Haugen et al¹ present an important article that should change practice. Despite improved outcomes in recipients of older donor livers, rates of discard of old livers have increased significantly. Of importance, this article raises the questions of why older livers are commonly discarded and what we can do to fix this problem.

Donor logistics are a key reason for these discards. When a surgeon is in the donor operating room evaluating a liver, it is not a simple assessment to determine whether the liver is usable. Instead, the donor liver is evaluated within the context of the recipient. When the liver does not look great (like many older livers), the decision is commonly made to pass for the intended recipient, who is thought to be better off waiting for a better liver. For the liver to be used, it must be reallocated in a short amount of time. At best, it requires 4 to 6 hours to identify a new recipient and bring them in for the transplant. Other transplant teams are present in the operating room procuring other thoracic and abdominal organs. Having the entire system stop for 6 hours is rarely feasible. Also, receiving a call from a surgeon you do not know saying that “the liver does not look great, is usable, but we are passing” is not appealing. The recipient is likely just as sick as the recipient they are passing for and may also do poorly with a mediocre liver. Unfortunately, the end result is that these organs are often discarded.

Haugen等人¹提出了一篇重要的文章，应该改变实践。尽管较老的供体肝脏的接受者的结局有所改善，但弃用旧肝的比率已显着增加。重要的是，本文提出了以下问题：为什么通常会丢弃较旧的肝脏，以及我们可以采取哪些措施来解决此问题。

捐助者后勤是造成这些丢弃物的关键原因。当外科医生在供体手术室中评估肝脏时，确定肝脏是否可用并不是简单的评估。取而代之的是，在接受者的背景下评估供体肝脏。当肝脏看起来不佳时（就像许多较老的肝脏一样），通常会决定将其传递给预期的接受者，认为这种接受者会更好地等待更好的肝脏。要使用肝脏，必须在短时间内重新分配肝脏。最多需要4到6个小时来识别新的接受者并将其带入移植。手术室中还设有其他移植团队，负责采购其他胸部和腹部器官。整个系统停止运行6个小时几乎是不可能的。还，接到外科医生打来的电话，您不知道说“肝脏看起来不好，可用，但是我们正在过去”并不吸引人。接受者可能和他们所接受的接受者一样生病，并且对于平庸的肝脏也可能表现不佳。不幸的是，最终结果是这些器官经常被丢弃。