In 2023, Spain had the highest rate of deceased organ donors among select OECD countries with ** people per million population. Organ donation is an important life-saving method for people with organ failure and late-stage disease. Organ Donation Organs can be donated from either living or deceased persons, depending on the type and supply of select organs. Each country is responsible for organizing its own organ transplant systems. In the United States, for example, organ donors are required to register to a national database. A lack of organs available for transplant remains a problem in many countries around the world. In the United States, there are over *** thousand people currently waiting for an organ transplant. Global organ donations The total number of transplants performed each year has been on the rise. Organ donations globally reached over *** thousand in the year 2023, with kidneys accounting for a majority of the organs transplanted. The Americas and Europe make up the largest proportion of global kidney transplants, while Africa has the lowest number. The Americans and Europe also have the highest proportions of global liver transplants.

Organ donation rates have been improving in Canada but it is clear that there is more work to be done. Every year, hundreds of Canadians die while waiting for an organ transplant. With over 4,300 people in Canada waiting for a transplant right now and only a fraction of Canadians registered as donors—the need is critical.

Organ transplants continue to redefine medical frontiers. Unfortunately, current demand for organs far surpasses availability, waiting lists are long and many people die before the organ they desperately need becomes available. One proposed way to increase organ availability is to admit patients to the ICU with severe neurological injuries, for a trial of therapy. If the injury is irretrievable, discussions would then focus on extending ventilation for potential brain death/organ donation if a prior wish to donate is known or if the substitute decision maker consents. The following debate discusses the ethical dilemmas of waiting for brain death.

Organ transplants continue to redefine medical frontiers. Unfortunately, current demand for organs far surpasses availability, waiting lists are long and many people die before the organ they desperately need becomes available. One proposed way to increase organ availability is to admit patients to the ICU with severe neurological injuries, for a trial of therapy. If the injury is irretrievable, discussions would then focus on extending ventilation for potential brain death/organ donation if a prior wish to donate is known or if the substitute decision maker consents. The following debate discusses the ethical dilemmas of waiting for brain death.

IntroductionLiver transplantation is the only curative option for patients with polycystic liver disease (PLD). In the United Kingdom, these patients are listed on the variant syndrome list due to their preserved liver function reflected in the United Kingdom End-stage Liver Disease (UKELD) score. The transplantation and survival rates for this patient group in the UK have not been previously reported.MethodsA retrospective cross-sectional analysis of patients receiving liver transplantation between 2010 and 2017 was performed using the NHS blood and transplantation database. This database contains the demographic, clinical parameters, indication for transplantation and follow-up of all patients in UK-based transplant centres. Basic statistics was performed using SPSS version 27.Results5412 recipients received elective liver allografts in the study period. 1.6% (100) of recipients had PLD as their primary indication for transplantation with 60 receiving liver only allografts and 40 receiving combined liver-kidney allografts. PLD patients had a >3-fold longer mean waiting time for transplantation compared to non-PLD patients, 508 days v 154 days respectively. PLD patients receiving combined liver-kidney allografts had a longer waiting time than those receiving a liver only allograft, 610 days v 438 days respectively. There were comparable patient survival rates for people with PLD and non-PLD primary indications at 30 days (94.0% vs 97.6%) and 1 year (92.0% vs 93.2%) but improved survival rates at 5 years (81.3% vs 76.5%). There were also comparable allograft survival rates for people with PLD and non-PLD primary indications at 30 days (93.9% vs 95.3%) and 1 year (91.9% vs 91.2%) but improved survival rates at 5 years (82.5% vs 77.3%). Transplant centre-level analysis identified variation in the proportion of liver transplantations for people with PLD as their primary listed indication.ConclusionsPatients with PLD wait significantly longer for liver transplantation compared to other indications. However, transplanted PLD patients demonstrate better longer-term patient and liver allograft survival rates compared to transplanted non-PLD patients. The unexpected variation between individual UK centres transplanting for PLD deserves further study.