How many liver grafts could be recovered after implementation of donation after cardiac death in Germany?

Utilization of livers donated after circulatory death for transplantation – An international comparisonJournal of HepatologyVol. 78Issue 5PreviewLiver graft utilization rates are a hot topic due to the worldwide organ shortage and the increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially enable the assessment of livers before use. Full-Text PDF Open AccessHow many liver grafts could be recovered after implementation of donation after cardiac death in Germany?Journal of HepatologyVol. 79Issue 3PreviewWe read with great interest the article by Eden et al. regarding the utilization of livers donated after circulatory death (DCD), analyzing liver offers from eight Western countries.1 Noticeably, Germany was not part of this analysis, where organ donation is by law restricted to donation after brain death (DBD) or living donation. However, the success of liver transplantation has been seriously limited, in particular in Germany, by a decline in organ donation over the last decade. Liver graft availability in Germany is restricted by a suboptimal registration process of potential organ donors, by a low social acceptance of organ donation, and by potential quality concerns of DBD grafts donated from an elderly population. Full-Text PDF Germany—the potentially underestimated key player in European DCD type III organ donation? To the Editor: With great interest we read the letter by Moosburner et al.[1]Moosburner S. Sauer I.M. Pratschke J. Raschzok N. How many liver transplants could be recovered after implementation of donation after cardiac death in Germany?.J Hepatol. 2023 Mar 11; (S0168-8278(23)00176-9)https://doi.org/10.1016/j.jhep.2023.03.001Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar concerning our recent publication on the utilization of controlled (type-III) livers from donation after circulatory death (DCD) donors.[2]Eden J. Da Silva R.S. Cortes-Cerisueloa M. Croome K. De Carlis R. Hessheier A.J. et al.Utilization of livers donated after circulatory death for transplantation-an international comparison.J Hepatol. 2023 May; 78 (Epub 2023 Feb 4): 1007-1016https://doi.org/10.1016/j.jhep.2023.01.025Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The authors discuss a few relevant points which we would like to comment on. First, the number of estimated DCD type-III donors in Germany is impressive and much higher than reported in any other country with active DCD III liver transplantation (Fig. 1). Nevertheless, the association between how many patients died on the ICU and rates of DBD and DCD donation in other European countries remain unclear. Differences between countries may for instance be related to variances in the number of inhabitants, financial and logistic factors, including the high number of specialized hospitals, the population density (people/km2), the health care system and financial stability. Based on the presented numbers, Germany could in theory be a major contributor to DCD III liver transplantation in Europe and even worldwide, which stands in stark contrast to the continuously rather low numbers of DBD donations in this country. The implementation of a DCD-III donation program in Germany could therefore have a huge impact on many patients on the waiting list. Change will require not only the medical community to be on board but also politicians, regulatory authorities and the general population. Ethical reservations need to be addressed and taken seriously, as this might be the main obstacle to the implementation of a DCD III program. Secondly, despite this high potential, Germany currently lacks experience regarding the DCD III process, the associated surgical procedures, and the application of modern machine perfusion technologies. Support is needed in terms of collaboration of intensive care unit staff, coordinators, surgical teams, and perfusionists, etc., and evidence-based education is key. Third, Moosburner et al. calculated 320 additional liver grafts from 1,500 potential liver offers, based on 8,500 potential donors each year. This figure appears rather low if machine perfusion technology is routinely applied. We would therefore emphasize that as many as 800-900 livers may be utilized from 1,500 donor liver offers, corresponding to a 50-60% utilization rate.[2]Eden J. Da Silva R.S. Cortes-Cerisueloa M. Croome K. De Carlis R. Hessheier A.J. et al.Utilization of livers donated after circulatory death for transplantation-an international comparison.J Hepatol. 2023 May; 78 (Epub 2023 Feb 4): 1007-1016https://doi.org/10.1016/j.jhep.2023.01.025Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Of note, this number of DCD III liver transplantations would be higher than that for all other European countries combined. In summary, a functioning DCD III program in Germany, together with the implementation of centralized assessment centers using modern liver perfusion technologies to improve and assess available organs for transplantation, is of utmost interest for the entire European transplant community. This will inevitably have a high impact on a large number of patients with acute and chronic liver diseases in all European countries. The authors received no financial support to produce this manuscript. The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details. JE: wrote draft (text and Figure). AS: revised draft. PD: revised draft. The following are the supplementary data to this article: Download .pdf (.2 MB) Help with pdf files Multimedia component 1