The Gift of Life

The first successful liver transplant in America was performed in 1967, and along with new hope for patients with end-stage liver disease came a new need: healthy donor livers. It's a need that has increased with time. Today, more than 17,500 people are on the national UNOS liver transplant list, and 1 in 10 die while waiting for a new liver. There are nearly 80,000 people waiting for all types of transplants.

Livers become available from deceased people who, when they were alive, made the choice to donate their organs and tissues. That decision can be made known by a signed donor card or an advance directive, a document that states a person's healthcare wishes. It's also a good idea to talk to family members. New Jersey has a law that supports a deceased's documented desire to donate organs, even if that goes against what the surviving family would like. The strength of the law is not known, as it has not been tested in New Jersey courts.

However,not many people sign the cards. Organs are acquired from only about 0.0025 % of all deaths in the United States, according to The Sharing Network, a New Jersey federally approved, state-certified organ procurement organization. The numbers nearly doubled, from 5,900 donors in 1988 to 11,589 donors in 2000, but resistance to organ donation continues.

Dorian Wilson, MD

"Many myths about organ donation persist: that people can pay for organs, or that doctors don't take all the measures they can to save a critically ill person if he or she is known to be an organ donor. These and other myths are entirely false," says Dr. Dorian Wilson, a surgeon on the liver transplant team at University Hospital and medical director of The Sharing Network. "For many years, certain religious beliefs were a barrier to donation, especially among minorities. Increasingly, spiritual leaders view donation as an extension of the healthcare process and a way to be altruistic even at the end of life."

Educating the public, especially minority groups, about organ donation is key to shattering myths, says Dr. Wilson. Some of their reservations about donating spring from lack of trust in the medical community, or fears of racism or that they'll be prematurely declared dead. And yet the need for minority donors is great. Minorities have higher rates of conditions that can lead to organ failure, such as diabetes, and a successful organ match is more likely between members of the same racial or ethnic group.

Organs from deceased donors are also in short supply for what's actually a positive reason. Historically, many organs have come from younger people who were involved in motor vehicle accidents. With fewer fatal accidents, more of the donors are older, and their organs might not be of sufficient quality to be transplanted.

Living Donors

There's another transplant option for some people with end-stage liver disease: living donation. While living kidney donors have been common for quite some time (the donor can give one kidney and still function well with one), living liver donations are a more recent development. The procedure was first done in 1989 from adult to child. A few years ago, some transplant centers began performing adult-to-adult transplants.

The liver is a remarkable organ because it can regenerate itself; part of a match liver can be taken from another person and transplanted into the patient's body. In time, the living donor's liver will become a "whole" again, and the transplanted portion will grow and function in the recipient's body. A living liver donation requires blood and tissue compatibility between donor and recipient; a healthy donor liver, and that the donor be in overall good health. There's also the question of whether the donor can handle the emotional aspects of transplant.

The procedure itself involves taking a part of the liver, usually either the left lobe for adult-to-child or the right lobe for adult-to-adult, and transplanting that piece to the recipient. For the donor, the operation takes about 5 to 8 hours. There are sometimes complications, such as bile duct leaks or infection. A very rare, but possible, complication is death. "There have been between 2,000-3,000 living liver transplants worldwide, and it's been reported that 6 to 8 donors have died," says Dr. Wilson. "Living liver donation carries significant risk, more than with living kidney donation. People have two kidneys, but only one liver."

Clearly, the primary benefit of living liver donation to the recipient is that he or she does not have to wait for an organ to become available. But the possibility of serious complications, notably the death earlier this year of a living liver donor, have caused the transplant community to proceed very cautiously with this procedure. Some transplant groups have called for a national registry of information about living donors, and the National Institutes of Health (NIH) is designing a database to track the long-term health status of these donors.

For more information about organ and tissue donation in New Jersey, or to sign up to be an organ donor, call the New Jersey Organ and Tissue Sharing Network at 1-800-SHARE-NJ or visit their web site at: www.sharenj.org.