Donation After Circulatory Death Liver Transplantation Early Challenges, Clinical Improvement, and Future Directions

DCD allografts for LT remain a widely underutilized means to increase access to LT. With suitable donor and LT candidate selection criteria, appropriate donor and recipient matching, good surgical technique, and appropriate perioperative management, these grafts can achieve patient and graft survival equivalent to that observed in DBD LT. Current limitations in further growth of DCD LT are driven by risk aversion, and the current US DCD LT experience has largely been sequestered in large centers. With time, and the advent of regional and machine perfusion promises to completely redefine the definition of a viable DCD liver allograft and hopefully will encourage more widespread usage of and comfort with these organs.

Automated summary

DCD liver transplantation is an underutilized method that can increase access to liver transplantation. With proper donor and recipient selection, matching, surgical technique, and perioperative management, these transplants can achieve similar patient and graft survival rates as DBD liver transplantation. The main limitations in the further growth of DCD liver transplantation are driven by risk aversion, and the current experience is mainly concentrated in large centers. With the advancement of regional and machine perfusion techniques, the definition of a viable DCD liver allograft may be redefined, encouraging wider usage and acceptance.