Enhancing Organ Availability: Increased <scp>DCD</scp> Liver Utilization Following Implementation of a Normothermic Machine Perfusion Program

In Australia, donation after circulatory death (DCD) liver utilization remains below that of comparable healthcare systems in the Northern Hemisphere, due to concerns over higher rates of early hepatocellular dysfunction/nonfunction and ischemic cholangiopathy, coupled with limited organ availability and challenging organ transport logistics. To address this, the Queensland Liver Transplant Service introduced the OrganOx Metra normothermic machine perfusion (NMP) device in 2018. Positive outcomes were initially reported for 10 livers, including five DCD livers deemed unsuitable for static cold storage (SCS). This retrospective, historical-control study evaluated whether NMP availability improved DCD liver utilization. The NMP era (June 2018 to June 2021) was compared to the SCS era (June 2015 to June 2018), with all DCD activity included, regardless of the preservation technique. Donor data were sourced from the DonateLife Queensland database, and patient outcome data were gathered from the electronic medical records of Princess Alexandra Hospital, Queensland. The NMP era showed significantly higher rates for medically suitable DCD offers(90.5% vs. 66.1%, p < 0.01), higher rates of formal DCD offers (88.1% vs. 61.0%, p < 0.01), greater DCD planned retrieval rate (56.6% vs. 23.7%, p < 0.01), and higher implantation rate as a proportion of all DCD offers (18.8% vs. 5.9%, p < 0.01). More potentially viable DCD grafts were declined because of the lack of suitable recipients, suggesting an abundance of available livers and reduced waitlist. Despite increased DCD utilization and a higher mean modified UK DCD risk score in the NMP era (1.5 vs. 0, p = 0.05), there was no increase in early allograft dysfunction, primary nonfunction, ischemic cholangiopathy, or re-transplantation.