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    When a Gift From the Heart Is a Kidney


    Liver donation is even more complicated. Unlike kidneys, the liver can regenerate itself to full size in less than two months, making it possible to remove about half of a donor's liver for implantation in someone in need of a new liver. But the surgery for donating and transplanting a liver is more difficult, and puts both the donor and the recipient at greater risk for serious complications than does the same procedure for a kidney transplant. For that reason living-donor liver transplantation is rarely performed.

    However, there is a critical shortage of donor organs, and many people who need a new kidney languish for as long as five years on waiting lists, making the idea of nondirected donation worth considering. In addition, advances in surgical techniques and in drugs that prevent the recipient's body from rejecting an organ from a nonrelated donor have made the surgery more successful.

    "There has been an evolution of thought," Matas tells WebMD. "Twenty years ago our argument was that there are risks to the donor operation and that there would be no advantage to a living unrelated donor vs. a cadaver donor, therefore there's no justification to put the donor through those risks. Over the last two decades we've learned that the results of living unrelated donor [kidney] transplants are similar to living related donor transplants, and it sort of changes the equation in terms of risks and benefits, because now you have the same risks as we're putting the related donors through and in fact the same benefits."

    Although accepting the sacrifice of healthy organs from altruistic individuals could help to ease the growing shortage of donor organs -- already at critical levels, transplant surgeons say -- it could also be the start of a slippery slope toward the competition and commercialization of organ procurement, some observers warn. And there is also the fear among some people that there may be an unintentional tendency to downplay the risk of donation in order to get an organ.

    "The program as described from Minnesota strikes me as well put together and reasonable, but my concern is that they will not be the only transplantation program to institute this way of getting living donors [for kidney transplantation]," Norman Levinsky MD, tells WebMD. "In a competitive environment where it's important to a program to shorten the wait of their recipients to less than three, four, or five years -- in other words to get some of their most needy recipients to the head of the line -- there might be shadings of meaning or body English, which are totally unintended but which minimize the risks of discomfort at the least, and the remote but not zero risk of death," says Levinsky, professor of medicine at Boston University Medical Center, who wrote an editorial accompanying the article.

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