The WHO has called countries to pursue self-sufficiency in transplantation by decreasing the burden of diseases treatable with transplantation and by increasing the availability of organs, with priority given to maximizing deceased donation and ensuring the protection of living donors. Depending on the level of human development, health priorities in transplantation may range from protecting the resident population from exploitation to developing deceased donation to its maximum therapeutic potential. The fundamental pillar of deceased donation is the organization of a multidisciplinary process of high complexity to ensure the systematic identification of individuals who die or about to die in conditions consistent with organ donation and their transition to actual donors. The engagement of the critical care community, the creation of a donor coordination network, efforts in professional training and continuous evaluation of performance are key elements of a successful deceased donor program. The progressive decline in the incidence of brain death, the changing profile of potential donors and the emergence of new end-of-life care practices make mandatory the search for novel strategies to further increase organ availability from the deceased: i) the transplantation of organs from expanded criteria and non-standard risk donors; ii) the routine consideration of intensive care to facilitate organ donation; iii) the promotion of donation after the circulatory determination of death. In situ and ex-situ preservation measures will help to improve post-transplant outcomes in these new challenging scenarios. With such a comprehensive approach, not only patients will gain better access to transplantation, but many other dying patients will be given the opportunity to donate their organs if this is consistent with their principles and values.
The TTS-ILTS Paired Transplant Centers Program is a collaboration between The Transplantation Society (TTS) and the International Liver Transplantation Society (ILTS) supporting new liver transplant programs in emerging economies.