Concerns About Living Donor Liver Transplants

According to an article published in The New England Journal of Medicine , adult liver transplants using livers from living donors is a practice that has spread too widely and too quickly. Many transplant centers are performing the procedure without the experience and skills needed and with no oversight, say the authors, Drs. David C. Cronin II, J. Michael Millis, and Mark Siegler, all from the University of Chicago (IL, USA).

Using livers from living donors was begun in 1995. Since 1997, more than 30 U.S. programs have performed more than 400 such procedures. Six programs performed only one, while one program has performed more than 100. As a sign of the practice's popularity, 23 centers are planning to initiate the practice. Unlike living donor liver transplants in children, many aspects of the practice in adults remain unformulated. These include a lack of agreement on the best and safest technique, a lack of standardized indications for surgery, and a lack of unvarying standards for institutional review.

The authors believe that the practice should be restricted to high-volume transplantation centers that are very experienced in the procedure. Data should be collected on short- and long-term outcomes. The authors are also concerned that donor deaths are not being reported accurately and that proper informed consent of both donors and recipients is not always acquired. To help solve these problems, they believe oversight should be provided by health insurers and government agencies.




Related Links:
New England Journal of Medicine