Report of the Paris consensus meeting on expanded criteria donors in liver transplantation

Abstract

Because of organ shortage and a constant imbalance between available organs and candidates for liver transplantation, expanded criteria donors are needed. Experience shows that there are wide variations in the definitions, selection criteria, and use of expanded criteria donors according to different geographic areas and different centers. Overall, selection criteria for donors have tended to be relaxed in recent years. Consensus recommendations are needed. This article reports the conclusions of a consensus meeting held in Paris in March 2007 with the contribution of experts from Europe, the United States, and Asia. Definitions of expanded criteria donors with respect to donor variables (including age, liver function tests, steatosis, infections, malignancies, and heart-beating versus non-heart-beating, among others) are proposed. It is emphasized that donor quality represents a continuum of risk rather than "good or bad." A distinction is made between donor factors that generate increased risk of graft failure and factors independent of graft function, such as transmissible infectious disease or donor-derived malignancy, that may preclude a good outcome. Updated data concerning the risks associated with different donor variables in different recipient populations are given. Recommendations on how to safely expand donor selection criteria are proposed.

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

“…Despite innovative strategies to expand the organ donor pool, the number of liver transplantations performed worldwide over the past decade has reached a plateau (1,2). Consequently, waiting lists are plagued with a 10-20% mortality rate (3).…”

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria

“…Estas razones son suficientes para que estemos familiarizados con los posibles hallazgos histopatológicos, las dificultades que se pueden presentar y sus diagnósticos diferenciales. Así cada grupo transplantador establecerá los pros y contras de esta metodología y decidirá la mejor conducta, para obtener el injerto que minimice al máximo los riesgos para el receptor (2,3).…”

Intentional use of Schistosoma mansoni-infected grafts in living donor liver transplantation

“…Extended criteria have been used for donors in order to expand the pool of available grafts. 2 In LDLT, the actual policy does not differ, and expanded criteria for living donors have allowed conditions such as steatosis, advanced age, and dual grafts. 3 The authors highlighted the impact of liver transplants infected by S. mansoni on the donors and the recipients.…”