Reviewing the causes for 1432 discharged liver donors: can donations be increased?

Thousands of patients are awaiting liver transplantation, mainly owing to the lack of donors. The aim of this study was to analyze the characteristics of discarded livers from donors seeking to understand how to increase the number of grafts. A retrospective analysis of 1432 discarded donor livers was performed in the period between 1994 and 2007. Data were stored in a standardized database in accordance with expanded donor criteria. The average donor age was 35.2 years with; 67.7% male subjects and 20.9% over age 50 years. The main cause of donor discard was family refusal (46.6%), followed by cardiorespiratory arrest (CRA) in 28.3%, and surgeon discard (16.9%), principally owing to sepsis (24.5%). Vasopressor drugs were used in 97.2%. Alcoholism was detected in 44.56% and drug addiction in 12.4%. There was infections documented in 23.9% of records, mainly of the respiratory type (75%). Intensive care time was over 120 hours in 11.0%. Hepatitis B infection was detected in 22.5%, (n = 338), and hepatitis C in 3.5% (n = 593). Finally, there were losses due to hypotension in 45.7% (516/1130) and also loss due to CRA. As family refusal was the principal cause for discarding a donor, it is necessary to investigate the role of information about organ transplantation to increase acceptance.