INTRODUCTION: As compared to other donor organs, there is little data regarding damage to deceased donor livers during recovery. The objective was to generate an estimate of transplantable organs lost because of technical or systems failures.

METHODS: A Standard Transplant Analysis and Research Deceased Donor file was analyzed for the period 1/00-3/10. Whole livers consented for recovery and not recovered, or recovered and not transplanted were included. For all missing or other data points, text variables were reviewed and re-coded where appropriate by 2 authors independently, and non-concordance was discussed to consensus.

RESULTS: 63,150 livers were recovered, of which 88% were transplanted, 2% were recovered for research, and 6,093 (10%) were recovered, but not transplanted. Of the latter organs, 642 (11%) were not transplanted for clear technical or logistical circumstances: 34% because recipients were deemed unsuitable for transplantation in the operating room, 24% for extended cold-ischemia times, 19% for vascular injuries, 14% for organ trauma (not associated with cause of death), and 9% for organ size/description. Additionally, 7,851 organs were consented for donation, but not recovered. Of these, 197 organs (2.5%) were not recovered for clear technical or logistic reasons: 76% because of time constraints or absence of recovery teams, and 24% because of surgical damage.

CONCLUSION: Within the confines of the database, a conservative estimate of approximately 80 livers are not recovered or transplanted annually because of technical or systems failures; a moderate estimate suggests a rate 3-4 times this. Although a small relative number, this stands as an estimate of lives that could be saved if these practices were addressed by better training recovery surgeons, and organizing an appropriate system for backing-up patients.

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