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Several factors spurred decrease in use of liver donations for transplantation
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A decline since 2004 in the use of donated livers for transplantation is attributable to advanced age and a greater prevalence of high BMI, diabetes and cardiac-related death among donors, according to recent results.
Using data from the United Network for Organ Sharing database, researchers assessed trends in the characteristics of 107,259 deceased organ donors in the United States between 1988 and 2010 to determine potential associations between specific factors and the nonuse of donated livers. Only adult donors from whom one or more organ was transplanted to a recipient were included.
Between 1988 and 2004, the proportion of unused donated livers decreased from 66.2% to 14.8%, but increased again to 20.7% by 2010. During the study period, investigators noted increases to average donor age (34.6 years in 1988 to 43.3 in 2010) and the prevalence of BMI of 30 kg/m2 or higher (15% in 1995 to 30.3% in 2010), diabetes (3.2% in 1995 to 12% in 2010) and organ donation after cardiac-related death (DCD) (1.1% in 1995 to 11.2% in 2010). Each factor was independently associated via multivariate analysis with the nonuse of donated livers.
The association between DCD and nonuse increased between 2004 (OR=5.53; 95% CI, 4.57-6.70) and 2010 (OR=21.31; 95% CI, 18.3-24.81). Nonuse of a donated liver was attributable to DCD in 28.4% of cases in 2010, compared with 8.7% in 2004. Nonuse attributable to donor age of 50 years or older also rose from 2004 to 2010 (16.7% of cases to 22.9%, respectively).
“The prevalences of advanced donor age, elevated BMI, diabetes and DCD have all increased,” the researchers wrote. “These factors are associated with liver nonuse, and the impact of DCD on nonuse has grown rapidly. A better understanding … for the increasing proportion of DCD in particular is critical to understanding this declining utilization. These trends, along with stagnant donation rates, suggest significant declines in liver transplant availability in the coming years.”
Disclosure: See the study for a full list of relevant disclosures.