Selection criteria for liver transplant donors

As the number of successful liver transplants has increased, the demand for donors has outpaced the supply. Approximately 25% of patients die awaiting an appropriate donor. Current criteria for assessing potential donors need to be closely examined. Fifty‐six potential donors were evaluated by our transplant team by utilizing standard liver function tests (LFT's)—SGOT, SGPT, bilirubin. Additionally, a lidocaine metabolism test was performed by giving a 1 mg/kg IV dose of lidocaine over 1 minute and measuring the accumulation of the major metabolite monoethylglycinxylidide (MEGX) at 15 minutes by fluorescent polarization immunoassay (Abbott Diagnostics, Abbott Park, IL). Previous work has suggested that a MEGX <50 ng/mL is associated with initial non‐function. Thirty‐four donors were transplanted (group l) and all had initial function (all MEGX values were >50). Twenty‐two donors (39%) were judged unacceptable (group II) by our transplant team and by outside centers based upon one of the following criteria: II (A) elevated LFT's—8, II (B) donor age—5, II (C) donor instability—4, II (D) no available recipient—3, II (E) miscellaneous—2. Standard LFT's were not statistically different in the donors used and in those not used when excluding category II A. Six of seven donors excluded in group I had acceptable MEGX values indicating they may have been transplantable. Ten of 12 patients excluded in groups II B–D had normal LFT's and nine of 12 had acceptable MEGX values indicating they may have been transplantable also. In this era of organ shortage, a reevaluation of donor selection criteria utilizing new tests like MEGX may be necessary to meet the increased need.