Reduction of Hepatectomy Times in Dutch Organ Procurement Teams

Introduction: Donor hepatectomy time exceeding 60 minutes is associated with poor liver transplant outcomes. A nationwide audit in 2018 showed that this critical time limit was frequently exceeded in Dutch procurement teams, particularly by those teams that were not affiliated with a liver transplant center. In order to reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training and introduction of simultaneous procurement of lung- and liver in all procedures.

Methods: In this retrospective study, we describe the effects of this intervention program on donor hepatectomy time in the Netherlands. A total of 1788 liver procurements performed between January 2013 and December 2022 were analyzed, divided in 873 before and 915 procedures after the intervention.

Results: Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes (p<0.001), with virtually no more difference between all procurement teams. After introduction of simultaneous procurement, the difference in donor hepatectomy time between liver-only and liver-lung disappeared, (34 [28-42] vs. 35 [29-43] minutes, p=0.73). Importantly, the decrease in hepatectomy time did not result in an increase in severe surgical injury leading to graft loss (p=0.11).

Discussion: In conclusion, a significant and relevant reduction in hepatectomy time was achieved with this intervention program. We advocate a similar procurement intervention plan in any organ donation program independent of their context.