Fig. 1: Information about discarded livers in the UK between November 2016 and February 2018.
From: Transplantation of discarded livers following viability testing with normothermic machine perfusion
a The study livers inclusion flowchart. Over the 16-month study period there were 185 discarded liver research offers, of which 59 (32%) were not eligible for the trial due to an incidental finding of cancer, macroscopically apparent cirrhosis or advanced fibrosis, severe organ damage or previous machine perfusion. There were 126 livers suitable for the trial, with steatosis being the leading cause of organ discard with 78 (42%) offers. Stringent donor inclusion criteria were not met in 25 (14%) offers and on 21 (11%) occasions the research team was already committed to the perfusion of another study liver. A liver was considered for the trial only if it could be allocated to a consented, potential blood group- and size-matched low-risk recipient. Many recipients were apprehensive to participate in such a high-risk clinical trial, and as a consequence, at any given time there were usually only one to three patients consented. A significant proportion of approached patients declined to take part, or were transplanted with a standard quality liver before agreeing to take part in this study. Eventually, thirty-one livers were enroled to the trial, of which 22 (71%) grafts met the viability criteria and were successfully transplanted. b A summary of reasons for livers being discarded in the United Kingdom between November 2016 and February 2018. A total of 64 livers were discarded for severe steatosis on visual assessment, with 14 discarded for severe steatosis based on urgent liver biopsy. A percentage of livers were declined due to intra-abdominal or lung malignancies (e.g. colonic cancer in donor 22). This did not include primary brain tumours or small renal cell cancers which are almost always considered for donation. The reasons for logistic discard, include the transplant team already being committed to one or more transplantations, lack of a suitable recipient or too long an anticipated cold ischaemia time due to delays with transportation.
