Living Donor Liver Transplantation Saves Lives
Because of the manner in which the national organ donation system is organized, some regions, such as the New York tri-state area, have longer waiting lists than others. As a result, patients in New York face longer waiting times for deceased-donor organs, and consequently, a higher risk of dying while on the waiting list. At this time there are eight patients on the waiting list for every available liver and many patients are considered too sick or too old to even get a place on the list. To address this serious shortage, the Center for Liver Disease and Transplantation (CLDT) is pioneering methods of increasing access to liver transplantation.
Living donor liver transplantation offers one solution. In this procedure, a healthy adult undergoes a surgical procedure to remove part of his or her liver. The donated portion is then transplanted into a blood-type compatible adult or child with end-stage liver disease. For an adult transplant, up to 60% of a donor's organ may be removed, while a child's transplant may require 20-25% of a donor's liver tissue. In some cases, family members or friends choose to donate a portion of a liver, which saves a patient from having to wait on the list for a donor.
Although some potential donors are reluctant to take the risks associated with donation, the risks are low, according to Jean C. Emond, MD, Chief of Transplantation. The donor's liver regenerates to its original size in several weeks, and donors are able to return to normal activity in about a month. Dr. Emond, a member of the team that performed the first living donor liver transplant in the United States, in 1989, brings the perspective of nearly 20 years of experience with living donation to the center.
At the center, living donor transplantation is facilitated, but never pushed. An Independent Donor Assessment Team (IDAT) performs medical evaluations of every potential donor, educates them about the procedure, and serves as a dedicated donor advocate. Even when a parent is considering donation to a child, a separate doctor assesses the parent in order to protect his or her best interests. The center is especially vigilant about ensuring that there is no coercion involved in the donor's decision. The recipients' insurance pays the costs involved with evaluation, education, and donation.
To provide yet another method of increasing access to liver transplantation, John F. Renz, MD, PhD, Surgical Director of CLDT, specializes in "extended criteria" transplantation, or the use of organs that don't meet the usual criteria for transplantation due to various health problems, but are still healthy enough for a successful transplant. Dr. Renz explains that "EDC recipients accept a slightly higher risk of a donor-transmitted disease, but EDC livers are used in patients who are not as sick as those who receive optimal organs." Regular and EDC liver recipients have equivalent survival rates.
In addition to the A2ALL study, about 40 other studies related to liver function are underway at this center. A number of these address hepatitis C, which is the leading indication for transplantation and a major cause of organ failure after transplantation.