Liver transplants
The liver is unique. Unlike any of the
body’s other major solid organs, it has an extraordinary ability to
regenerate itself – even when more than half its original mass has
been surgically removed.
This capacity to regrow could, some experts
hope, be the key to saving more lives among those in urgent need of
a transplant.
So-called live donor transplants have been
carried out for several years on children at some of Britain’s
leading transplant centres.
Now the technique is being rolled out to more
adults in the hope that they too will benefit.
But why do we need live donor transplants and
how do they work?
The first ever whole liver transplant from a
deceased donor was carried out in Denver, Colorado, in 1963, by a
team led by surgeon Dr Thomas Starzl.
Since then, more than 10,000 patients in
Britain have benefited from organs donated by others who died in
accidents, or from non-liver related conditions.
But demand continues to outstrip supply and
despite continued efforts to encourage people to sign up to the NHS
donor register, there remains a serious shortage.
Spain, for example, has a liver donation rate
of 38 per million population. In Britain, it’s just 12 per million.
Spanish surgeons, therefore, are able to perform more than double
the number of transplants we can here.
As a result, some UK transplant centres have
had to ration donated organs, restricting them to patients with the
best chances of survival.
‘The number of cadaver organs available has
fallen in recent years, with 40% of relatives refusing consent to
the use of the organ,’ says Professor Roger Williams, professor of
hepatology at University College London and also a specialist at
The London Clinic.
‘If we are to keep up with the numbers needing
a liver transplant, and sadly the number of patients who die on the
waiting list is rising, we will, as a country, have to do much
better with organ donation.’
While the debate continues over whether
Britain should switch to an ‘opt out’ system for organ donation,
there is hope that live donor transplants could partly fill the
gap.
Doctors have known for years about the liver’s
extraordinary powers of regeneration.
In fact, it’s not uncommon for a donated
cadaver liver to be split in two – the larger right lobe going to
an adult in need of a new organ, the smaller left lobe going to a
child.
In each case, the donated ‘mini liver’ grows
back to its normal size.
Now it is possible to take either the right or
left lobe from a matching ‘live’ adult donor and transplant it into
a related adult or child who needs it.
The National Institute for Health and Clinical
Excellence, the government’s NHS spending watchdog, has sanctioned
its use in adults.
But the procedure is not without dangers.
Removing the smaller left lobe carries a risk of death for the live
donor of around one in 1,000. Taking the larger right lobe
increases this to about one in 200. There is also a chance of
post-operative complications.
‘The safety of the donor is of utmost
importance,’ says surgeon Steven Olde Damink, who will be working
closely with Professor Max Malago as part of The London Clinic’s
liver transplant team.
‘But this type of surgery has a very good
record in other countries. In South Korea, for example, they are
doing live organ donations practically on a daily basis. ‘And among
the recipients, we would expect survival rates to be roughly the
same as those in whole organ donation, with 90% still alive after
the first year and 70% at five to ten years.’
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