Since the first deceased donor liver transplant in 1967 by Dr. Thomas Starzl at the University of Colorado, many medical and surgical advances have improved the long-term survival of transplanted livers. Advances in liver transplantation also have increased the number of conditions that liver transplantation can effectively treat.
These advances have led to more people exploring liver transplantation as a treatment option, with continued annual increases in the number of people being added to the United Network of Organ Sharing (UNOS) liver transplant waiting list.
According to data from the Organ Procurement and Transplant Network (OPTN), in the United States, there are currently 15,767 people waiting for deceased donor livers. In the greater Philadelphia region, there are more than 700 people waiting.
The Gift of Life Donor Program
Thanks to the Gift of Life Donor Program, this region’s federally designated, organ procurement organization, significant advances in organ donation continue to be made. For example, last year the number of liver transplants increased by 14 percent in our region. Unfortunately, even with this notable improvement in the number of deceased donor livers, less than half of those waiting for a liver received one and only 322 people in the greater Philadelphia region received liver transplants in 2013.
Source: OPTN data, June 2014
The transplant gap
Despite the increased support for organ donation and the increase in the number of deceased donor livers that become available, the number of people being added to the liver transplant waiting list dramatically outpaces the number of deceased donor livers that become available. As a result of this gap between deceased donor livers and those waiting, many patients die before a deceased donor liver becomes available.
While work to increase organ donation from deceased donors continues, living donors are an important part of the solution to this critical shortage. Living donation allows a patient in need of a liver transplant to receive an organ sooner, and eliminates the risk of dying while waiting for a deceased donor organ.
“A person only needs a portion of their liver to survive, which is why living liver donation can occur,” explained David Goldberg, MD, MSCE, medical director for Living Donor Liver Transplantation at Penn. “The liver has the ability to regenerate, and within three to six months of donation, the liver of both the donor and recipient will have re-grown to near full size.”
Risks and outcomes
Dr. Goldberg went on to explain that the first two questions he is often asked is whether it is safe to be a living donor and if the recipient is expected to have a similar outcome to those receiving a deceased donor transplant.
Nationally, approximately one-third of live liver donors have some complications after donation; however, the vast majority are minor and reversible. The risk of death associated with live liver donation in the U.S. is less than 0.2 percent -- less than the risk of death that is associated with motor vehicle accidents in our country. Furthermore, recent work from Dr. Goldberg and his colleagues from the University of Pennsylvania, currently in press at Hepatology, demonstrates that outcomes in recipients of living donor liver transplants are as good as those receiving a deceased donor graft and in certain recipients transplanted at an experienced living donor transplant center, superior to that of deceased donor recipients.
Source: Goldberg D FB, Abt P, Olthoff K, Shaked A. Superior Survival Using Living Donors and Donor-Recipient Matching Using a Novel Living Donor Risk Index. Hepatology. 2014. In Press.
“From the first donor evaluation consultation to the liver donation procedure, the donor’s safety is the primary concern of the Living Donor Liver Transplant team,” said Goldberg. “However, it is a major surgery, and as such, there are always risks which make choosing an experienced transplant center very important.”
Since the transplant team at the University of Chicago performed the first live donor liver transplant in 1989, more than 3,500 people in the United States have donated a portion of their liver to friends or family members and 36 transplant centers now offer live donor liver transplants.
In the Gift of Life service area, which is eastern Pennsylvania, southern New Jersey and Delaware, adult live donor liver transplant began at the Penn Transplant Institute in 1999 followed by Hahnemann University Hospital from 2002 to 2008, Penn State Hershey in 2008 and Thomas Jefferson University Hospital in 2010.
For more information about live donor liver transplant, please contact the Penn Living Donor Liver Transplant team at 215-662-6200.
More information regarding the live donor liver transplant surgery and evaluation process is offered on the UNOS website.
If you are interested in learning if it is safe for you to be a living donor for a friend or family member at Penn, please complete the Living Donor Health Screening Questionnaire.