Liver transplant center variability in accepting organ offers and its impact on patient survival

David S. Goldberg, Benjamin French, James D. Lewis, Frank I. Scott, Ronac Mamtani, Richard Gilroy, Scott D. Halpern, Peter L. Abt

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background & Aims Despite an allocation system designed to give deceased-donor livers to the sickest patients, many transplantable livers are declined by U.S. transplant centers. It is unknown whether centers vary in their propensities to decline organs for the highest priority patients, and how these decisions directly impact patient outcomes. Methods We analyzed Organ Procurement and Transplantation Network (OPTN) data from 5/1/07-6/17/13, and included all adult liver-alone waitlist candidates offered an organ that was ultimately transplanted. We evaluated acceptance rates of liver offers for the highest ranked patients and their subsequent waitlist mortality. Results Of the 23,740 unique organ offers, 8882 (37.4%) were accepted for the first-ranked patient. Despite adjusting for organ quality and recipient severity of illness, transplant centers within and across geographic regions varied strikingly (p <0.001) in the percentage of organ offers they accepted for the highest priority patients. Among all patients ranked first on waitlists, the adjusted center-specific organ acceptance rates ranged from 15.7% to 58.1%. In multivariable models, there was a 27% increased odds of waitlist mortality for every 5% absolute decrease in a center's adjusted organ offer acceptance rate (adjusted OR: 1.27, 95% CI: 1.20-1.32). However, the absolute difference in median 5-year adjusted graft survival was 4% between livers accepted for the first-ranked patient, compared to those declined and transplanted at a lower position. Conclusion There is marked variability in center practices regarding accepting livers allocated to the highest priority patients. Center-level decisions to decline organs substantially increased patients' odds of dying on the waitlist without a transplant.

Original languageEnglish (US)
Pages (from-to)843-851
Number of pages9
JournalJournal of Hepatology
Issue number4
StatePublished - Apr 1 2016
Externally publishedYes


  • Decline
  • Organ offer
  • Waitlist mortality

ASJC Scopus subject areas

  • Hepatology


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