The Expanded Donor

The expanded donor, previously referred to as the marginal donor, has assumed a much greater role in transplantation due to the critical shortage of organs. Prior to the waiting list reaching its current size, ideal donors were primarily utilized. Ideal donors are young, normotensive, brain-dead donors free of any disease and with minimal warm ischemia times. Table 5.4, which outlines the relative contraindications to transplantation may also be viewed as criteria that define the expanded donor. DCD donors, whether controlled or uncontrolled, should also be included in the expanded donor pool since warm ischemia times are greater and there are higher rates of delayed graft function. Likewise, split liver transplantation, where one donor liver is shared between one adult and one child or between two adults, should also be considered in the expanded donor definition. However, what is important to consider when utilizing expanded donors is the risk of a patient dying on the waiting list versus the risk of dying with transplantation of an organ from an expanded donor. Although graft function may initially be worse and long-term patient and graft survival less than from organs transplanted from ideal donors, the risk of dying has been shown to be less than if the patient continued on the waiting list. As more is learned about the expanded donor, pharmacologic interventions and changes in preservation, such as machine perfusion instead of cold storage, may eventually yield results similar to that obtained from ideal donors.

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