Average Wait Time for Deceased Donor Liver Transplant for Blood Type O Patients
Blood type O patients face significantly longer wait times for deceased donor liver transplantation compared to other blood groups, with median wait times ranging from 109-142 days depending on geographic location and era, representing approximately double the wait time of non-O blood group recipients.
Geographic Variation in Wait Times
United States
- Blood type O recipients experience median wait times of approximately 109 days, compared to 58 days for other blood types 1
- This disparity has worsened over time, with the difference in median waiting time between blood groups increasing from 44 days in early years to 108 days in later periods 1
- The longer wait time translates to higher mortality risk, with blood type O candidates showing a 2-year mortality odds ratio of 1.52 compared to other blood groups 1
United Kingdom
- Adult patients wait an average of 142 days for liver transplant, while pediatric patients wait approximately 78 days 2
- The UK system is center-oriented with allocation based on UKELD scoring, which may contribute to these wait times 2
Spain
- Waiting list clearance ranges from 103 to 124 days across all blood groups 2
- Spain maintains one of the highest organ donation rates globally (35.12 donors per million population), which helps reduce overall wait times 2
Why Blood Type O Patients Wait Longer
The "Double Penalty" Phenomenon
- Blood type O recipients can only receive O donor organs, while O donor organs can be transplanted into any blood type recipient 3
- Despite O blood group representing a higher percentage of deceased donors than O candidates on the waiting list, O recipients experience a negative difference between harvested and transplanted livers 3
- AB blood group recipients receive the shortest wait times because they can accept organs from all blood types, creating a positive difference (transplanted livers exceed harvested livers from AB donors) 3
Clinical Impact of Prolonged Waiting
- Blood type O candidates have 13.3% pretransplantation mortality compared to 7.0% for other blood types 1
- Despite having better clinical status at initial evaluation, the longer wait time results in deterioration and higher overall mortality 1
- The 2-year mortality odds ratio increases progressively as the wait time disparity widens 1
Strategies to Reduce Wait Times for Type O Recipients
ABO-Incompatible Transplantation
- A2 donor livers can be successfully used for blood type O recipients with favorable outcomes (patient survival 10/10, graft survival 8/10 in one series) 4
- This approach is particularly valuable for urgent situations or patients with hepatocellular carcinoma where compatible grafts are unavailable 4
- B non-secretor donors represent another potential option, though outcomes require further documentation 4
Expanded Donor Criteria
- Uncontrolled donation after circulatory death (uDCD) donors can expand the donor pool, though with higher rates of primary nonfunction (8% vs 1.5%) and biliary complications (30.6% vs 10.6%) 5
- Five-year patient survival with uDCD livers (71.5%) approaches that of donation after brain death (DBD) livers (78.8%), making this a viable option for carefully selected recipients 5
Critical Pitfalls to Avoid
- Do not delay listing blood type O patients until advanced disease stages, as they will deteriorate during the prolonged wait 1
- Monitor pretransplantation clinical status closely in O blood group candidates, as they are at higher risk of death while waiting despite initially better clinical parameters 1
- Consider ABO-incompatible options proactively for deteriorating type O patients rather than waiting for compatible organs, particularly using A2 donors 4
- Account for the systemic disadvantage when counseling blood type O patients about transplant timing and prognosis 3, 1