Addressing organ shortages: progress in donation after circulatory death for liver transplantation

Addressing organ shortages: progress in donation after circulatory death for liver transplantation

Can J Surg 2020;63(2):E135-E141 | PDF

Jordan J. Nostedt, MD, MSc: A.M. James Shapiro, MD, PhD; Darren H. Freed, MD, PhD; David L. Bigam, MD, MSc

Abstract

Reducing wait list mortality among patients awaiting liver transplantation remains a substantial challenge because of organ shortage. In efforts to expand the donor pool there has been a trend toward increased use of donation after circulatory death (DCD) liver grafts. However, these marginal grafts are prone to higher complication rates, particularly biliary complications. In addition, many procured DCD livers are then deemed unsuitable for transplant. Despite these limitations, DCD grafts represent an important resource to address the current organ shortage, and as such there are research efforts directed toward improving the use of and outcomes for transplantation of these grafts. We review the current progress in DCD liver transplantation.

La réduction du nombre de personnes en attente d’une greffe de foie qui décèdent avant la transplantation demeure un défi important en raison de la pénurie d’organes. On remarque actuellement une tendance à la hausse dans l’utilisation de greffons de foie provenant de don après décès circulatoire (DDC) dans le but d’élargir le bassin de donneurs. Ces greffons marginaux sont toutefois associés à des taux de complications plus élevés, particulièrement pour ce qui est des complications biliaires. De plus, de nombreux foies obtenus à la suite d’un DDC sont jugés inadmissibles à la greffe. Malgré ces restrictions, les greffons provenant de DDC représentent une importante ressource pour atténuer la pénurie d’organes. Des initiatives de recherche sont donc actuellement en cours dans le but d’améliorer leur taux d’utilisation et les issues des transplantations. Nous analysons ici l’état actuel des progrès pour les transplantations de foie
provenant de DDC.


Accepted July 24, 2019

Affiliations: From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed).

Competing interests: D. Freed is a co-founder of Tevosol Inc. Tevosol had no input in the design, review or writing of this paper. No other competing interests were declared.

Contributors: J. Nostedt, J. Shapiro and D. Bigam designed the review. J. Nostedt acquired and interpreted the information collected, which D. Freed and D. Bigam also interpreted. J. Nostedt wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.005519

Correspondence to: D.L. Bigam, Department of Surgery, University of Alberta, 8440 — 112 ST NW, Edmonton AB T6G 2B7, david.bigam@albertahealthservices.ca