Background: Liver donation is the cornerstone for the expansion of liver transplantation. Although big efforts have been performed to release alternatives for increasing the donor pool, only extended-criteria donors have become a feasible option.
Methods: The success of the Spanish Model for organ transplantation is well known. Approximately 5.4% of all the liver transplants (LT) are performed in Spain, with a rate of 22.9 LT per million people (pmp).
Results: Approximately 70 papers on extended-criteria donors have been reported from Spanish LT teams. Pioneering works in donor steatosis, non-heart-beating donors, donor age-hepatitis C virus, ischemia/reperfusion injury, normothermic extracorporeal membrane oxygenation, and donor steatosis-hepatitis C virus are among the main contributions in the field. Considering data from the Spanish National Registry, it can be observed that an accumulation of donor and recipient factors leads to a continuum of risk for liver transplantation. Donors are not "bad" enough to decline a liver offer per se.
Conclusions: In Spain, clear efforts should be made to work on more stable and homogeneous criteria for donor acceptance. In this sense, defining a specific Spanish donor risk index would be helpful.