Paired-exchange programmes

Paired-exchange programmes

Liver paired exchange (LPE) allows liver donors and their intended incompatible recipients to exchange livers with another donor–recipient pair so that a compatible transplant can be performed. The advantage is that it allows the two transplant recipients to be removed from the deceased donor waiting list, thereby shortening the waiting for other patients who remain on the list, decreasing waiting list mortality . ABO blood group incompatibility , size incompatibility (small donor liver into large recipient or vice versa) or anatomical considerations (multiple arteries or bile ducts to reconstruct) are common reasons for non-acceptance of otherwise suit able donors in LDLT . In all these circumstances, donor and recipient pairs who are not optimally matched might benefit from a better match through LPE. At times, these LPEs can be initiated by a non-directed anonymous living donor (i.e. a domino pair ed exchange), where a person e ff ectively donates a portion of their liver to the pool of patients on the deceased donor transplant waiting list. Compared with kidney paired exchange, LPE is inherently more complex owing to the greater morbidity and mortality risks to the donor and to the logistics involved, hence it is not widely practised. Christian Johann Doppler , 1803–1853, Professor of Experimental Physics, Vienna, Austria, enunciated the Doppler principle in 1842. Strategies to overcome the shortage of livers for transplantation /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Increasing the donor pool Implementing an organ donation opt-out system (introduced in the UK in Wales – December 2015; England /uni00A0 – May 2020; Scotland – March 2021) Use of marginal DBD deceased donors Use of DCD deceased donors Increased use of split LT Increased living donor LT Use of HCV-positive donor grafts Improve the preservation and assessment of quality of donor grafts Use of machine perfusion systems (normothermic/ hypothermic machine perfusion) Maximise post-transplant long-term survival Reduce or avoid immunosuppression after LT to minimise side effects