INTRODUCTION: Discrepancy between demand (end stage organ disease) and supply (organs) remains one of the limiting factors in solid organ transplantation and underlies the dynamics of organ allocation and utilization.

Although the main forces driving organ utilization include organs shortage, recipient medical conditions, acuity of organ disease and donors / organs quality, other factors may be involved.

We reviewed organ utilization from deceased donor liver through the SRTR database and analyzed factors involved.

MATERIAL AND METHOD: Review of the SRTR data base (public data).

RESULTS: In 2012 from 8144 donors, only 5942 liver allograft were transplanted, 691 (8.5%) were recovered but not transplanted and 1141 (14%) were not recovered. In the first group allografts were not transplanted because recipient was not located in 21 cases or for other reasons in 117 cases (total 138 / 691: 19.9 %). In the second group allografts were not recovered because recipient was not located in 70 cases or for other reasons in 124 cases (total 194 / 1141: 17 %). Of 1832 liver allografts 332 (18%) were not utilized for reasons probably not medically related.

CONCLUSIONS: Recipient medical conditions and quality of the allografts don't seem to be the only factors involved in liver allografts utilization: ethnic and geographical disparities and other socio-economic barriers, may also be involved. Livers not utilized due to inability to identify a recipient and / or for reasons listed as “other” in the SRTR database may reflect these disparities and barriers. Since liver allocation is based on disease acuity with high patients' mortality in the absence of organ replacement therapy, unused organs for reasons that don't seem to be medically related, contributes to increased patients' mortality on the waiting list as well as increased healthcare costs. Patients' and providers' education may attenuate these disparities and improve liver utilization for transplant where multifactorial elements are involved.

Study limitations: retrospective review, not capturing all aspects involved in the liver allografts utilization and allocation process, from deceased donors. Additional studies may provide further insight to improve liver utilization for transplant in the US.

« Back to 2015 American Transplant Congress