Organ Donation from Patients with Child-Pugh Class C Cirrhosis: A Clinical Feasibility or Ethical Dilemma?

Introduction Germany faces a significant shortage of organ donations, ranking among the lowest in Europe. This shortfall leads to the deaths of thousands of patients each year. Brain-dead patients with advanced cirrhosis, particularly those with Child-Pugh Class C cirrhosis, are frequently deemed unsuitable for organ donation due to their critical clinical state.

Case Report We present the case of a 50-year-old patient with alcohol-induced Child-Pugh Class C liver cirrhosis, admitted for liver transplant evaluation. Following a thorough assessment, including psychiatric evaluation, our interdisciplinary team determined the patient to be eligible for transplantation. However, on the day she was scheduled to be placed on the transplant waiting list, she suffered a severe cerebral hemorrhage and was transferred to the intensive care unit. Despite maximal intensive care and neurosurgical intervention, brainstem areflexia was confirmed. After obtaining consent from the family, the patient was evaluated for organ donation and deemed a potential donor. In the subsequent hours, her condition deteriorated further, leading to hepatorenal syndrome with decreased urine output. Terlipressin and furosemide were administered to support renal function. After a prolonged waiting period, one kidney was successfully transplanted into an adult recipient, with good post-transplant outcomes.

Conclusion Patients with Child-Pugh Class C cirrhosis are at an elevated risk of cerebral hemorrhage due to coagulopathy, which can result in brain death. Despite their compromised condition, organ donation should still be considered on a case-by-case basis, as demonstrated in this report.

Publication History

Article published online:
20 January 2025