Johns Hopkins Surgery - The Case for Live Donor Liver Transplants
The Case for Live Donor Liver Transplants
Date: February 1, 2014
So many cards must fall into place before a recipient can ever make it to the operating room. A donor organ extracted from a recently deceased patient must be viable and quickly transported to the recipient's hospital. Recipients, meanwhile, must be ready at a moment's notice and meet a stringent set of qualifications, right down to the degree of illness. Too sick, and the organ might go to waste: No transplant could save them. Not sick enough, and their case may not be considered urgent enough compared with patients who might be mere days or weeks away from dying.
But when it comes to liver transplants, finding a donor doesn't have to mean waiting for someone else to die. In many cases-particularly for those healthier patients not quite sick enough to make it to the top of the list-a live donor may be their best or only option, says Johns Hopkins transplant surgeon Ben Philosophe. Because of the liver's regenerative properties, a person can feasibly live with as little as one third of their natural organ. By sacrificing an estimated 50 to 60 percent of their own liver, live donors, usually a family member or close friend,can offer hope to patients who otherwise might spend years battling painful liver disease. For those patients who've found a willing donor, the Johns Hopkins Hospital Comprehensive Transplant Center is among the highest-volume centers, accounting for an estimated 2 percent of live donor liver transplants across the nation.
Little Reason for American Skepticism About Live Donor Liver Transplants
Worldwide-but particularly in Asia and Eastern Europe-live donations are often the rule, because of laws prohibiting the use of organs from the deceased. And while such laws may limit the number of transplants performed overall, the result is a much higher volume of live donor transplants than in the U.S., where they are far less common and looked upon with more skepticism. "Turkey alone is doing almost twice as many live donor transplants as the whole United States because they don't have a good alternative," Philosophe explains. "The same is true in many Asian countries. Because they're solely relying on living donation, they're really able to push the envelope."
American hesitance about live transplant programs stems mostly from a small number of
high-profile cases, in which the liver donor died. "When you're doing 200 of these surgeries per year across an entire country and it happens once or twice," Philosophe says, "it sends some shockwaves and people get scared."
But those cases are the exception, he explains. The reality is that live liver transplantations have proven overwhelmingly successful, with a donor fatality rate of .05 percent and a recipient success rate around 90. Hopkins own live donor transplant program performs between 10 and 20 per year. Surgeons in the program have dedicated significant time and resources to training, including traveling to Turkey and other countries that have thriving live donor programs.
"The fact that we do this operation is fairly unique in the U.S.," Philosophe says. "It's something that very few centers have embarked on. We want to be able to offer and expand our options for our liver patients. Since the deceased donor waiting list is long some may not make it. In 2012, nearly 11,000 people died on the liver transplant list nationally. Living donor liver transplant gives them that shot at life before it's too late."
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