Assessment of Donor quality and risk of graft failure after liver transplantation: The ID2EAL score

Sumeet K. Asrani, Giovanna Saracino, Anji Wall, James F. Trotter, Giuliano Testa, Ruben Hernaez, Pratima Sharma, Allison Kwong, Srikanta Banerjee, Gregory McKenna

First published: 02 September 2022

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ajt.17191


Accurate assessment of donor quality at the time of organ offer for liver transplantation candidates may be inadequately captured by the donor risk index (DRI). We sought to develop and validate a novel objective and simple model to assess donor risk using donor level variables available at the time of organ offer. We utilized national data from candidates undergoing primary LT (2013-2019) and assessed prediction of graft failure 1 year after LT.

ID2EAL score: The final components were donor Insulin dependent diabetes mellitus, Donor type (DCD or DBD), cause of Death=CVA, serum creatinine, Age, height and weight (length). The ID2EAL score had better discrimination than DRI using bootstrap corrected concordant index over time, especially in the current era.

We explored donor-recipient matching. Relative risk of graft failure ranged from 1.15-3.5 based on relevant donor-recipient matching by the ID2EAL score. As an example, for certain recipients, a young DCD donor offer was preferable to an older DBD with relevant comorbidities. The ID2EAL score may serve as an important tool for patient discussion about donor risk and decisions regarding offer acceptance. In addition, the score may be preferable to succinctly capture donor risk in future organ allocation that considers continuous distribution.