ORGAN ALLOCATION: Most Children’s Livers Go to Adults
About two-thirds of livers donated by children go to adults, while 75 children die each year waiting for liver transplants, a new seven-year study reveals. Dr. Jorge Reyes, chief of pediatric transplantation at Pittsburgh's Children's Hospital and the Starzl Transplant Institute, tracked 6,028 pediatric livers donated between 1991 and 1998 and found 4,288 were given to adults. Meanwhile, the number of children awaiting transplants increased from 768 in 1990 to 1,285 in 1996 (Graham, Chicago Tribune, 5/18). Doctors have utilized various techniques to ease the liver shortage for children, such as transplanting segments of livers from living donors, or splitting a cadaver liver between recipients. But the AP/Nando Times reports that children generally do not survive as well with older livers as they do with organs from other children -- 67.9% versus 75.7%, respectively (Coleman, 5/17).
On top of the national debate over local versus needs-based organ donation, the medical community is polarized over the relative utility of giving transplants to children or adults. "On one side stand surgeons who argue that extending a child's life is not inherently of greater value than extending the life of a young or middle aged adult," while others "argue that children deserve special consideration because of their life potential and their vulnerability." Dr. Paul Colombani, chief of pediatric surgery at Johns Hopkins Hospital, said, "The reality is, in my area, children can't live long enough to rise high enough on the waiting lists to get transplants. There somehow has to be a way to balance the playing field for these kids" (Tribune, 5/18). Reyes suggests that pediatric livers be offered to children nationally and that the best adult livers be split between a child and an adult if no child's liver is available (AP/Nando Times, 5/18). Reyes' colleague Dr. Rakesh Sindhi pointed out that livers will become increasingly scarce as more Americans develop symptoms of hepatitis C (Davis, USA Today, 5/18). United Network for Organ Sharing spokesperson Bob Spieldenner said the organization agrees with Reyes' basic conclusion and "is working to revise its system," as it has done for heart transplants. But Dr. Sue McDiarmid, head of UNOS' pediatric committee, said the agency is mindful of not increasing adult mortality in the process. She said, "The last thing I want to do is to develop any kind of policies that would have a significant impact on adult mortality" (AP/Nando Times, 5/17).