Pool expansion for organ procurement: Older donors for liver transplantation

Graft survival is influenced by donor age especially in the long term. Use of grafts from elderly donors (ED) for liver transplantation is increasing in Europe and the US. ED have to be included in the category of extended criteria donor (ECD) grafts, with a risk of allograft failure, poor graft function and transmissible disease. Various attempts to quantify the risk associated with ECD in solid organ transplantation such as the donor risk index (DRI) have been made over the last years. The widespread attitude towards ECD and ED grafts is a careful selection of recipients, based on coupling of clinical, laboratory, and histology variables. Allocation of ECD grafts is a balance between two different policies: transplanting patients with the highest possibility of overcoming the post-transplant period course (healthiest recipients) or transplanting patients with the aim of reducing the waiting list mortality (sickest recipients). Donor grafts have to be used complying with the basic tenets of utility, quality, and transplant benefit.