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Between Friends: Living Donors

It's a trend that's changing transplant medicine. More and more people are willing to donate a kidney or part of a liver - while they're still alive.

Battling "The List"

Science can take some credit for this shift. New surgical techniques let doctors remove a kidney through small incisions that leave little scars and are easier to recover from. New anti-rejection drugs let patients receive organs that aren't close genetic matches.

But there has also been a shift in medical thinking. While anti-rejection drugs have been available since the 1980s, until several years ago doctors routinely rejected donors who weren't immediate family members. Placing a healthy donor at any risk from surgery -- no matter how small -- violated the physician's obligation to "first, do no harm," they argued.

So what has changed? It can be summed up in two words -- The List. As medical technology keeps people alive longer and improved transplant techniques offer new hope, the number of people on the waiting list for organs has swelled. Today, more than 83,000 people are waiting -- and hoping -- for an organ, compared to 60,000 six years ago.

"Living donors are a desperate move to compensate for the lack of organs," says Amadeo Marcos, MD, clinical director of transplantation at the Starzl Transplantation Institute and professor of surgery at the University of Pittsburgh School of Medicine. He was one of the first doctors to transplant a partial liver from one adult into another.

Officially, more people on the waiting list today need kidneys than livers. But experts predict our need for livers will soon explode, triggered by the Hepatitis C virus. Some health officials estimate that 75,000 Americans may need a liver transplant by the year 2010, compared with just 15,000 today. And many, like Steven, will turn to their friends for a portion of the most vital organ in the human body.

The New World of Transplant Medicine

Most people don't realize the number of body functions dependent on the soft, reddish-pink organ. Damaging your liver is like tipping over the first domino in a line. Energy levels fall, blood fails to clot, concentration is lost, and heart and lung problems develop. A person with kidney failure can survive on dialysis treatments while awaiting a kidney transplant; a patient with liver failure has no such recourse.

"Every organ starts to shut down around the liver," Marcos says.

But unlike kidneys, each person has only one liver. Until partial liver transplants became possible in 1989, people couldn't donate their livers while alive. That year, the first parent-to-child partial liver transplant was performed, and after its success, surgeons began experimenting with adult-to-adult partial transplants. Still, the procedure didn't really take off until 1998. By May 2000 there were 2,745 partial livers transplanted between adults, and the number grows each year.

Liver transplants from living donors are actually safer for recipients than transplants from deceased donors, according to research presented in 2003 at the 68th Scientific Meeting of the American College of Gastroenterology. But they do pose some risk to the healthy donor.

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