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    The Domino Effect: Two Donor Livers Serve Four Patients


    At last report both the patients with FAP and the recipients of their organs -- both men with hepatitis C, one age 53 and the other age 68 -- were doing well, says Dave Lewis, MD, director of Lahey's liver transplant program and associate professor of surgery at Tufts University School of Medicine in Boston.

    Although some people might question whether it is ethical to give patients with a critical illness a "diseased" organ, there is good therapeutic rationale for the experimental surgery, says Martha Skinner, MD, an expert on FAP and other amyloid protein abnormalities.

    "The livers taken out of these patients are very good looking livers; they don't have the usual end-stage liver disease like people who usually get liver transplants," Skinner, professor of medicine and director of the amyloid program at Boston University School of Medicine, tells WebMD.

    She says that although it is still unknown how livers from donors with FAP will affect the recipients, "these people are not ideal candidates for transplants because of problems like hepatitis C that would make a donor liver more likely to fail, so they may not be at the top of the transplant lists, but this clearly is giving several years of life to these people that they would not have."

    Bioethicist Jeffrey Kahn, PhD, MPH, tells WebMD that for patients with hepatitis C or other life-threatening illnesses, the prospect of receiving a less-than-perfect liver almost certainly beats the alternative. "Why limit this to patients with hepatitis C? There are others waiting for liver transplants who probably will die if they don't have one. Would they not rather accept a liver with this inborn error of metabolism than none at all?" says Kahn. He is director of the Center for Bioethics and an associate professor in the department of medicine at the University of Minnesota Medical School in Minneapolis.

    "There is already a 'second-tier market' in livers from people who are hepatitis C-infected but don't even know it when they die," Kahn notes. "So those livers will not be transplanted into healthy people, but they will be transplanted into people with hepatitis C who need a liver transplant, which in a way expands the pool of useable organs." A liver from someone with hepatitis C can function for many years before failing.

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