Donation After Circulatory Death Liver Transplantation Early Challenges, Clinical Improvement, and Future Directions

DCD allografts for LT remain a widely underutilized means to increase access to LT. With suitable donor and LT candidate selection criteria, appropriate donor and recipient matching, good surgical technique, and appropriate perioperative management, these grafts can achieve patient and graft survival equivalent to that observed in DBD LT. Current limitations in further growth of DCD LT are driven by risk aversion, and the current US DCD LT experience has largely been sequestered in large centers. With time, and the advent of regional and machine perfusion promises to completely redefine the definition of a viable DCD liver allograft and hopefully will encourage more widespread usage of and comfort with these organs.