2. Expanded Criteria - An Overview
• No universal national definition
• Significantly increases the availability of organs
BOTTOM LINE:
• These are organs with a potential higher risk of graft
failure
3. Common Reasons for Selection
DONOR FACTORS SPECIAL SITUATIONS
• Donor with history of • Split Liver Transplantation
Hepatitis C • DCD "Donation after
• Donor is inactive carrier of Cardiac Death" Liver
Hepatitis B
• Donor Liver with Steatosis
• Donor Age >70 yo
4. Donor with Hepatitis C
• Only for Recipients with Hepatitis C
• Need to have Biopsy evidence of NO HEPATIC DAMAGE in
donor
5. Donor with Inactive Hepatitis B
• Can be transplanted into patient with Hepatitis B or a
patient with prior immunization for Hepatitis B
• Recipients may potentially need anti-viral treatment post
transplant to prevent reactivation
6. Donor Liver with Steatosis
• Not the strictest of criteria
• May not be appropriate for all patient populations
• May have slow recovery of graft function post transplant
7. Donors of Older Age
• Age > 70year old
• May have slow graft function
• Higher risk of Graft Failure (~3-4 % higher that younger
donors)
8. Split Liver Transplantation
• Single liver may be split to be transplanted in two different
patients
• Usually large portion for adult and smaller portion for
pediatric patient
• Much higher risk of complications (bleeding, vascular,
biliary)
• Much higher risk of failure (RR 1-4% higher)
9. Donation after Cardiac Death (DCD)
• Donor does not qualify for brain death
• Involves warm ischemia for a few minutes before organ is
harvested after which cold ischemia is provided
• Increases risk of graft failure (1-5% higher) and delayed graft
function
10. Conclusion
Massive shortage of donors currently exists
Expanded donor criteria may provide that increased number of
available livers
ALL SOUNDS GOOD BUT...
THERE IS AN URGENT NEED FOR PROSPECTIVE, ROBUST
DATA TO SHOW THE SAFETY AND EFFICACY FOR THESE
AS IT IS TOO EARLY TOO TELL FOR MANY OF THEM!
