The Domino Effect: Two Donor Livers Serve Four Patients
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.
Lewis tells WebMD that all patients involved are likely to benefit from the domino procedure. "To my knowledge, the longest-surviving domino FAP liver recipient is about two-and-a-half years out and has not developed, to this point, any symptomatic amyloidosis," he says.
He also tips his surgical-scrub cap to the patients with FAP for their willingness to undergo a difficult procedure -- a typical liver transplant can last up to 16 hours -- while helping others at the same time. "Neither of the amyloid patients even blinked when we presented this whole science-fiction kind of scenario to them," he says. "Both of their responses were essentially 'I don't want this thing any more and if someone else can use it, please, please give it to them.'"