Use of Extended Criteria Deceased Donors in Adult Liver Transplantation

Reflective of the gross national shortage of organs available for transplantation, utilization of extended criteria donor livers has gained momentum, arguing the merits of transplantation with higher risk organs outweighs the risks associated with staying on the waiting list. As a result, high-risk extended criteria allografts, previously referred to as marginal or compromised organs, have become an important part of the donor organ supply. Unfortunately, the use of “expanded” criteria liver allografts remains undefined. Therefore, due to regional heterogeneity in the landscape of national scarcity, allocation policies for extended criteria allografts have largely been transplant center specific and calibrated based on predicted recipient benefit, projected reduction in waitlist mortality, and parity. The utility, selection, and performance of “extended criteria” donor allograft livers are examined in this review.