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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.
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Battling "The List" continued...

"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.

The human liver is an atlas of tiny blood vessels and vital arteries that must be severed and sealed off or the donor can bleed to death. Marcos likens the surgery to a plumber fixing a leak without turning off the water. The donor must give up at least half of his or her liver, which means surgery can last up to 14 hours. And while the liver apparently fully regenerates in about two weeks, there are other risks. Donors face a 20% chance of a complication. Typically, these will be minor, such as developing an infection or catching a cold while in the hospital. However, 4% may face a serious complication requiring a second surgery, such as hemorrhage or the development of an abscess.

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