POLICIES IN EUROPE ON MARGINAL QUALITY DONOR LIVERS

Shortage of donor livers has led several liver transplant centres to w iden their definition of liver donor suitability. We have assessed the function of liver grafts from ''marginal'' donors and attitudes to us e of such organs. Over an 18-month period, livers used in 30 of 213 co nsecutive liver transplantations in Birmingham, UK, came from marginal donors (history of alcoholism, abnormal liver function test results, drug overdose that included paracetamol, advanced cardiovascular disea se, sepsis, lengthy hypotension [systolic blood pressure <80 mm Hg for >1 h], high-dose inotropic drug use). 16 of these donors had been ref used by other UK liver transplant centres, 11 on medical grounds. The controls were grafts retrieved from ''good'' donors (n=183) during the same period. All 30 grafts showed satisfactory early function but had greater day 1 (p=0.004) and peak serum aspartate aminotransferase (p= 0.0008) values than control grafts. Graft and patient survival at 1 ye ar in the two groups was similar (72% vs 73% and 80% vs 82%, respectiv ely). To assess attitudes to marginal donor livers, a questionnaire ou tlining the details of these 30 donors was sent to the 80 centres in t he European Liver Transplant Group, and 60 replied. Median immediate r efusal rate of the marginal donors was 7/30 (range 0-18) and median ou tright acceptance rate was only 11/30 (1-26). Larger centres were less selective, with a significantly lower refusal rate (p=0.03). These re sults indicate that, because of existing liver donor criteria within E urope, usable donor livers are being unnecessarily refused on medical grounds.