Doctors to transplant livers from live donors

By NICK PERRY

Health reporter

Live donors could be used for liver transplants at Auckland Hospital within months.

The controversial surgery involves 60 per cent of a healthy liver being sliced from a donor and "plumbed in" to an adult patient in an operation that takes up to 10 hours, with donor and recipient in adjacent theatres.

The organ's remarkable ability to regenerate means that, in a successful operation, each liver section would return to full size within six weeks.

The director of the New Zealand Liver Transplant Unit, Professor Stephen Munn, said yesterday that he hoped to gain ethical approval and start operations at Auckland Hospital in May.

But leading Australian liver surgeon Professor Russell Strong said he would not perform the procedure, because it was too risky for the donor and put unfair pressure on liver patients' nearest and dearest to go under the knife.

Professor Munn performed the first successful liver transplant in New Zealand two years ago.

Since then, 41 further transplants have been carried out, all using brain-dead cadavers as donors.

Professor Munn said surgery using live donors would be most useful to the 20 per cent of the unit's patients who suffered acute liver failure and did not have a donor organ.

Those patients sometimes had just days to live and could not wait for a suitable cadaver.

Live transplants would give them about a 75 per cent chance of surviving more than five years.

The unit had seen a total of 16 acute patients in the past two years, eight of whom had died waiting for a suitable liver.

About 250 live adult-to-adult donor operations had been performed around the world in the past two years and Professor Munn knew of just one donor death.

"If family and friends knew they had the opportunity to help their loved ones but we hadn't told them, I can imagine they would be quite upset."

But Professor Strong said the true mortality rate of donors was probably much higher than Professor Munn suggested.

There was the "potential for coercion" of those close to liver patients who would feel compelled to help and ignore potential risks.

"To take a fit, living person who wants to save someone's life and have them die doing it is a terrible tragedy."

The liver is an organ essential for purifying blood and making proteins, including those needed for blood clotting.

There are no effective artificial livers and humans can survive just a few hours without the organ.

The two patients in the radical procedure must have compatible blood types, but it is not necessary for them to have matching tissue types as with kidney transplants.

Part of the donor's liver is removed, using an ultrasonic dissector.

Surgeons cut the liver between major blood vessels with the machine, which uses high-frequency sound to destroy cells.

Once the section of liver is removed, it stays healthy for up to 12 hours in a special solution.

As the first operation progresses, the procedure to remove the unhealthy liver from the recipient begins.

After the unhealthy liver is replaced with the healthy section, the blood vessels are reconnected.