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Invited Commentary
August 5, 2020

A Move to Demarginalize the Liver Donor Allograft

Author Affiliations
  • 1Comprehensive Transplant Center, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
JAMA Surg. 2020;155(10):932-933. doi:10.1001/jamasurg.2020.2520

Progress in liver transplantation during the past 30 years has been dramatic. The complexities of the operation have been standardized, candidate mortality has been objectified (Model for End-stage Liver Disease [MELD]), and survival has been maximized. Historically, the use of “marginal” liver allografts has often resulted in suboptimal results; thus, these grafts were often discarded except in the direst of circumstances. The more contemporary era of liver transplantation, perhaps the MELD era, has seen increasing use of marginal allografts owing to many factors, including the proliferation of transplant centers, growing transplant wait lists, intense competition for organs, and improvements in surgical, anesthetic, and critical care skills.1 The evaluation of the marginal donor allograft by Zhang et al2 in this issue of JAMA Surgery makes the case that earlier definitions of marginal are no longer accurate.

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