Declining a liver offer during organ procurement likely increases the risk of discard, but the specifics around late reallocation remain obscure. This voluntarily submitted, prospectively collected data describe late declines and the ultimate disposition of 893 livers. Once a liver suffered an intraoperative decline, only 49% of recovered livers were transplanted. Livers declined ≥80 minutes prior to cross‐clamp were transplanted 80% of the time versus livers declined ≥80 minutes after cross‐clamp, which were transplanted 45% of the time. The final disposition of these livers was into a predetermined backup patient (51%) or required an out‐of‐sequence expedited allocation (42%). Prerecovery imaging and prerecovery biopsy did not influence the ability to reallocate a liver, and livers from donors after circulatory death are rarely successfully reallocated. In conclusion, this study begins to shed light on this seemingly common practice. A total of 85% of centers had an intraoperative decline, but 4% of centers accounted for 25% of the declines. Organ procurement organizations often enter expedited liver allocation, and instituting a cross‐clamp delay to allow for reallocation may influence the disposition of these liver grafts. Expedited allocation was more time consuming than allocation into a predetermined backup. Although a certain number of intraoperative declines probably suggests a healthy amount of donor selection aggressiveness at the time of the initial organ offer, the 47% risk of discard of livers declined intraoperatively suggests that United Network for Organ Sharing should consider systematically collecting data about intraoperative declines so we can learn more about this event that influences organ utilization.

中文翻译：

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了解采购开始后拒绝的肝脏的最终处置：全国器官采购组织的努力

在器官采购过程中拒绝肝脏报价可能会增加丢弃的风险，但后期重新分配的具体细节仍然不清楚。这份自愿提交、前瞻性收集的数据描述了 893 个肝脏的晚期衰退和最终处置。一旦肝脏在术中出现衰退，恢复的肝脏中只有49%可以进行移植。交叉钳夹前肝脏衰退 ≥80 分钟的移植率为 80%，而交叉钳夹后肝脏衰退 ≥80 分钟的移植率为 45%。这些肝脏的最终处置是分配给预定的备用患者（51%）或需要无序的快速分配（42%）。恢复前成像和恢复前活检不影响重新分配肝脏的能力，循环死亡后捐献者的肝脏很少能成功重新分配。总之，这项研究开始揭示这种看似常见的做法。共有 85% 的中心出现术中下降，但 4% 的中心占下降的 25%。器官获取组织通常会进行快速肝脏分配，并且实行交叉夹延迟以允许重新分配可能会影响这些肝移植物的处置。快速分配比分配到预定备份更耗时。尽管术中一定数量的下降可能表明在最初提供器官时有健康的供体选择积极性，