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How to face organ shortage in liver transplantation in an area with low rate of deceased donation

机译：献血率低的地区如何应对肝移植中的器官短缺

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Despite advances in patient selection, surgical technique, immunosuppression, and peri-operative management, the need for liver replacement exceeds organ availability. Moreover, in Italy, where the overall rate of cadaver donation is 21 donors per million per year, there are areas of the country, such as Sicily, where the rate of cadaver donation is 9.3 donors per million per year. In fact, this ongoing shortage of organs has led surgeons to develop innovative techniques in an attempt to expand the donor pool, and clinicians are continually modifying criteria to accept organs, particularly the previously defined expanded or marginal donor organs, which are now defined as extended criteria donor. Rarely, in certain specific settings alternative strategies based on the appropriate donor–recipient match allowed the use of grafts that otherwise would have been discarded due to anatomic anomalies. The organ shortage becomes more problematic in the scenario of re-transplantation where the use of a limited resource such as a liver graft must be weighed against the risk of a more difficult surgery.
机译：尽管在患者选择，手术技术，免疫抑制和围手术期管理方面取得了进步，但肝脏替代的需求超出了器官的可用性。此外，在意大利，尸体捐赠的总比率为每年每百万21个捐助者，该国的某些地区，例如西西里岛，尸体捐赠的比率为每年每百万9.3捐助者。实际上，器官的持续短缺已导致外科医生开发创新技术以试图扩大供体库，并且临床医生正在不断修改接受器官的标准，尤其是先前定义的扩展或边缘供体器官，现在定义为扩展的标准捐助者。很少，在某些特定情况下，基于适当的供体-受者匹配的替代策略允许使用由于解剖异常而被丢弃的移植物。在重新移植的情况下，器官短缺变得更加成问题，在这种情况下，必须权衡使用有限的资源（例如肝移植）和更困难的手术风险。

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