Are some livers better than others?

The difference between DBD, DCD and live donor livers

A number of factors affect how well your new liver will function. It can depend on the type of liver transplant you have, the type of liver you receive and even factors associated with the liver donor themselves.

People on the liver transplant waiting list can be offered three types of liver, DBD, DCD and LDLT:

  • DBD (donation after brain stem death) - the new liver is one retrieved from an individual whose heart is still beating, but brain has ceased to function 81. The DBD liver is usually seen as being ‘ideal’ because the liver receives an adequate supply of blood, nutrients and oxygen up until it is taken for transplantation.
  • DCD (donation after cardiac death) - less commonly, liver transplantation may have to be performed using a DCD organ 82. DCD liver transplant recipients tend to have a higher rate of bile duct problems in their first year, and PSC is no exception. A 2017 research study 83 found that for PSC patients, DCD vs DBD transplantation did not adversely affect overall patient survival or graft survival rates, suggesting that DCD transplants could be a viable option for selected PSC patients in the future.
  • LDLT (donation from a living person- becoming more common, a person donates part of their liver to you. People with PSC who have a LDLT do very well indeed, better than those who receive organs from deceased donors 2.

Sometimes part of a liver from a deceased donor is put into an adult and the other part into a child (or small adult). This is called a split liver transplant.

The quality of the donor liver is affected by factors relating to the donor themselves; some donors are fit and healthy while others are overweight with a fatty liver. The new organ allocation system takes into account these factors to ensure the right liver is donated to the most suitable person on the waiting list.

In an ideal world, everyone would receive the ‘perfect organ’, but due to the lack of organ donors and the increasing number of people waiting for a transplant, this isn’t always possible. The important thing is to consider the liver that is right for you at that time. Your transplant unit will go through the different types of liver you might be offered and explain any additional risks and benefits associated with those livers.

DCD v DBD livers Trivedi

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