Commercial Aviation as an Alternative to Charter Flights in Liver Transplantation: A Case Report

Abstract

The transition to the acuity circle liver allocation system has increased transportation distance, cold ischemia time, and procurement costs. The increase in procurement cost is largely due to a higher reliance on charter flights. Although charter flights are flexible, they are expensive and have a considerable environmental impact. At the same time, advances in controlled hypothermic preservation have extended safe preservation times and may allow broader use of ground and commercial air travel as cost-conscious alternatives to charter flights. We report a case of a donor liver preserved with contemporary hypothermic technology was transported using a commercial airline flight. A 52-year-old donor underwent donation after circulatory death with normothermic regional perfusion. The liver was preserved using the LIVERguard system and transported 356 nautical miles on a commercial flight. Total transportation costs were 14,152 dollars, compared to an estimated 19,000 dollars for a comparable charter flight with ground transfer. LIVERguard preservation time was 9 hours 30 minutes, followed by 4 hours 42 minutes of hypothermic machine perfusion, for a total cold ischemia time of 16 hours 48 minutes. The recipient was a 61-year-old female with metabolic dysfunction associated steatohepatitis and a MELD score of 21. The postoperative course was complicated only by a GI bleed. She had excellent early allograft function and was discharged home on postoperative day 15. This case suggests that commercial flights, paired with advanced hypothermic preservation, can provide a viable, cost effective, and environmentally favorable alternative to charter flights while maintaining organ quality under current allocation practices.