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Strategies to Improve Liver Allocation, Distribution, and Utilization in a Broader Sharing Climate

  • Liver Transplantation (DC Mulligan and R Batra, Section Editor)
  • Published:
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Abstract

Purpose of the Review

In an attempt to eliminate geographic disparities in median MELD at transplant, the allocation of deceased donor liver allografts has transitioned to the use of acuity-based circles. This has provided new obstacles for both organ procurement organizations and transplant centers to accommodate the implications of a broader sharing climate.

Recent Findings

With changes to allocation, OPOs and transplant centers have experienced new challenges in donor organ evaluation and logistics. However, these changes present an opportunity to refocus on the deceased liver donation process. Opportunities exist to develop strategies to optimize collaborations between OPOs and transplant centers, facilitate informed donor organ evaluation and acceptance, and create efficiency in donation logistics.

Summary

By standardizing the evaluation of deceased donors and providing the necessary tools to ensure informed transplant center decisions regarding organ acceptance, improved efficiency in the new allocation system can be attained. Similarly, with anticipated changes in organ recovery travel and logistics, increasing reliance on local surgeon recovery and improved communication tools have the potential to facilitate adaptation to geographic changes in allocation and reduce costs.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Merion RM, Sharma P, Mathur AK, Schaubel DE. Evidence-based development of liver allocation: a review. Transplant Int: Off J Eur Soc Organ Transplant. 2011;24:965–72.

    Article  Google Scholar 

  3. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. Jama. 1968;205:337–40.

  4. Starzl TE, Iwatsuki S, Van Thiel DH, Gartner JC, Zitelli BJ, Malatack JJ, et al. Evolution of liver transplantation. Hepatology. 1982;2:614–36.

    Article  CAS  Google Scholar 

  5. network UOpat. 42 USC 274: Organ procurement and transplantation network.

  6. Goldberg DA, Gilroy R, Charlton M. New organ allocation policy in liver transplantation in the United States. Clinical liver disease. 2016;8:108–12.

    Article  Google Scholar 

  7. Gentry SE, Massie AB, Cheek SW, Lentine KL, Chow EH, Wickliffe CE, et al. Addressing geographic disparities in liver transplantation through redistricting. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13:2052–8.

    Article  CAS  Google Scholar 

  8. OPTN Policy notice liver and intestine distribution using distance from donor hospital. https://optn.transplant.hrsa.gov/media/2788/liver_policynotice_201901.pdf. Accessed 3/1/2020.

  9. OPTN/UNOS Guidance on requested deceased donor Information.https://optn.transplant.hrsa.gov/media/2504/opo_guidance_201806.pdf. 2018;Accessed 3/1/2020.

  10. Charatcharoenwitthaya P, Lindor KD. Role of radiologic modalities in the management of non-alcoholic steatohepatitis. Clin Liver Dis. 2007;11:37–54 viii.

    Article  Google Scholar 

  11. Mazhar SM, Shiehmorteza M, Sirlin CB. Noninvasive assessment of hepatic Steatosis. Clin Gastroenterol Hepatol. 2009;7:135–40.

    Article  Google Scholar 

  12. Mangus RS, Borup TC, Popa S, Saxena R, Cummings O, Tector AJ. Utility of pre-procurement bedside liver biopsy in the deceased extended-criteria liver donor. Clin Transpl. 2014;28:1358–64.

    Article  Google Scholar 

  13. El-Badry AM, Breitenstein S, Jochum W, Washington K, Paradis V, Rubbia-Brandt L, et al. Assessment of hepatic steatosis by expert pathologists: the end of a gold standard. Ann Surg. 2009;250:691–7.

    Article  Google Scholar 

  14. Homeyer A, Nasr P, Engel C, Kechagias S, Lundberg P, Ekstedt M, et al. Automated quantification of steatosis: agreement with stereological point counting. Diagn Pathol. 2017;12:80.

    Article  Google Scholar 

  15. Oliver JB, Machineni P, Bongu A, Patel T, Nespral J, Kadric C, et al. Liver biopsy in assessment of extended criteria donors. Liver Transplant: Off Publ Am Assoc Stud Liver Dis Int Liver Transplant Soc. 2018;24:182–91.

    Article  Google Scholar 

  16. de Boer JD, Putter H, Blok JJ, Alwayn IPJ, van Hoek B, Braat AE. Predictive capacity of risk models in liver transplantation. Transplant Direct. 2019;5:e457.

    Article  Google Scholar 

  17. •• Volk ML, Goodrich N, Lai JC, Sonnenday C, Shedden K. Decision support for organ offers in liver transplantation. Liver Transplant: Off Publ Am Assoc Stud Liver Dis Int Liver Transplant Soc. 2015;21:784–91 This study provides an evaluation of clinical decision support tools for accepting or declining donor liver offers. Here they found that these tools may augment clinical judgement and ultimately improve patient survival.

    Article  Google Scholar 

  18. Wey A, Salkowski N, Kremers WK, Schaffhausen CR, Kasiske BL, Israni AK, et al. A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18:897–906.

    Article  Google Scholar 

  19. Wu JX, Nguyen AT, de Virgilio C, Plurad DS, Kaji AH, Nguyen V, et al. Can it wait until morning? A comparison of nighttime versus daytime cholecystectomy for acute cholecystitis. Am J Surg. 2014;208:911–8 discussion 917-8.

    Article  Google Scholar 

  20. Dalton MK, McDonald E, Bhatia P, Davis KA, Schuster KM. Outcomes of acute care surgical cases performed at night. Am J Surg. 2016;212:831–6.

    Article  Google Scholar 

  21. Anantha RV, Parry N, Vogt K, Jain V, Crawford S, Leslie K. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective. Can J Surg. 2014;57:E9–E14.

    Article  Google Scholar 

  22. Bertges Yost W, Eshelman A, Raoufi M, Abouljoud MS. A national study of burnout among American transplant surgeons. Transplant Proc. 2005;37:1399–401.

    Article  CAS  Google Scholar 

  23. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250:463–71.

    Article  Google Scholar 

  24. Patti MG, Schlottmann F, Sarr MG. The problem of burnout among surgeons. JAMA Surgery. 2018;153:403–4.

    Article  Google Scholar 

  25. Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, et al. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg. 2010;211:609–19.

    Article  Google Scholar 

  26. George TJ, Arnaoutakis GJ, Merlo CA, Kemp CD, Baumgartner WA, Conte JV, et al. Association of operative time of day with outcomes after thoracic organ transplant. Jama. 2011;305:2193–9.

    Article  CAS  Google Scholar 

  27. Lonze BE, Parsikia A, Feyssa EL, Khanmoradi K, Araya VR, Zaki RF, et al. Operative start times and complications after liver transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2010;10:1842–9.

    Article  CAS  Google Scholar 

  28. Lindemann J, Dageforde LA, Brockmeier D, Vachharajani N, Scherer M, Chapman W, et al. Organ procurement center allows for daytime liver transplantation with less resource utilization: may address burnout, pipeline, and safety for field of transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2019;19:1296–304.

    Article  Google Scholar 

  29. de Boer JD, Van der Bogt KEA, Putter H, Ooms-de Vries KM, Haase-Kromwijk B, Pol RA, et al. Surgical quality in organ procurement during day and night: an analysis of quality forms. BMJ Open. 2018;8:e022182.

    Article  Google Scholar 

  30. Thuluvath PJ, Amjad W, Savva Y, Thuluvath AJ, LaMattina J. Survival outcomes are not affected when liver transplant surgery is done at night, during weekends, or summer months. Transplant Direct. 2019;5:e449–9.

  31. Orman ES, Hayashi PH, Dellon ES, Gerber DA, Barritt AS. Impact of nighttime and weekend liver transplants on graft and patient outcomes. Liver Transplant: Off Publ Am Assoc Stud Liver Dis Int Liver Transplant Soc. 2012;18:558–65.

    Article  Google Scholar 

  32. Doyle M, Subramanian V, Vachharajani N, Collins K, Wellen JR, Stahlschmidt E, et al. Organ donor recovery performed at an organ procurement organization-based facility is an effective way to minimize organ recovery costs and increase organ yield. J Am Coll Surg. 2016;222:591–600.

    Article  Google Scholar 

  33. Doyle MB, Vachharajani N, Wellen JR, Lowell JA, Shenoy S, Ridolfi G, et al. A novel organ donor facility: a decade of experience with liver donors. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2014;14:615–20.

    Article  CAS  Google Scholar 

  34. SRTR Analysis Report: Data Request on Circle Based Allocation.https://optn.transplant.hrsa.gov/media/2640/li2018_01_analysis-report_20180924.pdf. 2018;Accessed 3/1/2020.

  35. Puri V, Hachem RR, Frye CC, Harrison MS, Semenkovich TR, Lynch JP, et al. Unintended consequences of changes to lung allocation policy. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2019;19:2164–7.

    Article  Google Scholar 

  36. Englesbe MJ, Merion RM. The riskiest job in medicine: transplant surgeons and organ procurement travel. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2009;9:2406–15.

    Article  CAS  Google Scholar 

  37. Schenk AD, Washburn WK, Adams AB, Lynch RJ. A survey of current procurement travel practices, accident frequency, and perceptions of safety. Transplant Direct. 2019;5:e494.

    Article  Google Scholar 

  38. Serrano OK, Vock DM, Snyder JJ, Chinnakotla S, Kandaswamy R, Pruett TL, et al. Influence of the procurement surgeon on transplanted abdominal organ outcomes: an SRTR analysis to evaluate regional organ procurement collaboration. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2019;19:2219–31.

    Article  Google Scholar 

  39. van Wezel HB, van der Vliet JA, Hordijk W, Haase-Kromwijk B, Barendregt WB, Boll AP, et al. A regional explantation team: a big step forward in the organisation of organ procurement. Transplant Proc. 1997;29:1487–8.

    Article  Google Scholar 

  40. Signori S, Boggi U, Vistoli F, Del Chiaro M, Pietrabissa A, Costa A, et al. Regional procurement team for abdominal organs. Transplant Proc. 2004;36:435–6.

    Article  CAS  Google Scholar 

  41. Gubernatis G, Oldhafer K, Rohwer K, Fieguth HG, Korner MM, Vogelsang F, et al. Regional organ procurement teams for abdominal and thoracic organs provide a rapid and personal service for organ donation in peripheral hospitals. Transplant Proc. 1997;29:1484–6.

    Article  CAS  Google Scholar 

  42. Lynch RJ, Mathur AK, Hundley JC, Kubus J, Pietroski RE, Mattice BJ, et al. Improving organ procurement practices in Michigan. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2009;9:2416–23.

    Article  CAS  Google Scholar 

  43. Salvalaggio PR, Ferraz-Neto BH. Liver grafts procured by other transplant teams do not affect posttransplantation outcomes. Transplant Proc. 2012;44:2293–6.

    Article  CAS  Google Scholar 

  44. Shiraishi Y, Ochoa L, Richardson G, Semenkovich JR, Trulock EP, Sundaresan S, et al. Retrieval by other procurement teams provides favorable lung transplantation outcome. Ann Thorac Surg. 1997;64:203–6.

    Article  CAS  Google Scholar 

  45. •• Hobeika MJ, Glazner R, Foley DP, Hanish S, Loss G, Quintini C, et al. step toward standardization: results of two national surveys of best practices in donation after circulatory death liver recovery and recommendations from The American Society of Transplant Surgeons and Association of Organ Procurement Organizations. Clin Transplant. 2020:e14035 This study uses survey data, literature review, and subject-matter expert consensus opinion to create a foundation for DCD liver recovery best practices. This may aid in increased utilization of DCD liver grafts.

  46. Pan ET, Yoeli D, Galvan NTN, Kueht ML, Cotton RT, O'Mahony CA, et al. Cold ischemia time is an important risk factor for post-liver transplant prolonged length of stay. Liver Transplant: Off Publ Am Assoc Stud Liver Dis Int Liver Transplant Soc. 2018;24:762–8.

    Article  Google Scholar 

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  1. Division of Transplantation, Department of Surgery, University of Wisconsin, 600 Highland Ave, MC 7375, Madison, WI, 53792, USA

    Adam D. Gracon & David P. Foley

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Correspondence to David P. Foley.

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Gracon, A.D., Foley, D.P. Strategies to Improve Liver Allocation, Distribution, and Utilization in a Broader Sharing Climate. Curr Transpl Rep 8, 1–8 (2021). https://doi.org/10.1007/s40472-021-00316-3

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