**7. References**

314 Liver Transplantation – Basic Issues

Knowledge of the additional dangers documented here as they can arise from a liver injury and may possibly be positively affected by e.g. a specific coagulation treatment and an early substitution of ECs. The immunological changes to be expected from a liver injury in the meantime may possibly even reinforce the frequently described post-trauma

**6.2 Investigate the indication of liver transplantation for uncontrollable liver trauma**  In conclusion, we largely agree with the aforementioned reports. The therapeutic option of liver transplantation also needs to be accessible for patients with liver injuries caused by trauma. However, not least due to the mentioned poor transplantation results in severely injured patients, indication for transplantation needs to be critically proposed by the

**6.3 Try to answer the question – Is transplantation a valuable option or just a "waste** 

It is essential to sensibly and appropriately allocate the organs so that the shortage of donor organs is not further enlarged. In patients where no hemodynamic stabilization can be achieved despite exhaustion of all extensive care measures, transplantation should not be considered any further. Although, there is a fundamental difference regarding the timeframe after trauma during which patients are to be transplanted. It has shown, that especially patients with acute, non-controllable liver injuries as described by us have clinically changed for the worse rapidly after transplantation and have died in MOF. Therefore, we postulate that indication for transplantation in these patients may only be

It should be noted that the success of transplantation medicine with a simultaneously increasing shortage of donor organs will only be assured if all available resources are exploited. Increasing acceptance of "expanded criteria donor" organs appears more justified than ever under these circumstances, but also with sustained good results despite constantly deteriorating organ quality. Approaches to increase the transplant quality, not only of extended criteria donor (ECD) organs, offer further developed possibilities that support perfusion such as machine perfusion and optimized perfusion solutions. Moreover, shortened ischemic periods are achieved through further improved logistics and allocation processes, which together with individualized, medicinal immune suppression ultimately benefit the transplant and the organ recipient. In addition to this continuously improving and thus optimized use of postmortal organs, it must also be the common objective of the medical profession and politics to increase the overall number of donor organs and to

In order to achieve this, priority should be given to an improved exploitation of the existing organ donation potential through hospital-based advising, for example by a contact person for organ donation at each intensive care unit. Information and advising by Eurotransplant and the transplant centers for physicians, nursing staff and the population are of key importance here. Furthermore, to an ever great extent it will be the task of all parties

provided after critically reviewing every single case as not to "waste of organs".

**6.4 Identifying new approaches to improving organ donation** 

**of organs" in polytraumatized patients with liver injury –** 

immunosuppression.

attending surgeons.

improve their quality.


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**Part 8** 

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