Successful outcome following transplantation of an injured liver from a nonheart beating donor

Abstract

Summary Nonheart beating donation (NHBD) of the liver is a relatively new potential source of grafts. Guidelines to indications and contraindications to donation from controlled nonheart beating donors are still being formulated. We report a successful case of transplantation of a liver from a controlled nonheart beating donor who sustained significant injuries following a road traffic accident. Emergency laparotomy with peri‐hepatic packing was performed to control haemorrhage from lacerations in segments VI and VII. Forceful packing resulted in an area of focal ischaemia in segment VI. Trauma to the liver should not be considered an absolute contraindication to controlled NHBD.

Uncontrolled organ donation following prehospital cardiac arrest: a potential solution to the shortage of organ donors in the United Kingdom?

“…A traumatic death does not by necessity prevent DCD and others have transplanted abdominal organs following uncontrolled DCD in similar circumstances [6]. Even donation of a liver damaged during blunt trauma, from controlled DCD, has been successfully transplanted [11]. However, the proportion of suitable donors among the cohort presented here is likely to be low for several reasons.…”

Living donor liver transplantation using a left lobe graft from a donor with severe liver trauma: A 7-year follow-up

“…For years, transplant surgeons have been reluctant to use traumatized livers because of concerns regarding the additive effect of parenchymal damage on reperfusion injury related to warm or cold ischemia, the risk of hemorrhage, and, subsequently, the risk of septic complications. By the end of the 1990s, several centers had begun to use traumatized livers from deceased donors as allografts, and this led to acceptable outcomes 4–8. The use of deceased donor livers with injuries is a safe way to expand the donor pool.…”

“…Despite the current trend toward conservative treatment, as many as 14% of all liver injuries and 33% of major liver injuries may require hepatic resection 2, 3. The use of deceased donor livers with preexisting traumatic injury has been reported by several centers, and the outcomes were acceptable 4–8. However, living donor liver transplantation (LDLT) using a traumatized donor liver has never been reported.…”

Advances in the management of the explanted donor liver

“…Furthermore, case reports on transplantation of traumati cally damaged organs are usually biased by the exclusive presentation of patients with good outcomes. [128][129][130] Despite the lack of data in the literature, with accurate donor organ management (including extensive backtable diagnostics and aggressive surgical treatment) even severe liver lacera tions do not necessarily mean an absolute contraindication for transplantation.…”