Living-Donor Transplants - The Gift of Life
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A Shortage of Organs continued...
"If we had a sufficient supply of cadaver organs, we wouldn't want to subject a healthy donor to an operation of this magnitude," says Christopher Shackleton, MD, director of the multi-organ transplant program at Cedars-Sinai and a leader of the transplant team that performed the Chavez surgeries.
The success rate of living-donor procedures is 95% at Cedars-Sinai, and a bit lower nationwide. This is higher than the 85% success rate achieved with cadaver liver transplants at the same hospital.
Weighing the Risks
Despite many successful transplants, there are clear risks associated with the procedure. In January 2002, a 57-year-old donor, Mike Hurewitz, died at New York's Mount Sinai Hospital from surgical complications following his donation of part of his liver to his younger brother. As a result, Mount Sinai temporarily halted its living-donor liver transplantation program until the Hurewitz case could be evaluated and the hospital's procedures reassessed.
Although the death in New York is only the second known fatality of a living donor in an adult-to-adult liver transplant in the U.S. (the other occurred before the United Network for Organ Sharing began formally keeping such statistics in 1999), it is still very troubling to those who perform these operations. Mark Fox, MD, PhD, director of the program in transplant ethics and policy at the University of Rochester (N.Y.) Medical Center, says that surgeons and ethicists continue to debate the level of acceptable risk.
"As I understand it, the mortality risk among donors is thought to be 0.2% in these procedures, so two out of 1,000 living donors will die undergoing this procedure," says Fox. But, he asks, even if the risk were much higher -- say, one out of 100 living donors -- "would that distinction matter to potential donors if they had the opportunity to do something to save the life of someone important to them?"
Because of the risks, transplantation programs put potential donors through a battery of tests to ensure their good physical health. "Every potential donor also undergoes psychosocial assessments to make certain that they fully understand the risks and benefits, and that they're choosing to become a donor for altruistic reasons," says Shackleton. "We also sit down with the potential donor and his family members in the absence of the prospective recipient and make it clear that this is an entirely voluntary process -- that he shouldn't feel compelled to move forward with the procedure, and that he is completely free to withdraw at any time up to the induction of anesthesia."
The success rate of living-donor operations remains high, in part because the donor organs come from healthy individuals rather than someone who may have died many hours earlier. Also, the patients receiving liver transplants may not have spent many months on the waiting list for an organ, and thus may not be as desperately ill.
"With the living-donor procedures, we can intervene in a more timely way based on the recipient's condition," says Shackleton.