Brother gives sister a liver - and life

By MARTIN JOHNSTON health reporter

A brother and sister are recovering after taking part in New Zealand's first live liver transplant.

The woman, who is in her 40s, had liver cancer from hepatitis B. She got part of her 30-year-old brother's healthy liver in the complex Auckland Hospital operations.

Living-donor liver transplants are internationally controversial because the death rate of otherwise-healthy donors is around 1 per cent.

There is also a 20 per cent risk of significant complications, including infections, blood clots, and bile leakage.

The simultaneous Auckland surgery was done last month.

Both the donor and recipient have been discharged from hospital and are recovering.

They have requested anonymity.

The operations took six hours for the donor and nine for the recipient.

"It is a very major exercise and there's the potential for many things to go wrong," Associate Professor John McCall, who operated on the donor, said yesterday.

"It's a great relief to have the first one behind us successfully."

The liver is the body's chemical factory. It regulates the level of most of the main chemicals in blood. For adult-to-adult transplants, 60 per cent of the donor's liver is needed.

The surgeon slices out the organ's right lobe with an ultra-sonic cutter that uses high-frequency sound to destroy cells. The painstaking operation must preserve blood vessels and ducts.

As the first operation progresses, surgery to remove the recipient's diseased liver begins. The section from the donor, stored in a special solution, is placed in the recipient and connected to his or her blood vessels and liver ducts.

If the procedures are successful, the sections in both donor and recipient grow back to full size in about six weeks.

The head of the New Zealand Liver Transplant Unit, Professor Stephen Munn, who operated on the recipient, said yesterday that both procedures had been straightforward.

Transplants from a live donor were technically little different from using a section of liver from a brain-dead person, he said, except that the surgeon had to be more careful with the vessels, which took longer.

"You have to remove the diseased liver in a slightly different way to make sure you have got plenty of vessels to plug [the donated section] into and that's what takes the extra time."

The first Auckland Hospital transplant was part of a trial of up to five transplants from live adults to patients who have acute liver failure or liver cancer.

These are the patients most likely to die on the waiting list. A third of urgent cases die, compared with 10 per cent of elective (non-urgent) cases. Of patients with liver cancer, about 14 per cent are removed from the list because their tumours become too big or spread.

Patients with acute liver failure have a "window of survival" of up to seven days, said liver specialist Associate Professor Ed Gane.

Live donors are seen as a way of increasing the number of transplants, especially since only about 40 people a year become donors after death in New Zealand.

New Zealand's demand for liver transplants is rising because of an increasing rate of hepatitis C and since, under the hepatitis B screening programme, many more cases of liver cancer are picked up early.

Live-donor liver transplants cost about $140,000 - around the same as using a liver from a dead person.

More than 3000 live-donor liver transplants have been performed, since the first in 1989. After Auckland Hospital first mooted live-donor liver transplants in 1999, a 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 patients' families to go under the knife.

He declined to comment yesterday.

Professor McCall said potential donors were rigorously screened. As well as being fit, having blood-group compatibility and a significant relationship with the patient, they must be volunteers.

"They can pull out at any time without explanation. We routinely offer an alibi. We say there is a medical reason why the person can't donate."

Christchurch Hospital surgeon Phil Bagshaw, chairman of the New Zealand Liver Transplant Advisory Group, welcomed the move to live-donor operations.

"Perhaps most importantly, it increases the number of available organs for this type of work."

Since Auckland Hospital began liver transplants in 1998, it has performed them on 128 patients. Ninety-three per cent have survived for at least a year beyond surgery.

nzherald.co.nz/health