Reviewing the Causes for 1432 Discharged Liver Donors: Can Donations Be Increased?

Prevalence and Profile of Discarded Liver Donors in a Tertiary Health Service in Brazil From 2015 to 2018

BACKGROUND

Little has changed in donor management and liver utilization rates in Brazil over the last decade. With a growing demand for liver donations, organ waste is an important obstacle toward better patient care. The study of discarded donors helps to shed light on the possibilities of increasing organ usage, including by using extended criteria donors.

METHODS

We retrospectively analyzed all discarded liver donors in a high-volume Brazilian transplant center from January 2015 to December 2018. Pertinent clinical and laboratorial data were collected from the donors' electronic health records.

RESULTS

In our study period, there were 248 liver harvests, of which 67 (27.0%) were discarded. Most discarded donors were male (65.7%). More than three-quarters of donors were Caucasian (79.1%). Median donor body mass index was 26.27 kg/m², and most discarded donors presented no comorbidities. Donor liver injury tests were abnormal in 56 (83.5%) out of 67 discarded donors. Forty-three (64.1%) donors presented elevated transaminases. Alanine aminotransferase levels were elevated in 35 (52.2%) discarded donors, with a median value of 38 U/L. Half of all discarded livers were due to graft-related issues. Twenty-eight organs (41.79%) presented external pathologic alterations. Organ refusal due to donor clinical and laboratorial condition was reported in 24 cases.

CONCLUSION

It is clear there is a considerable issue of organ waste in Brazil, with the subjective judgment of graft quality and inadequate interpretation of donor's laboratorial exams leading to excessive denial of organs that could be fitted into extended criteria for donation.

Liver Transplantations and Brain Dead Donors With Alcohol Abuse

BACKGROUND AND AIM

Liver grafts from donors with chronic and active history of alcohol abuse are usually immediately ruled out for use in liver transplantation (LT). The aim of our study is to evaluate the use of those grafts.

METHODS

From 2011 to 2016, a study group (Group 1) composed of 5 adult LT patients transplanted with livers from donors with alcohol abuse, was compared with a control group (Group 2) of 10 randomly matched patients who received liver transplants. Preoperative, intraoperative, and postoperative data were compared.

RESULTS

Among donors, serum gamma-glutamyl transferase values were significantly higher in Group 1. In recipients, post-LT laboratory exams showed significantly higher peak values of aspartate transaminase and alanine transaminase in Group 1; higher values of aspartate aminotransferase, alanine aminotransferase, and total bilirubin in Group 1 were also recorded on day 0. Early allograft dysfunction occurred at higher rates in Group 1 (80% vs 20%, P = .025), with no differences in early rejection episodes or early surgical repeat interventions. All patients from both groups were alive after 20 ± 10 (range 6-35) months from LT.

CONCLUSION

Despite higher rates of early allograft dysfunction, selected liver grafts from donors with alcohol abuse can be accepted for LT with good clinical results.

Heavy Alcohol Use Among Deceased Donors Does Not Impact Recipient Outcomes After Liver Transplantation

BACKGROUND

Data on liver transplant (LT) outcomes using deceased donors with heavy drinking (HD) (>2 drinks per day) are scanty.

METHODS

Using the United Network for Organ Sharing database (2002-2014), we examined outcomes after LT in adults comparing deceased HD donors with non-HD (ND) donors.

RESULTS

Of 56 182 first LTs performed in the United States for 10 common indications using deceased donors, 47 882 with available information on alcohol use were analyzed. Of these 47 882 LT recipients, 7298 (15%) were from HD donors, with similar proportion over time (2002-2014, Armitage trend test P = 0.75) and for recipient liver disease etiology (χ P = 0.42). Proportion of liver organ used for LT was lower for HD donors compared with ND donors (63% vs 78%; P < 0.001). Five-year outcomes on first LT comparing 7166 HD donors and 21 498 ND donors matched based on propensity score were similar for liver graft (73.7% vs 73.7%, log rank P = 0.98) and patient survival (77.6% vs 77.0%, P = 0.36). On Cox regression analysis, history of HD in deceased donors did not affect liver graft 1.02 (0.97-1.08) or patient survival 1.03 (0.97-1.09).

CONCLUSIONS

Among LT recipients using select liver grafts, history of HD in deceased donors does not impact outcomes after LT.

Religious and ethnic influences on willingness to donate organs and donor behavior: an Australian perspective

CONTEXT

Globally, the demand for donated organs outstrips supply, meaning that there are both practical and theoretical reasons for examining factors that are predictive of individuals' willingness to donate their organs upon their death.

OBJECTIVES

To determine whether individuals of different religious denominations living in Australia have different views on organ donation, whether donation attitudes differ significantly across ethnic groups, and whether factors identified in international research are predictors of willingness to donate and actual donor behavior in this population.

PARTICIPANTS

Data for this study were collected from students at an Australian university from a range of religious and ethnic backgrounds, and their friends and relatives (N = 509). Intervention-Participants were administered the Organ Donation Attitude Scale, as well as additional attitudes and knowledge measures.

MAIN OUTCOME MEASURES

Self-reported "willingness to donate" and "donor behavior".

RESULTS

Our findings complemented those reported in comparable countries, with females, younger Australians, and those with high knowledge levels being more willing to donate than males, older persons, and those with low knowledge. Persons who described themselves as having stronger religious beliefs (particularly Buddhist and Islamic) held less favorable attitudes toward donation, had lower knowledge levels, and were more likely to oppose donation.

CONCLUSIONS

Although this study established that attitudes toward, knowledge about, and predictors of organ donation in Australia are similar to those reported elsewhere, donation rates remain low. Further in-depth research examining the impact of religion and culture on attitudes, beliefs, and behavior is essential when exploring strategies to improve organ donation rates in highly multicultural societies such as Australia.

Religious and Ethnic Influences on Willingness to Donate Organs and Donor Behavior: An Australian Perspective

Context

Globally, the demand for donated organs outstrips supply, meaning that there are both practical and theoretical reasons for examining factors that are predictive of individuals' willingness to donate their organs upon their death.

Objectives

To determine whether individuals of different religious denominations living in Australia have different views on organ donation, whether donation attitudes differ significantly across ethnic groups, and whether factors identified in international research are predictors of willingness to donate and actual donor behavior in this population.

Participants

Data for this study were collected from students at an Australian university from a range of religious and ethnic backgrounds, and their friends and relatives (N = 509).

Intervention

Participants were administered the Organ Donation Attitude Scale, as well as additional attitudes and knowledge measures.

Main Outcome Measures

Self-reported “willingness to donate” and “donor behavior.”

Results

Our findings complemented those reported in comparable countries, with females, younger Australians, and those with high knowledge levels being more willing to donate than males, older persons, and those with low knowledge. Persons who described themselves as having stronger religious beliefs (particularly Buddhist and Islamic) held less favorable attitudes toward donation, had lower knowledge levels, and were more likely to oppose donation.

Conclusions

Although this study established that attitudes toward, knowledge about, and predictors of organ donation in Australia are similar to those reported elsewhere, donation rates remain low. Further in-depth research examining the impact of religion and culture on attitudes, beliefs, and behavior is essential when exploring strategies to improve organ donation rates in highly multicultural societies such as Australia.