ArticleIntestinal Failure (New York, N.Y.)
The discarded donor intestine: A review of donor criteria, availability and utilization, and current efforts to expand the donor pool.
Article in Intestinal Failure (New York, N.Y.). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intestinal transplantation (ITx) remains the least performed abdominal organ transplant. Despite increasing indications for intestinal transplantation, annual case volume remains fewer than 150 in the U.S., with waitlist mortality exceeding 30-40 %. This study summarizes current intestine donor criteria, availability, and utilization, and explores evidence-based strategies to expand the donor pool. Methods: This study included registry analysis of Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) and STAR, as well as a literature review of emerging donor expansion efforts. Predictors of organ discard, simulation modeling of donor criteria, temporal trends and geographic variation were examined. Results: Approximately 1 % of eligible donors proceeded to intestine procurement from 1980 to 2025, of which ∼ 90 % were transplanted. Most discards are due to listing/evaluation, organ quality, or anatomic concerns. No single donor variable significantly predicted discard. Higher donor creatinine and age were associated with increased graft failure (p = 0.001, p < 0.001, respectively). Relaxing donor criteria-defined by less stringent cutoffs for age, body mass index (BMI), creatinine, and medical comorbidities-was not associated with higher graft failure (p = 0.394). Simulation modeling suggests that relaxing criteria could double eligible donors and increase transplant volume by ∼ 60 %, potentially saving over 100 lives annually. Regional disparities in usage further suggest that standardization may improve equity. Conclusion: A small number of modifiable barriers-particularly strict donor criteria and center-level variability-limit intestinal graft utilization. Expanding donor eligibility, implementing machine perfusion, and targeting discard drivers could substantially improve transplant access and outcomes.
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