Normothermic machine perfusion has emerged as a critical tool for assessing high-risk liver grafts from extended criteria donors. With organ shortages driving increased use of donors after circulatory death, this technology enables real-time evaluation of liver function through perfusion, enzyme release, and bile production metrics.
A meta-analysis of 568 livers - 297 from donors after brain death and 271 from donors after circulatory death - demonstrated excellent post-transplant outcomes across donor types. Despite DBD grafts being older with longer cold storage times, primary non-function occurred in just one DCD case.
The technology addresses critical challenges in liver transplantation where donor after circulatory death organs face prolonged warm ischemia time during the agonal phase, historically leading to higher rates of complications. Dutch data shows DCD donations now comprise roughly 50% of all organ donations, with liver utilization doubling over the past decade.
These findings suggest viability assessment through machine perfusion can replace donor type as the primary decision factor, optimizing transplant decisions and reducing organ discard rates for end-stage liver disease patients.