Prospects for the ex situ liver machine perfusion in Brazil

Abstract

Brazil, like most countries in the world, experiences the expansion of extended criteria donors, mainly due to the aging of the population and the obesity epidemic. Concerns regarding the quality of these organs along with the vast territorial areas of the country compromise the utilization rate of livers from donors and aggravate the discrepancy between the number of liver transplants performed and the needed. Ex situ liver machine perfusion offers superior preservation for livers from extended criteria donors, limiting cold ischaemia time and offering the possibility of evaluation of their function before transplantation as well as the reconditioning of marginal organs. Objections such as the financial cost, difficulty in transporting the device between hospitals, and demand of trained professionals in the handling of the device must be pondered with the possibility of increasing the number of transplants and the utilisation rate of donor organs. The optimal use of this resource, through the careful selection of donors and the appropriate technical and scientific knowledge, can ensure an effective and successful implementation of this technology.

A tale of two kidneys, and the case for machine perfusion in South Africa

“…In-service training and supervision by a representative should be negotiated as part of the rental agreement during the early stages of implementation. [24] As suppliers and distributors are looking to expand the use of MP devices beyond the USA, Europe and Australia, and the need to improve access to transplantation is becoming more apparent, the use of MP devices in SA may be more relevant and affordable now than ever before. Macroscopic assessment may be highly subjective, and as our case illustrates, may result in two different decisions being made regarding graft utilisation.…”

What is the role of heat shock protein in abdominal organ transplantation?

“…The mapping of I/R-related biomarkers points to possible organ conditioning during normal or hyperthermic dynamic preservation methods. (23,24)…”

Disposal of donor livers in Brazil: how to optimize their utilization rate in transplants?

“…(15,16,18) In Brazil, careful donor selection and adequate technicalscientific knowledge can guarantee the effective and satisfactory implementation of this technology. (19) Among the strategies to increase the use of deceased donor organs proposed by the participants, improvements in donor organ procurement are highlighted, such as the allocation of experienced professionals for this procedure (especially in extended criteria donors), and the facilitation of liver biopsy performance in the donor's hospital and air logistics for organ transportation. Other suggested initiatives focused on the field of transplant policies, the creation of an alternative list dedicated to oncologic patients for organs discarded by all teams, reduction of consultation time for donor evaluation, creation of a national policy for the use of split organs, and audits of the harvesting operations and the causes of organ disposal, with the definition of criteria for the registration and maintenance of transplant centers.…”