PITTSBURGH, August 27, 1999 — Despite a severe shortage of cadaveric organs, a number of surgeons who convened at a special international meeting in Pittsburgh Wednesday suggested living-related liver transplants for adults should only be performed at the most experienced transplant centers and with caution. While such transplants are gaining in popularity, the trend could see disastrous consequences for the donor -- otherwise healthy individuals who must undergo an operation with numerous risks.
A better and safer way to expand the donor pool would be to encourage more transplants that use surgically divided livers from cadaveric donors, thus providing benefit to two patients from one organ donor. If put into more widespread practice, split liver transplants could eliminate deaths of children on the national waiting list and also offer adults an alternative source of organs without the risks associated with living-related transplants.
More than 375 surgeons participated in the First International Symposium Dedicated to Expanding the Donor Pool, which focused exclusively on issues related to split liver and living-related liver transplantation.
"Many medical, surgical and ethical issues need to be resolved before adult living-related liver transplants can be widely applied to an ever-growing population of adults with end-stage liver disease. We need to proceed cautiously," said Ronald W. Busuttil, M.D., Ph.D., professor and chief, division of liver and pancreas transplantation at the Dumont-UCLA Transplant Center, who co-chaired the meeting along with Koichi Tanaka, M.D., professor of surgery at Kyoto University in Japan.
Since 1989, more than 1,300 liver transplants using live donors have been performed throughout the world. About 1,000 of these have involved a parent giving a piece of their liver to their child, and the remaining 300 involved adult recipients. About 70 adult living-related liver transplants have been performed in the United States in the past three years, including 45 so far in 1999.
Split liver transplantation is the preferred method to expand the donor pool, surgeons who attended the special symposium all agreed. Yet only 18 of the 125 liver transplant programs in the United States perform the procedure. It is estimated that an additional 500 to 600 transplants could be performed on a national basis if the split liver procedure were more utilized.
"Full development of split liver transplantation may make living-related donation and reduced grafts obsolete except in emergent or special circumstances. In addition, the practice could provide enough liver grafts for the entire pediatric population," said Dr. Busuttil, a staunch advocate of split liver transplants.
Some at the meeting recommended that national and international registries be established that would allow surgeons to monitor transplant outcomes. A national registry could also provide a mechanism to more widely share split livers across regional boundaries. A United Network for Organ Sharing (UNOS) policy that will go into effect later this year has limitations, surgeons said, because it is voluntary and is limited within the designated boundaries of the UNOS regions.
The First International Symposium Dedicated to Expanding the Donor Pool was sponsored by the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh School of Medicine and supported by an unrestricted education grant from Fujisawa Pharmaceuticals Co., Ltd.