Concurrent Final Acceptance Associated with Decreased Deceased Donor Liver Utilization
1United Network for Organ Sharing, Richmond, VA, 2Center for Organ Recovery and Education, Pittsburgh, PA, 3Emory University Hospital and LifeLink of Georgia, Atlanta, GA, 4Mid-America Transplant Services, St. Louis, MO
Meeting: 2020 American Transplant Congress
Abstract number: A-118
Keywords: Allocation, Donation, Liver, Liver transplantation
Session Information
Session Name: Poster Session A: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: With broader sharing for candidates with high MELD scores, it is not unusual for liver candidates to receive offers from multiple donors. Accepting multiple liver offers for an extended period of time can have an adverse effect on the system as a whole. To address this issue, OPTN OPO Committee implemented a policy limiting candidates to accepting two livers at once in June 2018. The goal of this analysis was to describe the prevalence of concurrent liver offer acceptance and its impact on liver utilization after this policy went into effect.
*Methods: We queried the OPTN database for all deceased donor liver offers sent between June 13, 2018 and June 12, 2019 to identify concurrent acceptances. Expected donor liver yield was calculated using the SRTR Fall 2019 model. Liver utilization was assessed using observed to expected liver yield (O/E), where a ratio below 1 implied underutilization.
*Results: Over the course of a year, 597 candidates accepted two livers concurrently. Median length of concurrent acceptances was 4.75 hours (IQR: 0.5-10.3), and 256 candidates eventually turned down both livers. There were 917 possible liver donors with at least one concurrent acceptance on a match run. Of these, 65 did not donate any organs. 771 donors had a liver recovered, accounting for 8% of all liver donors recovered over the study period, and 81 had an organ other than a liver recovered. 341 livers were transplanted to the candidate with the concurrent acceptance, while 511 were not (Table 1). The group of livers transplanted to the concurrent acceptor had a larger expected yield than those not transplanted in the concurrent acceptor (Expected Livers Transplanted per Donor 0.85[95%CI: 0.84-0.87] vs 0.78[0.76-0.80]). Livers not transplanted to the concurrent acceptor had lower than expected liver yield (O/E Ratio: 0.91[0.88-0.93]), which suggests that these livers are being underutilized.
*Conclusions: It is not uncommon for centers to enter two concurrent acceptances for a single liver candidate, and decision makers spend hours determining which organ, if any, to accept. This practice may result in underutilization of the livers ultimately declined.
| Transplanted to Concurrent Acceptor | N | Livers Transplanted | Expected Livers Transplanted | Expected Livers Transplanted per Donor | Observed/Expected |
| Yes | 341 | 341 | 290.65 | 0.85(0.84-0.87) | 1.17(1.16-1.19) |
| No | 511 | 361 | 398.34 | 0.78(0.76-0.80) | 0.91(0.88-0.93) |
To cite this abstract in AMA style:
Robinson A, Shutterly K, Sellers M, Rosendale J, Brockmeier D. Concurrent Final Acceptance Associated with Decreased Deceased Donor Liver Utilization [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/concurrent-final-acceptance-associated-with-decreased-deceased-donor-liver-utilization/. Accessed November 24, 2024.« Back to 2020 American Transplant Congress