ORGAN-SPLITTING: New Procedures Could Shrink Shortage
Liver donor waiting lists will likely shrink as surgical teams become more proficient at split-liver and living-donor transplants, even as need increases an estimated fivefold over the next decade, American Medical News reports. The United Network for Organ Sharing is poised to call for an agreement among the nation's transplant centers to divide donated livers into two parts when appropriate. Under the UNOS proposal, which could be approved as early as this summer following a public comment period ending April 29, transplant patients could voluntarily join the organ-sharing arrangement, but once a center signed on, splitting livers would be mandatory when clinically appropriate. The program is particularly important for pediatric cases, which account for 10% of the liver waiting list, because the procedure allows surgeons to transplant the smaller lobe of the donated liver into the child, while leaving the larger lobe for an adult candidate. "Mathematical modeling suggests if all eligible organs were split, it would eliminate the pediatric waiting list," said Dr. Michael Millis of the University of Chicago. Nevertheless, many centers that do not perform both adult and pediatric transplants are reluctant to dive in. American Medical News reports that in 1997, only about six of the country's 123 liver transplant centers performed the split-liver procedure.
Living-donor procedures are cropping up, and while they have mainly benefited children -- all but two of the 67 performed in 1997 involved youths -- the procedure is being tweaked to facilitate adult-to-adult transplants. Dr. John Lake of the American Society of Transplantation, predicts that "as many as a third of all liver transplants in this country could involve living donors" by 2005. The procedure is not without risks -- surgeons must remove enough of the liver to make it viable for the recipient but must leave enough so the donor's liver is not damaged. Such risks are fueling ethical and social concerns. American Medical News poses the questions, "How do you avoid coercion when the survival of a family member is involved? Should spouses by allowed to donate to each other if they parent small children who could be orphaned in a worst-case scenario?" (Shelton, 4/12 issue).