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Recipient and Donor Selection and Transplant Logistics: The US Perspective

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Liver Anesthesiology and Critical Care Medicine

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Abstract

Organ allocation for donor livers in the USA follows an algorithm of medical urgency determined by 3-month mortality risk based on objective laboratory values. However, a framework of local and regional distribution units is superimposed on the prioritization of organ recipients resulting in significant geographical differences with regard to waiting time and severity of disease at the time of transplant. Changes in the current allocation and distribution policies are evaluated but have to balance increased cold ischemia times and cost efficiency with equity. While the number of “standard criteria” deceased organ donors has remained relatively stable over the last decade, there was an increase of primarily older donors, donors with comorbidities, and donations after cardiac death. These so-called expanded criteria donors together with the use of donors with steatotic livers have broadened the donor pool, but bear an increased risk of organ dysfunction to the liver recipient. Currently clinical outcome research focuses on which patient population will benefit the most from which type of expanded criteria organ. In the United States, living donor liver transplantation has not evolved into a significant proportion of the total number of liver transplantations and remains an option predominantly for pediatric recipients and recipients who are not prioritized in the current allocation system.

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Author information

Authors and Affiliations

  1. Department of Surgery I, University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany

    Ingo Klein

  2. Department of Surgery, Division of Transplantation, University of California, San Francisco, San Francisco, CA, USA

    Ingo Klein

  3. Departments of Anesthesia and Perioperative Care and Surgery, Division of Transplantation, University of California, San Francisco, San Francisco, CA, USA

    Claus U. Niemann

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  1. Ingo Klein
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Correspondence to Ingo Klein .

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Editors and Affiliations

  1. , College of Physicians & Surgeons, Departments of Anesthesiology, of Columbia University, New York, 10032, New York, USA

    Gebhard Wagener

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Klein, I., Niemann, C.U. (2012). Recipient and Donor Selection and Transplant Logistics: The US Perspective. In: Wagener, G. (eds) Liver Anesthesiology and Critical Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5167-9_7

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  • DOI: https://doi.org/10.1007/978-1-4614-5167-9_7

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5166-2

  • Online ISBN: 978-1-4614-5167-9

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