Lost potential and missed opportunities for DCD liver transplantation in the United States

Abstract

Background: Donation after cardiac death(DCD) has been proposed as an avenue to expand the liver donor pool.

Methods: We examined factors associated with nonrecovery of DCD livers using UNOS data from 2015 to 2019.

Results: There 265 non-recovered potential(NRP) DCD livers. Blood type AB (7.8% vs. 1.1%) and B (16.9% vs. 9.8%) were more frequent in the NRP versus actual donors (p < 0.001). The median driving time between donor hospital and transplant center was similar for NRP and actual donors (30.1 min vs. 30.0 min; p = 0.689), as was the percentage located within a transplant hospital (20.8% vs. 20.9%; p = 0.984).The donation service area(DSA) of a donor hospital explained 27.9% (p = 0.001) of the variability in whether a DCD liver was recovered.

Conclusion: A number of potentially high quality DCD donor livers go unrecovered each year, which may be partially explained by donor blood type and variation in regional and DSA level practice patterns.

Keywords: DCD; Geography; Liver transplant; Organ donation; UNOS.