LOS ANGELES (July 7, 2005) – Because need far outweighs the availability of organs for transplantation, transplant specialists are increasingly utilizing adult-to-adult living donor liver transplantation, but the procedure includes significant risks to the healthy donor.
Now, to support quality assurance standards nationwide, the United Network for Organ Sharing (UNOS) – the organization that administers the nation's policies on organ transplantation – offers institutions the opportunity to qualify as UNOS-approved live donor liver transplant centers, and Cedars-Sinai's program has become the first to receive this designation. Living donor liver transplantation has been available at Cedars-Sinai since 1999.
The UNOS application process explores the depth and breadth of a transplant program, requiring documentation about the program's history and patient outcomes as well as details of the transplant team, including administrative support, financial counselors, clinical transplant coordinators, data coordinators, social workers, and medical and surgical staff.
"In the United States, more than 18,000 patients are currently on liver transplant waiting lists while only about 5,000 deceased donor organs become available each year. More patients are dying each year while waiting, and many thousands of others are experiencing a decline in their quality of life," said Andrew S. Klein, M.D., director of the Comprehensive Transplant Center at Cedars-Sinai who has held a number of prominent positions with UNOS, currently serving as secretary on the organization's board and chair of the Living Donor Transplant Committee. Klein recently was elected to the governing board of the American Association for the Study of Liver Disease (AASLD).
"Living donor liver transplantation should be thought of as an option that is appropriate for only some patients, and it is certainly not the answer to the organ shortage," said Steven D. Colquhoun, M.D., director of Liver Transplantation in the Center for Liver Disease and Transplantation at Cedars-Sinai and a member of the UNOS Liver and Intestine Transplantation Committee.
"Deceased donor organs are always offered to the sickest first, so we tend to categorize patients waiting for livers into one of three groups. First are those who are very ill and at the top of the waiting list. They will likely get a deceased donor organ. At the other end of the spectrum are those who are not yet especially ill and who can safely continue to wait. But in the middle is a group of patients who are really suffering. They're already quite ill but, unfortunately, they will need to become much worse before they are likely to get an organ offer. These are the people who we primarily consider as good candidates for living donor liver transplantation," Colquhoun said. "If they are lucky enough to have a family member or friend of the right blood type who is willing to donate, then we can assess their anatomy and social circumstances. If all aspects are acceptable, then we may be able to intervene early so the patient doesn't continue to decline."
Colquhoun said transplant teams take into account many factors when considering the living-donor option. "There are risks involved with any surgery, but usually these are balanced by the potential benefit to the patient. In the case of the living donor, they derive no direct physical benefits, so the risks are much more difficult to justify and their safety is of utmost importance. An enormous amount of energy goes into screening potential donors. We need to feel certain that they are appropriately motivated and educated regarding the risks," he said.
Among its minimum requirements, UNOS expects approved programs to employ two qualified liver transplant surgeons. At Cedars-Sinai, three surgeons – Klein, Colquhoun and Nicholas N. Nissen, M.D. – all meet the criteria. Colquhoun has been with Cedars-Sinai since 1996, Nissen joined the staff in 2001, and Klein came to Cedars-Sinai last year after serving in several capacities at Johns Hopkins Hospital for more than 20 years. Fred Poordad, M.D., chief of hepatology at the Center for Liver Disease and Transplantation, and Tram T. Tran, M.D., medical director of Liver Transplantation, oversee the pre- and post-transplant medical care of patients.
"Transplantation, and especially something as demanding as living donor transplantation, is one area of medicine where there are no individuals. This has always been, and forever will be, a team endeavor, predicated on communication among many people with different areas of expertise," said Colquhoun, adding that in developing its program, Cedars-Sinai has always taken a cautious stance.
"We felt very strongly that we wanted to move slowly and conservatively," he said. "When you're dealing with liver transplantation, you're dealing with people who will die without surgery. The only way to make that worse would be to add a complication in a living donor. Therefore, from the beginning we carefully planned all aspects of the living donor program, including the involvement of social workers, psychiatrists, and the hospital ethics committee. We moved very methodically and deliberately through the process and continue to be very conservative to this day."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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