Introduction. The primary strategic goal for the OPTN is to increase the number of transplants. To that end, we analyzed the characteristics of donors from whom livers have been historically difficult to place, but ultimately were transplanted. Discards from such donors may represent missed opportunities for transplant. Methods. Based on data from 6/18/13 – 10/31/14, tree regression was used to identify donor factors on the match that were associated with sharing of the liver (transplanted outside of the procuring DSA). We excluded donors from whom livers were shared regionally according to OPTN policy, as well as donors from Puerto Rico/Hawaii. Having identified donor factors that were predictive of a difficult to place liver (DTPL), we then analyzed all donors from whom at least one organ was recovered for transplant from 10/1/13 – 9/30/14 to see which ones met the criteria. Results. The profiles of DTPL donors (N=3295) are shown in the table. Positive serology (HCV, HBV), increasing donor age, DCD, and greater BMI were all predictive of sharing. As a group, DTPL donors were more likely to be shared than non-DTPL donors (OR=2.68, 95% CI=2.34,3.08). For individual profiles, the OR of sharing (comparing each profile to non-DTPL donors) ranged from 1.8 to 7.4. Of organs not recovered, 65.9% (n=734) met a DTPL profile. Of organs recovered, but not for transplant, 80.3% (n=282) met a DTPL profile, and of organs recovered for transplant, but not transplanted, 55.9% (n=372) met a DTPL profile. Of organs transplanted during that era, 30% (n=1853) met a DTPL profile. The reasons why livers were not recovered varied, but included time constraints, failure to identify a potential recipient, and poor organ function. The reasons why livers were recovered for transplant but were not transplanted also varied, but included biopsy findings, organ abnormalities, and failure to identify a potential recipient. Conclusion. Special consideration should be given to alternative allocation schemes for donors meeting the DTPL criteria to decrease time constraints and identify suitable recipients which may increase the likelihood of transplanting these livers.

CITATION INFORMATION: Edwards E, Harper A, Rosendale J, Eason J. Difficult to Place Livers: Implications for Expanding the Donor Pool. Am J Transplant. 2016;16 (suppl 3).

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