Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2023; 15(2): 255-264
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.255
Extended criteria brain-dead organ donors: Prevalence and impact on the utilisation of livers for transplantation in Brazil
Victoria S Braga, Amanda P C S Boteon, Heloisa B Paglione, Rafael A A Pecora, Yuri L Boteon
Victoria S Braga, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Amanda P C S Boteon, Heloisa B Paglione, Rafael A A Pecora, Yuri L Boteon, Transplant Centre, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Author contributions: Boteon YL contributed to study conception and design; Boteon YL, Braga VS, Boteon APCS, and Paglione HB contributed to acquisition of data; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to analysis and interpretation of data; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to drafting of manuscript; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to critical revision of manuscript; all authors contributed to editing and approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Hospital Israelita Albert Einstein (Approval No. 4.696.905 CAAE 39704520.0.0000.0071).
Informed consent statement: Informed consent was waived for patients in the study because of the study's retrospective nature and the use of a retrospective database.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuri L Boteon, FACS, MD, PhD, Doctor, Professor, Surgeon, Transplant Centre, Hospital Israelita Albert Einstein, 2nd floor, Building A1, Office 200B, 627/701 Albert Einstein Avenue, São Paulo 05652-900, Brazil. yuri.boteon@einstein.br
Received: November 23, 2022
Peer-review started: November 23, 2022
First decision: December 9, 2022
Revised: December 17, 2023
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 27, 2023
ARTICLE HIGHLIGHTS
Research background

The use of extended criteria donor (ECD) organs for transplantation has become a global need due to the lack of donor organs to attend to the high demand for the procedure.

Research motivation

Knowing the real prevalence of ECD in donation after brain death (DBD) donor organs can pave the way for future research to understand better how to improve their use safely.

Research objectives

To determine the prevalence of ECD allografts in DBD liver transplantation and the likelihood of organ acceptance over the years.

Research methods

This is a retrospective, single-centre study. Liver donor offers for the Solid Organ Transplant Program of the Hospital Israelita Albert Einstein, Sao Paulo, Brazil, were included between June 2017 and December 2020. Multivariate analysis was performed to determine if any Eurotransplant ECD criteria (ET-ECD) were independent risk factors for organ refusal for transplantation.

Research results

The prevalence of ECD among a total of 1619 organ donors analysed was 78.31%. There was an increase in the acceptance of ECD DBD organs for transplantation along the studied period. Despite that, for each addition of one ET-ECD criterion, the estimated chance of organ refusal was 64.4% higher (OR 1.644, 95%CI 1.469-1.839, P < 0.001).

Research conclusions

There was a high prevalence of ECD DBD even though an increase in the utilisation rate of these higher-risk organs was noticed. The presence and the number of extended donor criteria were risk factors for their refusal for transplantation.

Research perspectives

Further research is needed to develop more general accepted criteria to indicate ECD donor organs. This must guarantee more reliable data for comparison between countries. Furthermore, based on this diagnosis, strategies to increase ECD liver transplantation safely are urgently needed to attend to the demand for the procedure.