PhD defence M. (Marjolein) van Reeven

Summary:

Liver transplantation (LT) remains the only curative treatment option for end-stage liver disease.  In 1967, Starzl and colleagues were the first to perform a successful human orthotropic liver transplantation. The first organ transplantations with grafts from post-mortem donors have all been executed with grafts obtained from donors after circulatory death (DCD). However, after a clear definition of the concept of brain death had been formulated in 1968, the use of organs donated after brain death (DBD) became the worldwide gold standard. As a result of the growing shortage of donor organs, the use of DCD grafts for liver transplantation regained international interest in the 1990s. 

Since its renewed introduction, the landscape of DCD-LT has changed significantly: the number of countries implementing a (national) DCD-LT program has increased substantially, and over 400 scientific articles on DCD-LT have been published in the past two decades. Nowadays, DCD-LT is on the verge of a new era, in which the long-lasting gold standard of DCD-LT with conventional static cold storage will probably be replaced by either a combination of static cold storage with machine perfusion or solely machine perfusion. 

This thesis is divided in three parts. The first part provides insight in the current status of DCD-LT in the Netherlands and in other countries in Europe and North America. The second part of this thesis focuses on the effect of several phases of (relative) ischemia on the outcomes of DCD-LT. In part three, the focus is shifted to new ways to use the pool of DCD liver grafts to its full potential. For example, by organ donation after euthanasia.