The Surge in Deceased Liver Donors Due to the Opioid Epidemic: Is It Time to Split the Difference?

Abstract

Background– This study aimed to compare trends in use of drug overdose (DO) donors in adult vs. pediatric liver transplants and the utilization of split liver transplantation in this donor population. Methods– The UNOS database was reviewed for deceased donor liver transplants from March 2002 – December 2017. Recipients were categorized by donor mechanism of death. Donor splitting criteria was defined as age < 40 years, single vasopressor or less, transaminases no greater than 3 times the normal limit, and BMI ≤ 28 kg/m². Results– Adult liver transplants from DO donors increased from 2% in 2002 to 15% in 2017, while pediatric liver transplants from DO donors only increased from <1% to 3% in the same time. While 28% of DO donors met splitting criteria, only 3% of those meeting splitting criteria were used as a split graft. Both pediatric and adult recipients of DO donor livers achieved excellent patient and graft survival. Conclusions– DO donors are underutilized in pediatric liver transplantation. Increased splitting of DO donor livers could significantly decrease, if not eliminate, the pediatric liver waiting list.