Organ shortage and organ allocation for liver transplantation in Germany. Critical considerations

The extreme shortage of donor organs in Germany has led to a major discrepancy between availability and requirement of organs for liver transplantation, and-as aconsequence-to an allocation dilemma. This results on one hand in a high lethality on the waiting list and, on the other, to worse results after transplantation, due to the current organ allocation policy favoring extremely ill patients. Potential solutions are (1) increasing the number of donor organs; (2) innovative approaches for improved use of suboptimal donor organs (e.g., from older, multimorbid donors, fatty livers); (3) an increase in living organ donation; and (4) modified/optimized allocation rules. Measures 2 and 3 would benefit from more centralization of liver transplantation in Germany. Since all four options are probably not realizable in Germany in the near future, organ shortage and the dilemma in organ allocation will persist.