Live donor liver transplants
U.Va. helping to standardize novel
by Andrew Shurtleff
Carl Berg (left) and Tim Pruett at the University Hospitals
By Elizabeth Kiem
more than 17,000 Americans, survival depends on finding a healthy
Most of those livers will become available when an organ donor
is deemed brain-dead, allowing surgeons to remove the organ while
the heart is still beating. But only 3,000 such beating-heart
cadavers contributed to successful liver transplantations
U.Va. is making a concerted effort to bridge that donor gap by
joining a national consortium to study the efficacy of living
seven years of funding from the National Institutes of Health,
U.Va. and nine other transplant centers will pool data and experience
to better understand the risks and benefits of what Carl Berg,
U.Va.s director of hepatology, called a novel and
lifesaving form of liver
transplantation that has generated significant national attention.
first liver transplant from a living donor was performed in 1989.
Since then, more than 1,830 such procedures have taken place,
compared with more than 51,000 live kidney donations. Kidney recipients
generally have a higher survival rate than do liver recipients,
and both fare slightly better with live organs than with cadaveric
humans have only one liver, the organ must be bisected to remove
a lobe for transplantation. Both portions regenerate to almost
the original size within weeks if all goes well, but the risk
to the donor gives many practitioners pause.
living donor procedure goes against a lot of the things we take
oaths to do, said Tim Pruett, director of U.Va.s transplantation
division. The first is to do no harm. Well, to cut somebodys
liver in half, whos perfectly well, who doesnt need
you to do that subjects them to a lot of risk and a lot of potential
promise of living donors was tested recently by the death of a
liver donor at a New York hospital. The ensuing inquiry over donor
safety and informed consent reflects the larger debate about applicability
and cost-effectiveness of live donor transplants.
trying to put this whole thing into a format that can be integrated
into our society and how we deal with it from a legal perspective,
an ethical perspective and a medical perspective, said Pruett.
liver disease, once stigmatized as the curse of alcoholism, can
be caused by a number of different renal failures, including immunologic
and metabolic diseases, hepatitis, tumors and fatty liver disease.
There is no accepted standard among transplantation experts as
to which forms of cirrhosis are best suited for live-donor transplants
and which are more responsive to cadaveric transplants.
has a history of advancing the acceptance of liver transplants.
In the 1990s, the transplantation division played a large role
in reversing the common wisdom that hepatitis B patients should
not receive transplants. In the course of a decade, U.Va.s
work in passive immunization helped slash infection rates in such
transplants by 70 percent, and survival rates shot up in response.
Even the government responded, approving Medicare coverage for
balancing the ethical concerns inherent in live donors is a more
delicate task than conquering infection rates.
hard to ethically serve both sides, explained social worker
Phyllis Yensen. If I know you as a potential recipient,
know that youre getting sicker, and your sister comes to
me and wants to donate, how can I serve you both?
U.Va., live donor candidates are deliberately channeled to an
independent party, called the Donor Advocacy Team, for initial
screening to be certain that there is no coercion on the part
of the recipients providers. Even after consulting with
the team about the medical and financial ramifications of being
a donor, as well as the likely toll on family and career, a donor
who wishes to proceed must assure the members of the transplantation
division as well.
we dont want to rush it. If you see a donor and are ready
to go through with the operation in a week, you havent given
it ample time, said Yensen.
component of the $18.6 million grant will be set aside for research,
in the hope that scientific advances will reduce the medical uncertainties
of live donor transplantations. In the meantime, U.Va. specialists
will continue to rely on time and information as key resources
in a complex decision.