Working up potential living liver donors

April 03, 2007

Voluntary living liver donors should undergo a careful, but quick, workup and their desire for altruism should not be hampered by negativism from the transplant community, say the authors of a new study in the April issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

Over the past ten years, living donor liver transplantation has become a practical alternative to deceased donor transplantation. Through it, donors can save the life of a loved one; however, morbidity and mortality of donors remain major drawbacks. The workup of the potential donor is a serious procedure with potentially profound impacts on his or her psyche, decision and satisfaction, as well as on the outcome of the potential recipient.

Researchers, led by Professor Sheung Tat Fan of the University of Hong Kong, sought to analyze and report the experiences of donor workups at their center, which performs many more transplants from living donors than from deceased donors because of a major scarcity of the latter.

The researchers included 399 people who offered to become a living liver donor for a loved one between January 2001 and December 2004. To do so, each had to successfully complete a four-step process which ascertained their suitability for the surgery. First, they provided a detailed medical and drug history. Second, they underwent a comprehensive psychological assessment as well as medical testing including chest radiographs and an electrocardiogram. Third, they underwent liver biopsy, if there was any suggestion of fatty liver changes. Lastly, they gave informed consent.

A full 32 percent of the potential donors made it through the workup and went on to the donor surgery. Most of those who did not make it to the surgery dropped out after the first step; 144 due to medical reasons such as ABO incompatibility or because they were hepatitis carriers, though 42 dropped out voluntarily, and 24 because there was another better donor. From step two onward, there were very few dropouts. Only two potential donors were rejected for psychological reasons. An additional twenty had incompatible liver anatomy. Thirty-six did not proceed because of changes in the condition of the potential recipient.

"Step one of donor workup is logistically crucial and should be accomplished expeditiously," the authors report, since nearly 68 percent of donors who made it past the first step went on to the donor surgery. For recipients whose cases were urgent, the time for workup and evaluation of the donor was condensed, in one case completed in just 8 hours. "There was much concern on the question of coercion due the pressing situation of the rapid deterioration of the patient," the authors report, however, a gradually deteriorating patient could also be a source of pressure, they note.

"The voluntary donor should undergo careful and expeditious workup. This includes provision of salient information about donor risks, the possible harm and recipient benefit," the authors conclude. "Even though a live donor will not benefit from the operation physically, the loss from failure to save the recipient can result in much psychological remorse. Based on personal values of the donor and recipient, they should have a say."

An accompanying editorial by Robert Fisher of Virginia Commonwealth University applauds the high proportion of living donors who made it to surgery in the report by Chan et. al. He also supports expeditious workups at experienced transplant centers for "high urgency" recipients.

"To further the spirit of "voluntarism" and to increase the understanding of the potential donors," he says, "we have always included psychological and social work interview in the first step." They also encourage potential donors to contact past donors to learn about their experiences. "This simple addition has caused no inefficiency and has furthered the respect and transparency of the donor process," he concludes.
-end-
Article: "Working Up Donors for High-Urgency and Elective Adult-to-Adult Live Donor Liver Transplantation." Chan, See Ching; Fan, Shueng Tat; Liu, Chi Leung; Lo, Chung Mau; Lam, Banny K.; Lee, Evelyn W. Liver Transplantation; April 2007; (DOI: 10.1002/lt.21029).

Editorial: "Enabling Altruism: Evaluating the Adult Living Liver Donor." Fisher, Robert. Liver Transplantation; April 2007; (DOI: 10.1002/lt.21012).

Wiley

Related Liver Transplantation Articles from Brightsurf:

Study reveals improving survival rates after liver transplantation in the UK
In the past two decades, death rates after liver transplantation have dropped by more than half in the UK, according to a recent analysis of almost 10,000 liver transplant recipients published in BJS (British Journal of Surgery).

Advancing transplantation: Hepatitis C-infected organs safe for transplantation when followed by antiviral treatment
Twenty patients at Penn Medicine have been cured of the hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease, according to a study published today in Annals of Internal Medicine.

US study reports dramatic reduction in likelihood of liver transplantation in patients with hepatoce
ILC 2018: Although hepatocellular carcinoma is now the leading indication for liver transplantation in the USA, the probability of patients receiving a transplant has declined significantly in recent years.

HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly in the era of direct-acting antiviral drugs
HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly in the era of direct-acting antiviral drugs.

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA
Two independent US studies confirm that, from 2016 onwards, alcoholic liver disease has led to more liver transplants than hepatitis C infection in patients without hepatocellular carcinoma (HCC).

The Journal of Heart and Lung Transplantation: 50 years of heart transplantation progress
This month marks the 50th anniversary of the world's first human heart transplant performed at Groote Schuur Hospital in Cape Town by South African surgeon, Christiaan Barnard.

Researchers develop new technique to model transplantation of the human liver
A novel technology developed by researchers at the Massachusetts General Hospital enables the model-ing of human liver transplantation in an experimental setting.

New method creates liver bioscaffolds with intact ECM for reseeding and transplantation
Researchers have reported a method for successfully removing the cellular material from whole human livers while retaining the organ's three-dimensional structure and extracellular matrix (ECM) components.

Routine hospital tool found to predict poor outcomes after liver transplantation
A routinely used hospital tool can predict which liver transplant recipients are more likely to do poorly after surgery, according to a study led by Cedars-Sinai.

Critically ill children can still undergo liver transplantation and survive
Advancements in critical care make it possible for even the sickest children to successfully undergo liver transplantation.

Read More: Liver Transplantation News and Liver Transplantation Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.