Liver transplantation from non-heart beating donors

Liver transplants from non-heart beating donors have the potential to increase the supply of organs by as much as 20%, according to experts in this week's British Medical Journal.

They believe that it's time to take notice of this promising way to boost the supply of human organs for transplantation.

Like most other solid organ transplants, liver transplantation has become a victim of its own success with more patients now on the waiting list as the number of donors declines.

In general liver donation rates are poor in the UK (13 per million population compared with 33 per million in Spain, the best in Europe). In order to use this scarce resource most effectively, clinicians are restricting access to transplantation to patients with a 50% chance of survival at five years.

Even so the supply is not able to meet demand. In the UK about 60 people die on the waiting list each year and up to 80 are removed from the list as their condition deteriorates.

To increase the number of organs available for transplantation, doctors use techniques such as split liver transplantation (one liver given to two recipients) or living donor transplants.

Another potential source of organs is the non-heart beating donor, where organs are retrieved after a "stand off" period of five minutes during which death is certified.

Although the early results were far worse than those with beating heart donors, survival rates are improving as new ways of preserving organs are found, say the authors.

The British Transplant Society has also recently published guidelines on all aspects of non-heart beating donation, including ethical and legal issues.

A reasonable prediction would be that non-heart beating donor livers have the potential to contribute about 10-20% more organs to the donor pool, a challenge which the medical community has to take up, they conclude.