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Selecting livers for transplantation: can beggars be choosers?

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 496–497 (2005)Cite this article

Liver transplantation is a proven, life-saving therapy for patients with end-stage liver disease.1 Unfortunately, there is an insufficient supply of donor livers to satisfy the mounting demand. In response to this problem, liver transplant surgeons have aggressively expanded the frontiers of organ acceptance and use. Although it has long been known that young, healthy people dying of trauma provide the ideal transplant organs, the desperate scarcity of organs demands thorough consideration of each and every potential donor, even if far from ideal. The expanding criteria of acceptability for potential organ donors increases the risks associated with transplantation. The magnitude of the increased risk posed by non-ideal situations has been explored in the literature as well as in meetings and consensus conferences.2,3

There are two main categories of risk that will be considered in turn: disease transmission and organ dysfunction. Organ transplantation has transmitted both malignant and infectious diseases. Historically, the only malignancies that did not impede organ donation were non-melanoma skin cancer and in situ cervical cancer. There has, however, been renewed interest in using organs from donors with a history of malignancies considered to have low metastatic potential, such as primary brain tumors (except glioblastoma and medulloblastoma) and small renal cell carcinomas.2,3,4 Available data strongly proscribe the use of organs from donors with melanoma, choriocarcinoma, or lung cancer, but provide little information regarding the risk posed by other tumors. The situation differs for donors with a serologic profile that connotes potential transmission of viral disease. The literature suggests that the appropriate choice of recipients and the administration of available antiviral medications substantially mitigates any potential adverse impact.2,3,5 Livers from donors who are positive for hepatitis C antibody are typically transplanted into recipients with hepatitis C. Livers from donors who are positive for hepatitis B core antibody can be transplanted into any recipient, but typically under the cover of hepatitis B immunoglobulin and/or antiviral agents such as lamivudine.5

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  1. Assistant Professor of Surgery in Residence at the University of California San Francisco, San Francisco, CA, USA

    Sandy Feng

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  1. Sandy Feng
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Feng, S. Selecting livers for transplantation: can beggars be choosers?. Nat Rev Gastroenterol Hepatol 2, 496–497 (2005). https://doi.org/10.1038/ncpgasthep0312

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