Donor Selection in DCD Liver Transplantation

Despite recent outcome improvement, liver transplantation from donation after circulatory death (DCD) donors remains a challenge. Multiple donor, graft and procurement factors not only contribute to the results after transplantation but also impact on the selection process and the decision to utilize or decline such livers, which potentially transmit a high risk for severe complications including primary graft non-function or ischemic cholangiopathy. Although the transplant community has gained significant experience in this field, the majority of risk factors is still inconsistently reported with various acceptance criteria and thresholds, when to accept a DCD donor liver, which also depends on national and centre guidelines and the surgeons’ experience. Throughout the past 10 years, we have developed an increasing awareness of the cumulative risk and how to best combine donor and recipient parameters, which encouraged the community to adapt the allocation process and to match certain DCD livers with presumed higher risk with healthier recipients, as, for example, with candidates with liver tumours. In this chapter, we highlight currently considered donor and graft risk factors and how they contribute to outcomes after transplantation. Additionally, we also describe the impact of donor surgery and current prediction models which may influence the DCD liver selection process and how we may expect new developments and preservation technology to impact on our decisions in the future.