsy Findings: Progress to Date.
abstract: OBJECTIVE
  This study investigated a fixed coordinator-directed donor management strategy's impact on donated liver quality, as determined by definitive biopsy results.
  
  
  METHODS
  We collected donated liver biopsy results from donations both before and after implementing a fixed coordinator-directed donor management strategy. This strategy involved full-time attendance by a donor coordinator and continued resuscitation of brain-dead donors. All donations took place in a single organ procurement unit. We also followed up results of biopsies from the Liver Transplantation Center database of Namazi Hospital in Shiraz, Iran.
  
  
  RESULTS
  We compared biopsy findings of 192 livers donated from 2012 to 2013 (group A) with 276 livers donated from 2015 until August 2016 (group B). Data analysis showed that 67 livers (34.9%) in group A were rejected for transplant owing to severe steatosis in 17 (8.9%), moderate/severe fibrosis in 9 (4.7%), moderate/severe necrosis in 28 (14.6%), and 13 (6.8%) rejected for other pathologies. Among group B livers, 59 (21.4%) were not deemed suitable for transplant owing to severe steatosis in 37 (13.5%), moderate/severe fibrosis in 6 (2.1%), and moderate/ severe necrosis in 16 (5.7%). Overall, steatosis was found in 94 livers (49.2%) in group A versus 175 livers (63.3%) in group B (P = .007). Donor age in group A averaged 36.5 years versus 47.9 years in group B (P = .02). Necrosis was found in 33 livers (17.2%) in group A and 22 livers (7.9%) in group B (P = .008). One-month survival rates were 95.3% and 96.3% for groups A and B (P = .08).
  
  
  CONCLUSIONS
  Donated liver disqualification before transplant noticeably decreased despite the shift in demographic patterns from 2012 to 2016. In group A, brain-dead liver donors were younger and more often died from trauma, whereas group B donors had more cerebrovascular accident-induced deaths. This achievement took place alongside increased rates of steatosis and decreased rates of necrosis.
authors.affiliation: Organ Procurement Unit, Lung Transplantation Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Meysam
authors.initials: M
authors.lastname: Mojtabaee
authors.forename: Alireza
authors.initials: A
authors.lastname: Shamsaeefar
authors.forename: Siavash
authors.initials: S
authors.lastname: Gholami
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mohsenzadeh
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Sadegh Beigee
mesh_terms: D000328:Adult; D001706:Biopsy; D002423:Cause of Death; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D046148:Donor Selection / Q000458:organization & administration*; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D007492:Iran; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014019:Tissue Donors / Q000600:supply & distribution*