Report of the Paris consensus meeting on expanded criteria donors in liver transplantation.

Abstract

Because of organ shortage and a constant imbalance between available organs and candidates for liver transplantation, expanded criteria donors are needed. Experience shows that there are wide variations in the definitions, selection criteria, and use of expanded criteria donors according to different geographic areas and different centers. Overall, selection criteria for donors have tended to be relaxed in recent years. Consensus recommendations are needed. This article reports the conclusions of a consensus meeting held in Paris in March 2007 with the contribution of experts from Europe, the United States, and Asia. Definitions of expanded criteria donors with respect to donor variables (including age, liver function tests, steatosis, infections, malignancies, and heart-beating versus non-heart-beating, among others) are proposed. It is emphasized that donor quality represents a continuum of risk rather than "good or bad." A distinction is made between donor factors that generate increased risk of graft failure and factors independent of graft function, such as transmissible infectious disease or donor-derived malignancy, that may preclude a good outcome. Updated data concerning the risks associated with different donor variables in different recipient populations are given. Recommendations on how to safely expand donor selection criteria are proposed.

• Authors: François Durand, John F Renz, Barbara Alkofer, Patrizia Burra, Pierre-Alain Clavien, Robert J Porte, Richard B Freeman, Jacques Belghiti
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 14 Issue 12 Pg. 1694-707 (Dec 2008) ISSN: 1527-6473 [Electronic] United States
• PMID: 19025925 (Publication Type: Journal Article, Review)

Chemical References

• Organ Preservation Solutions

Topics

• Cold Ischemia (standards)
• Consensus
• Donor Selection (ethics, methods, standards)
• Humans
• Liver Transplantation (ethics)
• Organ Preservation Solutions (standards)
• Paris
• Practice Guidelines as Topic
• Tissue Donors (ethics, supply & distribution)