[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.236.145.124. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 66
Citations 0
Invited Commentary
February 13, 2019

Fixing the Problem of Discard of Livers From Older Donors

Author Affiliations
  • 1Section of Transplantation Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
JAMA Surg. Published online February 13, 2019. doi:10.1001/jamasurg.2018.5587

Haugen et al1 present an important article that should change practice. Despite improved outcomes in recipients of older donor livers, rates of discard of old livers have increased significantly. Of importance, this article raises the questions of why older livers are commonly discarded and what we can do to fix this problem.

Donor logistics are a key reason for these discards. When a surgeon is in the donor operating room evaluating a liver, it is not a simple assessment to determine whether the liver is usable. Instead, the donor liver is evaluated within the context of the recipient. When the liver does not look great (like many older livers), the decision is commonly made to pass for the intended recipient, who is thought to be better off waiting for a better liver. For the liver to be used, it must be reallocated in a short amount of time. At best, it requires 4 to 6 hours to identify a new recipient and bring them in for the transplant. Other transplant teams are present in the operating room procuring other thoracic and abdominal organs. Having the entire system stop for 6 hours is rarely feasible. Also, receiving a call from a surgeon you do not know saying that “the liver does not look great, is usable, but we are passing” is not appealing. The recipient is likely just as sick as the recipient they are passing for and may also do poorly with a mediocre liver. Unfortunately, the end result is that these organs are often discarded.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×