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Return to Living Donor and Split Liver Transplants Help Ease Critical Organ Shortage Overview

More on Living Donor and Split Liver Transplants Help Ease Critical Organ Shortage

Living Donor and Split Liver Transplants Help Ease Critical Organ Shortage

New York (Apr 19, 2011)

A surgeon at New York-Presbyterian prepares a liver for transplant
A surgeon at NewYork-Presbyterian
prepares a liver for transplant.

According to the government's Organ Procurement and Transplantation Network (OPTN), about 6,500 liver transplants are performed in the U.S. every year. But currently, more than 16,000 people are on the waiting list. About 30 to 40 percent of those people have liver cancer; the rest have other diseases of the liver, including Hepatitis B, Hepatitis C or fatty liver disease. Drugs can help most of those people for a time, but the long term outlook is not good. As Daniel Cherqui, M.D., the Chief of Hepatobiliary Surgery and Liver Transplantation at New York-Presbyterian/Weill Cornell Medical Center, puts it, "Kidney patients can usually go on dialysis while they wait for transplants; liver patients die."

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The shortage of donors leads to patients waiting longer, so they are sicker when they receive a new liver. At the same time, rates of liver disease are skyrocketing, leaving a large supply and demand discrepancy between available livers and those who need them.

Under regional rules set by the United Network for Organ Sharing (UNOS), the national transplant registry system, the sickest patient gets the first available liver (depending on compatibility), but waiting times also depend on geography. In Dr. Cherqui's experience, a person in Indiana may be on the list for two weeks; a person in Paris for six months; and a person in New York may remain on the list for up to twelve months.

Daniel Cherqui, M.D.
Daniel Cherqui, M.D.

For those who are lucky enough to receive a liver transplant, prospects for survival are good. OPTN data show that nearly 90 percent of new liver recipients are alive after one year, and the five-year survival rate stands at 75 percent. But getting a liver is still a problem.

In an effort to address the donor shortage, surgeons have developed and are now refining two surgical advances to help make organs available to more patients.

Split Liver Transplant

One of those advances is a procedure known as split-liver transplant, where the liver from a deceased adult donor is literally divided into two pieces. The left lobe of an adult liver is generally the proper size for a baby, while the right lobe is large enough to act as a transplant liver in an adult. If all goes well, one liver could be donated to two patients. But, cautions Dr. Cherqui, "This doesn't happen every time. We need the perfect organ for this to work."

Jean C. Emond, M.D.
Jean C. Emond, M.D.

The split liver technique was originally developed to provide livers for children, who typically have biliary atresia, a condition where the bile ducts don't form during fetal development. "Most of these children are less than two years old, so there are many more of them than organ donors in that age group," says Jean C. Emond, M.D., the Vice Chair and Director of Transplantation at NewYork-Presbyterian/Columbia University Medical Center and a developer of the procedure, "so we began to develop techniques to cut down parts of adult livers and use them as whole livers to transplant children."

Living Donor Transplant

The liver's unique ability to regenerate itself – a small slice of liver will re-form an entire organ in a few weeks' time – has allowed surgeons to develop a procedure known as "living donor" transplant. Just as its name implies, a living donor transplant involves removing a portion of a liver from a live person (rather than a deceased person) and transplanting it into a recipient. Donors are typically family members or persons emotionally related to the patient. Having compatible blood type and a healthy liver, and being a generally healthy person are pre-requisites to being a living donor.

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The first such transplant was performed in 1989, from a mother to her 21 month-old daughter. Since then, the operation has expanded to adults, and doctors are working to refine the procedure. At NewYork-Presbyterian/Columbia, surgeons, for example, perform approximately 145 liver transplants a year (20 in children and 120-plus in adults) and of those, about 120 are deceased-donor transplants and 25 are living donor transplants. Currently, about three percent of U.S. liver transplants are from living donors. In Japan and Korea, all liver transplants are performed through living donors, a result of cultural preference.

Robert S. Brown, Jr., M.D., M.P.H.
Robert S. Brown, Jr.,
M.D., M.P.H.

Even in an age of excellent hospital care, it would be wrong to think of living donor transplants as a magic bullet. The procedure has risks, and donors and recipients alike have died. "Donors sometimes develop complications such as bile leakage, which can cause pain and sometimes infection, and have to remember this is major liver surgery," said Robert S. Brown, Jr., M.D., M.P.H., the Medical Director of Transplant Iniatitive at NewYork-Presbyterian/Columbia University Medical Center.

Commitment Required

Patients considering having a liver transplant of any kind must be committed to their new organ. They will need to be on a regimen of immunosuppression drug therapy for the rest of their lives. Side effects can include hypertension, renal trouble, diabetes, infection and other long-term problems. But, as Dr. Cherqui notes, the trade-off is worth it. "These were dying patients with poor quality of life and these drugs allow them to sustain their graft and live normal lives," he says.

Contributing faculty for this article:

Daniel Cherqui, M.D. is the Chief of Hepatobiliary Surgery and Liver Transplantation at NewYork-Presbyterian/Weill Cornell Medical Center and a Professor of Surgery at Weill Cornell Medical College.

Jean C. Emond, M.D. is the Vice Chair and Director of Transplantation at NewYork-Presbyterian/Columbia University Medical Center and the Thomas S. Zimmer Professor of Surgery at Columbia University College of Physicians and Surgeons.

Robert S. Brown, Jr., M.D., M.P.H. is the Medical Director of Transplant Iniatitive at NewYork-Presbyterian/Columbia University Medical Center and the Frank Cardile Professor of Medicine and Surgery at Columbia University College of Physicians and Surgeons.

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