The Dilemma of High-Risk Deceased Donor Livers: Who Should Get Them?

Key Points 1. The insufficient supply of deceased donor livers for transplantation has motivated the expansion of acceptance criteria; such organs are captured by the terms marginal and expanded criteria livers. 2. This context of aggressive liver utilization motivated the derivation of the donor risk index, a quantitative, objective, and continuous metric of liver quality based on factors known or knowable at the time of an organ offer. 3. Recommendations from traditional wisdom to pair high-risk livers with healthy candidates are strongly reflected in current practice. 4. Although deceased donor quality worsens posttransplant outcomes, it does not synergize negatively with increased recipient disease severity. 5. Calculations of survival benefit support the preferential transplantation of high-risk livers into sick candidates rather than healthy ones. 6. Those making individual decisions regarding transplant opportunities should consider donor and organ specifics, recipient characteristics, anticipated transplant circumstances, center expertise, and the dynamics of local organ availability in addition to data and analyses based on national registries. Liver Transpl 16:S60-S64, 2010. copy; 2009 AASLD. Copyright © 2009 American Association for the Study of Liver Diseases.