Public health service to fund live liver transplants

Nov 8 2005

An announcement that new organ transplant technology will now allow adult patients to receive liver transplants from a living relative for the first time on the NHS, marks a new era in public health services.

Edinburgh Royal Infirmary will from next April be the first hospital in Britain to take a section of liver from the body of a healthy living adult and transplant it into an NHS patient, despite the risk of complications and even death to the donor.

The news follows two years of concern over lengthening waiting times at the Edinburgh hospital, which has the worst rate of any in Britain for patients who die whilst awaiting a liver transplant.

Although live transplant operations are an established procedure for kidneys, as donors can survive with only one, until now ethical concerns have prevented Britain from following countries such as the United States and Japan by performing adult-to-adult live liver transplants.

The liver is unusual because unlike other internal organs it is capable of regenerating fully of its own accord.

John Forsythe, clinical director of the Edinburgh Royal Infirmary’s transplant unit, does not deny that there were risks but emphasises that nobody would be "coerced" into donating a liver.

The operation is a relatively straightforward procedure lasting an average of three hours and open to any two people with the same blood group and similar size of liver.

During the procedure as much as 60 per cent of a donor’s liver, a section around five inches long, is transplanted into the recipient’s body and the patient’s old organ removed.

Within three months both pieces of healthy liver then regrow to full size.

The surgery does have risks, it can cause the donor’s blood to clot less effectively during surgery, and encourage deep vein thrombosis and blood clots in the lungs.

The mortality rate for donors is roughly one in 200, compared with about one in 3,000 for live kidney donors, while the risk of complications is around 20 per cent.

For the recipient also the risks are slightly increased.

As many as five operations are expected to take place next year, rising to 15 within three years, and Mr Forsythe is concerned that the hospital could become inundated with requests from patients across Britain.

Transplant charities last night welcomed the initiative but emphasised that potential donors must be informed of the risks.

According to Mr Forsythe potential donors would be given advice from a four-strong "advocacy team", including a psychiatrist, to ensure that they understood the consequences of becoming a donor.

After the operation patients will be monitored in line with recommendations from a report in the US after Mike Hurewitz, a 57-year-old donor who gave part of his liver to save his brother, died in 2002 days after the operation.

The report concluded that the New York hospital had provided "woefully inadequate postsurgical care".