Changing typology of brain death liver donors: characteristics and impact of risk factors on short-term outcome

ACKGROUND/AIMS: An effective recruitment plan and the use of donors with risk factors are essential means of compensating for the lack of organs, but mean a significant change in the type of donor. This study defines the characteristics of the donors currently used, evaluates their impact on short-term outcome and underlines the need for a different approach to organ selection. METHODOLOGY: Data concerning 244 patients were collected for the study of donor characteristics by age groups, and the multivariate analysis of the associated risk factors. RESULTS: There were no significant differences other than the cause of donor death and the appearance of the organ. The annual percentage of donors aged more than 60 years has increased from 5.2% to 47.6%; the percentage of organs from over-60-year-old donors discarded after bioptic sampling was 25.6% (10.4% for donors aged < 60 years). Perioperative mortality did not significantly differ on the basis of donor age (p = 0.186). CONCLUSIONS: Today's liver donors are mainly subjects who have died of cerebrovascular disease, often at an age of > 60 years, and are also affected by other diseases or metabolic alterations. They require a different method of evaluation and, in those aged more than 60 years, the routine use of histological examinations in organ selection. Furthermore, the judicious extension of the inclusion criteria and the characteristics of the currently available donors do not seem to affect short-term, post-transplant outcome.