It was declined a staggering 2,239 times by transplant surgeons across nearly 40 transplant centers in October 2024. Against the odds, Donor Network of Arizona (DNA) placed this donated liver with a Florida transplant surgeon on the 2,240th offer, saving a patient’s life. This is a common, intricate hurdle DNA must jump since organs from medically complex donors can be a challenge to place 

The donor, a 68-year-old man, presented complex medical factors. 

“The donor’s age and medical history presented compounding factors,” says Nathan Fine, DNA’s manager of transplant partnerships. “In the end, all three organs from this donor—liver and both kidneys— required a variety of interventions to be successfully matched with recipients, but it’s worth it if it means we save more lives.” 

The donor also had hepatitis C and was able to donate through a process called donation after circulatory death (DCD)—as opposed to after a declaration of brain death—meaning the organs risked warm ischemic damage from the time delay between the withdrawal of the ventilator and start of organ recovery. In this case, over an hour had passed, potentially reducing the chances of immediate graft (organ) function and affecting long-term outcomes for the recipient. DNA, however, used advanced preservation techniques to navigate these obstacles. 

To maximize the chances of a successful liver transplant and mitigate the effects of warm ischemia (time with no blood flow or oxygen), the team performed normothermic regional perfusion (NRP) as part of the donor’s care, which temporarily restores blood flow and oxygen to the organs intended for transplantation. DNA preservationists then stored the liver in Paragonix LIVERguard, an advanced organ preservation device that maintains precise temperature control, preventing freezing of the organ’s cells compared to conventional storage on ice, known as static cold storage. This has proven to support the success of transplants after longer travel and preservation times. 

Ultimately, a surgeon in Florida accepted the liver, more than 1,700 miles away for multiple reasons including the fact that modern antiviral hepatitis C treatments have a 90% cure rate on the first try, though stigma around accepting such organs still exists. 

Once on the East Coast, the transplant team used an OrganOx metra, another tool that kept the liver oxygenated and nourished at body temperature, meaning the liver went through some type of advanced preservation for a notable 33 hours before the transplant—much more than the typical 10 hours. This prolonged preservation allowed the liver to improve its damage and function, addressing concerns for the recipient’s long-term health.