Whole-Organ Donor Liver Assessment Using PS-OCT: Science Translational Medicine | July 2026

Introduction:

Liver transplantation is limited by a shortage of suitable donor organs. Current viability assessment relies on needle biopsy, which samples only a small portion of the liver and may miss important regional pathology. This study evaluated polarization-sensitive optical coherence tomography (PS-OCT), a noninvasive imaging technique, for comprehensive whole-organ donor liver assessment.

Why was this study needed?

• Liver biopsy samples only a tiny fraction of the donor liver and may overlook heterogeneous disease.
• Better methods are needed to accurately assess extended-criteria donor livers.
• Inaccurate assessment can lead to unnecessary organ discard or transplantation of poor-quality grafts.
• Whole-organ, noninvasive viability assessment has remained an unmet need.
• Artificial intelligence may improve interpretation of advanced imaging data.

Results:

• PS-OCT accurately assessed steatosis, fibrosis, inflammation, and necrosis across the entire donor liver, showing excellent agreement with conventional histopathology.
• PS-OCT findings closely correlated with liver function during normothermic machine perfusion and with early post-transplant clinical outcomes, supporting its clinical relevance.
• By providing rapid, noninvasive whole-organ assessment, PS-OCT has the potential to reduce unnecessary organ discard while improving donor liver selection.

Clinical Impact:

This study represents a major advance in donor liver evaluation. PS-OCT combines high-resolution imaging with artificial intelligence to assess the entire liver rather than a small biopsy sample, potentially improving transplant decision-making and expanding the usable donor pool.

Bottom Line:

PS-OCT may redefine donor liver viability assessment. By providing accurate, noninvasive, whole-organ evaluation that correlates with graft function and transplant outcomes, it has the potential to reduce organ discard and safely expand liver transplantation.