NEED AND SUPPLY OF LIVER GRAFTS IN TUSCANY

Background, Epidemiological data are fundamental to ade quately plan t he activity of a liver transplantation centre. Aim. To evaluate the ra tio between need and supply of liver grafts in Tuscany and to develop a regional strategy aimed at increasing donor recruitment. Methods. Th e need for liver grafts was estimated on the basis of an epidemiologic al study: 19 Medical Units were requested to fill in a questionnaire i nquiring into all Tuscan patients evaluated for liver disease during t hree different periods of one month each in 1996. The information coll ected was matched with the selection criteria currently employed at ou r centre and the patients were classified into the following four cate gories: I. current transplantation candidates; 2. future transplantati on candidates; 3. candidates not suitable on account of age; 4. candid ates not suitable on account of exclusion criteria. The number of live r donors was obtained from the donor registry. Results, Questionnaires were returned for a total of 452 patients: 27(5.97%) were classified as current transplantation candidates, 62 (13.72%) as future transplan tation candidates and 19 (4.20%) as candidates not suitable on account of age. The annual incidence and prevalence of transplantation candid ates were 14.7 and 30.6 cases per million inhabitants, respectively. I f age (greater than or equal to 61 years) was not considered in the ex clusion criteria, the annual prevalence of transplantation candidates reached 52.1 cases per million inhabitants. During the same period the re were 44 organ donors (12.2 donors per million inhabitants) of whom 33 were suitable for liver donation (9.3 liver donors per million inha bitants). To reduce this discrepancy a new programme for organ recruit ment, based upon the Spanish model, has been recently employed. Conclu sions, The annual need for liver grafts in Tuscany largely exceeds the number of donors currently available. It is hoped that the new region al programme for organ recruitment will improve these figures.