Use of marginal donors

Abstract

Liver transplantation is limited by a scarcity of donor organs. The use of marginal or expanded pool donors is increasingly common as liver donor acceptance criteria are relaxed. Of these criteria, severe steatosis is associated with a definite risk of primary nonfunction. The other criteria may be associated with an increased risk of initial graft dysfunction. There remains a need for an effective objective predictive donor test of graft function and a universal definition of primary dysfunction. Recent work on the effects of brain death on donor organ injury and graft outcome has resulted in research in preconditioning to decrease prepreservation injury. Recipient selection is crucial when a decision to use a marginal graft is made and a better understanding of marginal grafts is necessary. In order to maximize the chances of success, acceptance of a marginal graft must be made considering not only all available donor information, but also recipient and operative factors.