Declining liver graft quality threatens the future of liver transplantation in the United States

National liver transplantation (LT) volume has declined since 2006, in part because of worsening donor organ quality. Trends that degrade organ quality are expected to continue over the next 2 decades. We used the United Network for Organ Sharing (UNOS) database to inform a 20-year discrete event simulation estimating LT volume from 2010 to 2030. Data to inform the model were obtained from deceased organ donors between 2000 and 2009. If donor liver utilization practices remain constant, utilization will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs. If transplant centers increase their risk tolerance for marginal grafts, utilization would decrease to 48%. The institution of "opt-out" organ donation policies to increase the donor pool would still result in 1380 to 1866 fewer transplants. Ex vivo perfusion techniques that increase the use of marginal donor livers may stabilize LT volume. Otherwise, the number of LTs in the United States will decrease substantially over the next 15 years. In conclusion, the transplant community will need to accept inferior grafts and potentially worse posttransplant outcomes and/or develop new strategies for increasing organ donation and utilization in order to maintain the number of LTs at the current level

Towards Reef Resilience and Sustainable Livelihoods: A handbook for Caribbean coral reef managers

This handbook aims to provide reef managers with tools, information and recommendations on management of coral reef ecosystems. The handbook sections range from ecological history and biogeography, resilience as well as climate change issues to fisheries, governance and the monitoring of coral reef ecosystems. Within each section are practical stand-alone ‘briefs’. These briefs offer concise information on particular reef-related issues, utilising some of the most recent scientific research to inform management actions. Each of the briefings is a unique grab-and-go resource. The accessible format also provides a useful resource for students, researchers, policy-makers and anyone interested in the future of Caribbean coral reefs