Guidelines Needed for Live Liver Donation, Doctors Say

Writing in today's issue of the New England Journal of Medicine, several doctors propose appointing an "external regulator" to review hospitals that perform live liver transplants, the AP/Albany Times Union reports. Lead author Dr. James Trotter, an associate professor at the University of Colorado Health Sciences Center, and colleagues also suggest that the medical community establish "uniform medical criteria" for selecting live liver donors and recipients. The suggestions come weeks after New York state health officials barred Mount Sinai Hospital from performing live liver transplants following the death of liver donor Michael Hurewitz in January. The officials cited the hospital for 18 deficiencies and said the facility provided "woefully inadequate post-surgical care" (Donn, AP/Albany Times Union, 4/4). In addition, the New York state Department of Health announced yesterday that it will investigate 32 deaths over nine years at the hospital's liver transplant center (Lasalandra, Boston Herald, 4/4).

At the center of the debate over live liver transplants is "determining what amount of risk is acceptable for the liver-transplantation community and for the public," Dr. Owen Surman of Massachusetts General Hospital writes in an accompanying NEJM editorial. Other questions that need to be addressed include the appropriate age of donors, the basic requirements for evaluation of transplant doctors, the necessary skill and experience of the transplant team and the prognosis for the recipient. The effect of the procedure on donors' physical and emotional health should also be examined. Surman suggests that potential donors should be told in a "noncoercive manner" of the possibility of personal risk during donation and of the prognosis of the recipient. He supports proposals by the American Society of Transplant Surgeons and the NIH to create a liver-donation registry (Surman, New England Journal of Medicine, 4/4). Currently, deaths of liver recipients need to be reported but deaths of liver donors do not, USA Today reports.

Live liver donation has become increasingly popular in recent years because of the long waiting list -- currently 17,641 people -- for livers donated by individuals who have just died, USA Today reports. One in 10 people waiting for livers die while on the list and more die after they are removed from the list to make room for others who have a greater chance of surviving a transplant. Patients and surgeons can bypass the waiting list by opting for live liver donation, USA Today reports, and the number of live liver transplants is likely to increase in coming years as the demand for livers increases. But a USA Today survey of 60 facilities that have performed live liver transplants since 1991 found that "most hospitals ... have done relatively few of them." In 2001, 39 of the 49 hospitals that performed live liver transplants did fewer than nine, a statistic that "worries some transplant experts" (Davis/Chong, USA Today, 4/4). However, the greater risk of live-liver transplants does not dissuade some people, Trotter writes in a ABCNews.com opinion piece. A recent survey found that respondents would accept a live liver donor mortality rate of 20% for themselves and would rather die donating their liver than watch the death of a loved one without the chance of a transplant (Trotter, ABCNews.com, 4/3).