Posted: 9-Nov-2005 << BACK
LIVER TREATMENT LIFELINE FOR SCOTS
Scotland will be first in the UK to facilitate living liver donations to seriously ill patients, it was announced today. The treatment will offer an alternative form of transplantation to many patients with chronic liver failure who would previously only have been able to receive a new liver from a donor who had died.
Health Minister Andy Kerr said: "In Scotland 13 patients have died in each of the last two years and many more have had to be removed from the liver transplant waiting list because they have become too unwell while waiting for a donor organ. Living liver donations will offer a lifeline to patients who would previously have only had the option of waiting on this list."The operations will be carried out at the Edinburgh Royal Infirmary (ERI) transplant unit where over 500 liver transplant procedures have been undertaken since 1992. Recent UK audit data demonstrates the unit has 12 month survival figures better than many other transplant programmes in the UK.
"Additionally, the extensive experience of living donor kidney transplantation at the unit will enable it to cope with the challenges associated with living donor liver donation. The most important element of the new programme is to ensure the donor fully understands the risks involved in the procedure before any further steps are taken. They will need to go through a rigorous process of independent assessment before they will be able to agree to the operation.
"In countries including Japan, USA, France and Germany the number of patients dying on liver transplant waiting lists has been reduced by the introduction of living liver donation transplants. It is good news for patients suffering from chronic liver disease in Scotland that they too will now have the option to receive this ground-breaking treatment."
Consultant Surgeon John Forsyth, Clinical Director at ERI Transplant Unit, commented: "In the Scottish Liver Transplant Unit we are delighted that this programme is being made available for those suffering from liver failure. Year by year the number of patients who die whilst waiting for a liver transplant is increasing. The surgery itself is quite daunting because operating on a living donor is so different to any other procedure which we do. Clearly, and fundamental to this approach, it is very important to us that any potential donor fully understands the risks and benefits".
Maureen Cunningham, Transplant co-ordinator and member of the Donor Advocacy Team, said: "Every potential donor will have to be fully assessed to ensure they are suitable and that they are not acting under any kind of coercion, whether emotional or financial. Once approved, a donor will need a lot of support and advice leading up to, and following, the transplant procedure. This aspect of care is new and daunting but we are excited that we are moving into this area of transplant surgery. We have been learning from world experts in this field and have adapted them to work within the NHS."
The unit is gearing up to start the programme from April 2006.
The liver is an unusual organ since, when part of it is removed, it can regenerate. Therefore the right lobe can be removed and transplanted into a recipient, and this is followed by regeneration in both the recipient and the donor so that the liver has the potential to grow to full size in both patients.
The total number of patients who would fit the indications for the programme would be around 50, but once all other factors have been taken into account, including those who receive a new liver from a cadaveric donor, it is likely that there would be around 5 procedures in the first year, 10 in the second year of the programme and around 15 thereafter. As patients and families become more aware of the possibility of living donor liver transplantation, it is likely that the programme would expand.
In the initial phase of the programme, the procedure will be limited to those suffering from chronic hepatic failure. Those who suffer from acute liver failure have only a few days to live and it is felt that this short time scale may give rise to errors in the assessment process during the early phase of the programme. In its early stages, only those patients who would normally be listed on the conventional liver transplant waiting list will be considered for the programme.
For living liver donation, the risk of death is somewhere between 0.5 and 1per cent, according to results reported from centres around the world. The risk of complications is around 20 per cent, which means that there is a one in 5 chance that the donor will experience problems after donation. This compares with a risk of death of 1 in 3,000 for living donor kidney transplantation, and a complication rate of about 1per cent.
In line with current recommendations, the assessment of the intended liver donor will be performed by a team consisting of all the health professionals qualified to comment on every aspect of the welfare of the intended donor and to provide a safe system for the evaluation of the suitability of the donor to proceed to donation. All donors will be seen by an Independent Medical Assessor, who will be independent of the Transplant Unit.
The donor must be an adult, ie someone over the age of 16, and must have the capacity to provide valid consent in legal terms. The potential donor will be given a minimum period of 24 hours of reflection to ensure that their decision to donate has been fully considered, and to allow time for discussion with family members.
These procedures will be amended to take account of any further requirements which the Human Tissue Authority may introduce once its procedures are put into place, which is expected to be shortly after the commencement of the programme.
