Liver transplants rationed as demand outstrips supply of donors

By Celia Hall, Medical Editor

February 17, 2006

Transplant doctors are having to ration liver operations to patients with the best long-term survival chances because of a shortage of donor organs, a leading specialist says today.

Most units will put patients on the waiting list only if they have a 50 per cent chance of surviving for five years, depriving many patients of the chance of a transplant and a new life. Some patients are removed from the list as their condition worsens.

Raj Prasad, a consultant surgeon at the department of organ transplantation at St James's University Hospital, Leeds, said the principle had developed in recent years in response to the disparity between supply and demand.

In an article in the British Medical Journal, he calls for more use of donors who have died without being resuscitated, the non-heart beating donors.

Organs for donation are usually taken from donors who are dead but whose hearts are kept beating artificially and whose blood is circulating.

In the past, transplants using organs from non-heart beating donors have been less successful but Mr Prasad says that results are now similar to results using organs from donors with circulating blood.

He says that the rate of liver donation in Britain is 13 per million of the population compared with 33 per million in Spain.

"To use this scarce resource most effectively, clinicians are restricting access to transplantation to patients with a 50 per cent chance of survival at five years," he says. "This restrictive listing excludes many patients, particularly those with hepatocellular [liver] cancer and older recipients. Even so, the supply is not able to meet demand.

"About 60 people die on the waiting list each year and up to 80 more are removed from the lists as their condition deteriorates."

Mr Prasad says that the use of non-heart beating donors could provide 10 to 20 per cent more donors.

Figures show that liver transplant operations have been falling while the number of patients waiting rises.

In the 12 months to February this year, 498 liver transplants were carried out, compared with 549 in the corresponding period the year before.

At the start of this month, 352 people were waiting. That compares with 264 at the end of March last year. Last year 22 liver transplants from non-heart beating donors were undertaken. Non-heart beating donor transplantation is becoming popular in kidney transplants, again because of shortages.

Mr Prasad says he wants colleagues in accident departments and intensive care units to be aware of the potential of non-heart beating donors in helping liver patients to survive.

A spokesman for UK Transplant said: "Given the shortage and the waiting list, no means of increasing the supply of donor organs should be overlooked. Forty per cent of loved ones in intensive care units refuse to give permission for organs to be used."

Nearly 13 million people are on the organ donation register.

Copyright © 2006 Telegraph Group Limited.

This article posted March 5, 2006.