Limits for Adult Liver Donation in Spain

Abstract

BackgroundLiver donation is the cornerstone for the expansion of liver transplantation. Although big efforts have been performed to release alternatives for increasing the donor pool, only extended-criteria donors have become a feasible option. MethodsThe success of the Spanish Model for organ transplantation is well known. Approximately 5.4% of all the liver transplants (LT) are performed in Spain, with a rate of 22.9 LT per million people (pmp). ResultsApproximately 70 papers on extended-criteria donors have been reported from Spanish LT teams. Pioneering works in donor steatosis, non–heart-beating donors, donor age–hepatitis C virus, ischemia/reperfusion injury, normothermic extracorporeal membrane oxygenation, and donor steatosis–hepatitis C virus are among the main contributions in the field. Considering data from the Spanish National Registry, it can be observed that an accumulation of donor and recipient factors leads to a continuum of risk for liver transplantation. Donors are not “bad” enough to decline a liver offer per se. ConclusionsIn Spain, clear efforts should be made to work on more stable and homogeneous criteria for donor acceptance. In this sense, defining a specific Spanish donor risk index would be helpful.