Transplant for the very sick: No limitations in donor quality?

Abstract

When it comes to maximizing allograft function, the recipient is just as important as the liver graft itself. Whereas the “healthiest” of liver transplant candidates are likely to gain significant benefit from a liver graft of any quality, the sickest of candidates may still die despite transplantation with even an ideal liver. However, the very sick patients are precisely the ones who have the greatest need for liver transplantation—with any liver, regardless of quality—because they are most vulnerable to pretransplant death without one. How does one balance the urgent need for liver transplantation with optimization of the allograft’s function and utility for the very sick patient?

Expanding MELD exceptions for colorectal liver metastasis: data and policy

“…Considering the immediate postoperative risk associated with these grafts, they are most often relegated to the lower-MELD or ‘healthier’ patients. Low MELD recipients are better able to handle the stress of a prolonged recovery period and ultimately recover a similar function to that of healthier grafts, whereas higher MELD recipients do not have the reserve required for the initial hit of a sluggish graft [18]. The use of marginal grafts is further supported when considering the high risk for CRLM patients of dying while awaiting liver transplantation [19].…”