In the modern days there is a trend to push the boundaries and utilise more and more organs for transplantation. But how willing are you to accept Isolated Small Bowels with unfavourable characteristics? Can we push the boundaries in Intestinal Transplantation?
Yes, I believe we can push the boundaries in intestinal transplantation. In fact that has been well demonstrated by the Indiana and recently the Miami group. All donors within a certain pre-agreed BMI criteria should be considered for isloated small bowel transplant. Factors such as inotropic support, lactate, down times, length of stay in ITU etc. are surrogate markers and are not absolute. This, in turn, should not affect the decision making for mobilization of a team to have a visual look at the organ. Positive factors for acceptability are related to appropriate size match, CMV negative status, and a negative virtual crossmatch for highly sensitised recipients with preformed antibodies.
I agree with Dr. Vaidya that the boundaries can be pushed in intestinal transplantation by individualized decision making for every single recipient and using donor criteria as surrogates but not dogmatic for either inclusion or exclusion. The willingness to accept isolated small bowel grafts with unfavorable criteria is probably most dependent on the recipient condition and underlying disease.
Our center has a very short wait time for isolated intestine transplant. In the U.S., there were over 7000 deceased donors last year and only ~140 intestine transplants. So, there are plenty of intestine grafts available. When we list a patient, we will have 5-10 offers per day until we transplant the patient. Therefore, the boundaries can be pushed for isolated intestine, but we are rarely forced to do so. Generally, we are able to find a healthy teenager or young adult. We don't consider issues such as down time, or inotrope support to be significant. Other factors are more important such as previous abdominal surgery, lengthy narcotic use, etc.
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