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Originally published January 6, 2026
Last updated January 6, 2026
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In the United States, there are still more people who need donated livers than there are livers available. Although living-donor donation has partially helped mitigate the gap, the fact remains that most liver donations still come from deceased donors.
When organs come from deceased donors, they must be healthy, whole and efficiently transported to the recipient. Transplant experts are continually seeking ways to maximize the number of successful transplants possible from deceased donors.
“A couple of exciting technological advancements in recent years are making it possible for more livers from deceased donors to make it safely to the patients who need them,” says Aaron J. Ahearn, MD, PhD, surgical director of the USC Liver Transplant and Comprehensive Liver Disease Center, part of the USC Transplant Institute and Keck Medicine of USC. The USC Transplant Institute also provides advanced heart, liver and lung transplant care and complex hepatobiliary care to patients living in Southern Nevada at its state-of-the-art facility Keck Medicine of USC – Las Vegas.
Specifically, Ahearn explains how normothermic regional advances such as normothermic regional perfusion and normothermic machine perfusion could change the landscape of liver transplantation in the years to come.
“Historically, the vast majority of donor livers have come from patients who were brain dead,” Ahearn says. “In brain death, life support continues circulating oxygenated blood, keeping organs healthy for transplant.”
Separate from brain-death donors, however, there is potentially a higher number of circulatory-death donors. These are patients who die after life support is withdrawn. Finding ways to successfully preserve organs from circulatory-death donors could significantly increase the number of Donation After Circulatory Death (DCD) livers available for transplant.
There are challenges involved, however. In the case of circulatory death, medical teams must allow the patient’s heart to stop naturally and then wait out a brief “no-touch period” to confirm the heart will not restart. During this time, the patient’s organs are without circulation and can rapidly lose oxygen, causing damage that could make positive outcomes for the recipient less likely.
In recent years, an organ-preservation technique called normothermic regional perfusion has allowed medical staff to support a donor organ, such as a liver, on a device that functions like a heart bypass machine while the organ is still inside the donor’s body.
“It pumps warm blood back through the liver,” Dr. Ahearn says. “And it has been proven to recover any damage that the liver underwent in cardiac death.”
Making more DCD livers available would greatly benefit liver transplant patients. “Circulatory-death donations used to make up only 5%-6% of transplants,” Ahearn says. “But the potential donor pool is much larger because many more deceased patients meet these criteria than traditional brain-death criteria.”
Another technological advance has made it possible for warm blood to continue to circulate through donated organs after they are removed from the donor and harvested. This process is called normothermic machine perfusion.
“Instead of putting the organ on ice, we put it on a machine that pumps blood through the liver,” Ahearn says. “This new technology helps with deceased donor livers of both types. In regard to cardiac death donations specifically, it supplements the health of the liver even further.”
Many machine profusion pumps also offer real-time data as to how well the liver is functioning. This gives the medical team specific data on any problems the organ might have and how the functionality of the liver may be expected to continue in the recipient’s body. As a result, more harvested livers are being identified as viable than would have been with limited information in previous years.
With both types of normothermic perfusion now widely established in clinical practice, the percentage of liver transplants that have been made possible by DCD donations has continued to climb at a startling rate.
“Researchers are predicting that by early 2026 it could actually be as high as 50%,” Ahearn says.
For the past three years, the number of people who have died waiting for a liver transplant has steadily decreased, largely thanks to these new technologies.
“There is still a massive shortage,” Ahearn says. “We still have about 2000 people every year who die waiting for a liver, which is why living liver donation is still so crucial. But while the problem is by no means solved, it’s good to see things moving in the right direction.”
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