- The Washington Times - Wednesday, May 12, 2004

The chronic shortage of livers available for transplant has prompted growing numbers of hospitals to accept donor livers they once would have refused.

At issue are organs from so-called “extended-criteria” donors, which offer transplant surgeons wider organ selection. These livers are not perfect matches for transplant recipients or may be from donors who were older and sicker than was once allowed. They also are intended for patients with the most severe cases of liver failure who cannot wait long for replacement livers.

“None of the major [liver transplant] centers in the United States would be able to serve patients [without organs from extended-criteria donors]. We couldn’t function,” Dr. Goran Klintmalm , chairman of the Baylor Regional Transplant Institute in Dallas, said yesterday.

Clinicians say it is not known whether transplantation of less-than-perfect livers affects long-term function of the organs or survival of the patients who receive them, but most data do not indicate they do.

“Because of the lack of organs, more centers are transplanting livers that were previously considered unacceptable,” Dr. Ronald W. Busuttil, head of liver transplantation at the University of California at Los Angeles Medical Center, wrote in a report published last year in the journal Liver Transplantation.

But health officials are scrutinizing such donations more closely after a hospital in Rochester, N.Y., was fined $20,000 last month for 10 violations in its adult liver transplant program.

Some violations against Strong Memorial Hospital, imposed by the New York Health Department, involved transplants in which patients had received livers from extended-criteria donors. In one case, a patient received a liver that did not match his blood type and died after successive transplantations. In another, a patient survived but needed a second liver transplant.

In both cases, state officials said Strong Memorial failed to provide proof that the transplant recipients were so ill as to require livers from extended-criteria donors or that they were fully informed of the risks. Hospital officials said the patients could not have waited for other organs.

Liver transplantation figures provided by the Richmond-based United Network of Organ Sharing (UNOS) demonstrate why some transplant surgeons are being less restrictive about the donor livers they accept.

“The current U.S. waiting list for liver transplants totals 17,400 [patients]. In 2003, 5,671 liver transplants were performed. Of those, 5,351 livers came from deceased donors and 320 from living donors,” said UNOS spokesman Joel Newman. Living donors can give part of their liver to a patient in need.

In 2002, use of expanded-criteria donors helped the University of Pittsburgh Medical Center (UPMC) reverse a 12-year decline in the number of liver transplants performed at local hospitals, the Pittsburgh Post-Gazette reported. Outcomes in terms of survival of patients and transplanted livers were among the best ever for UPMC, the newspaper said.

There is no clear definition for what constitutes an expanded-criteria liver donor, although UNOS has such guidelines for expanded-criteria kidney donors to help those who could die without a quick transplant.

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