Go-ahead for live donor surgery

By GREGG WYCHERLEY

A controversial new procedure using live donors for liver transplant operations could begin at Auckland Hospital within months.

The 10-hour surgery involves 60 per cent of a healthy liver being taken from a donor and "plumbed in" to an adult patient in an adjacent theatre.

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

The Auckland Ethics Committee has given the go-ahead for a five-patient trial.

The director of the New Zealand Liver Transplant Unit, Professor Stephen Munn, said the only barrier was getting the ACC's legal opinion on whether it would cover the procedure. "I don't know how much of a problem that is because we already do live kidney donations and they cover that."

He said the procedure was becoming more common overseas.

About 200 live donor operations were performed in the US last year.

Australia started live donor liver transplants last year.

Professor Munn said the fatality rate for the recipients was the same as for cadaver donor procedures, about 10 per cent.

But the mortality rate for donors, between 0.5 to 1 per cent, made getting ethical approval essential.

"The donors should all survive. They don't 100 per cent and that's the sticky point. That's why it's such a tricky proposition."

One of the main objections was that friends and relatives of liver patients might feel unfair pressure to go under the knife.

But Professor Munn said potential donors who did not want to go ahead with the operation would be given an escape route.

"If they tell us in confidence that they don't want to do it, that they're afraid to do it, we regard that as a medical contra-indication to donation.

"And if we tell the family and friends that there is a medical contra-indication we don't tell them what."

He said 40 per cent of patients with acute liver failure and 10 per cent of patients suffering from liver tumours missed out on transplants.

"There are a few patients every year who die because they don't get a liver," he said.

The liver is 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.

Recipient and donor must have matching blood types but matching tissue types is not necessary, unlike with kidney transplants.