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Sunday, January 27, 2008

About live liver donation

Partial liver donation by relatives of the patient is becoming more and more common all over the world. More than 1000 live donations have been carried out globally. Though the liver is a single organ, the anatomical disposition of the organ allows it to be split into two useful portions safely. Moreover the liver has in excess of 300% reserver capacity and can theoretically survive with only 30% of the total liver volume. The liver is also very unique in its ability to regenerate. It is documented that the liver regenerates to 90% of the original liver volume within 3 months of removing > 50% of the liver for donation. Liver donation is a major surgery and will leave a large scar. At the author's center over 50 live donor operations have been performed with few minor complications. 60% of the patients did not require blood transfusion during surgery. The only notable complication was a bile leak from the raw area of the liver that settled spontaneously within 3 weeks. Most donors were discharged within 10 days of surgery and they can return to non-manual work 4-6 weeks after surgery and full active life within 3 months. The only long term morbidity seems to be wound pain which may persist beyond 3 months in about 30% of the donors. Occassional death has been reported after live donation which underlines the fact that the procedure should be carried out only by experts in this field in transplant centers with good track record, who can guarantee donor safety and low complication rate.
Factors in Donation Process
When an organ is donated from a person who has died, it is made available to an eligible patient on the waiting list. Before the transplant can take place, however, several things happen. Although a patient meets all the criteria and appears to be a good match for the organ, the organ still has to be accepted by the transplant center. The transplant team has a very short time to consider several factors before accepting that organ for the particular patient. If, in the physician's judgment, the organ offered presents undue risks to the patient, it may be refused. There are a number of reasons for refusing an organ, such as:
  1. Patient condition - The patient may currently be too ill to undergo surgery. Or, the patient may be out of town or otherwise unavailable for surgery at that time.
  2. Donor condition - The donor might have had high blood pressure, diabetes or some other illness that might have harmed the donated organ.
  3. Organ condition - If an organ has been outside the donor's body for too long it might not work as well and may not help the patient. Or, the organ might have been damaged during recovery from the donor or during transit to the transplant center. Sometimes, final examination of the organ shows previously unseen risks, such as too much fatty tissue or badly formed blood vessels.
  4. Donor/recipient compatibility - Critical "matching" tests, done just prior to surgery, sometimes reveal unknown incompatibilities that would result in failure of the transplant.
  5. Transplant center factors - Geography may be a factor, as it may not be possible to get the organ to the center within a desirable amount of time.
There are some differences among transplant centers overall in terms of how often organs are accepted or refused. But recent studies have found that how often a center accepts or refuses transplant organs does not seem to affect such important factors as how long patients wait for transplant or how well those patients do either before or after transplant.

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