Scots hospital leads UK with first live liver transplants

By Louise Gray

November 8, 2005

Andy Kerr talks to Helen McNeil and Andrena Dunsatne at the ERI's transplant unit Picture: Neil Hanna

Key points

• Live liver transplants to be pioneered at ERI
• Procedure sees half of healthy liver given to damaged liver for regeneration
• Operation first of its type in the UK

Key quote

"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." - ANDY KERR, HEALTH MINISTER

Story in full

SCOTS will be able to give half of their liver to a dying relative in a risky but potentially life-saving operation that will be the first of its kind in the UK, it was announced yesterday.

Live liver transplants between two adults will be pioneered at the Edinburgh Royal Infirmary (ERI) from April next year.

Doctors expect up to 15 donors will choose to give the "gift of life", mostly to relatives and close friends, every year, and are open to patients coming in from across the UK.

The procedure, which is common in the Far East, continental Europe and the United States, works by cutting off half a healthy liver from the donor and implanting it in the recipient in place of a diseased or failing liver. Within three months, the donor's liver should have regenerated to normal size and the recipient should be able to lead a full life with a new liver.

But there are significant risks attached to both giving and receiving a live liver.

For the donor there is a one in 200 chance of death and a one in five risk of complications such as infections and bleeding.

The donor will be assessed physically and psychologically to make sure they are fully aware of the risk and have not been coerced or offered payment.

The decision to undertake the controversial operation was made because of the increasing number of people in Scotland who are dying while languishing on the waiting list.

In the last 18 months, 19 patients have died north of the Border while awaiting a conventional transplant.

Andy Kerr, the health minister, hailed it as a "lifeline".

"I welcome the fact that patients across Scotland and their families will have the option of considering this form of transplantation," he said.

Mr Kerr went on: "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 donations will offer a lifeline to patients who would previously have only had the option of waiting on this list."

The groundbreaking work is another UK first for the ERI, where the first UK kidney transplant was carried out in 1961.

Today, the hospital has a better than average survival rate of 12 months for liver transplants, carrying out 500 since 1992.

The NHS has already performed operations allowing adults to donate a smaller part of their liver to children, and King's College Hospital in London has privately provided adult-to-adult live liver transplants for patients from outside the UK.

But Scots will be the first to receive the treatment on the NHS, thanks to funding of £2.2 million over three years

Mr Kerr also backed Professor James Barber, the NHS's chief executive, in opening the programme to the rest of the UK.

Mr Kerr said no-one has yet come forward for the operation. Those who do will be people who are on the waiting list in February next year.

John Forsyth, a consultant surgeon and clinical director at the ERI transplant unit, said doctors are "delighted".

But he added that doctors are "daunted" by the risk to the donor, particularly following a high profile case in the US where Mike Hurewitz, a New York journalist, died in 2002 after donating his liver to his brother.

Mr Forsyth said a new donor advocacy team made up of a transplant co-ordinator, medical assessor, psychiatrist, physician and social worker would ensure donors are suitable and aware of the risks.

He said: "The surgery itself is quite daunting because operating on a living donor is so different to any other procedure which we do.

"It is very important to us that any potential donor fully understands the risks and benefits."

'It is difficult for me, but it is more difficult for my family'

THE FIRST live liver donation may offer hope to thousands of patients in the future, but traditional transplants are the only hope for those currently on the waiting list.

Andrina Dunstan, 47, from Fife, who has been on the waiting list for nine months, said she is "always waiting for the phone to go" telling her a liver donation will save her life.

"It is difficult for me," she said. "But it is more difficult for my husband and my family."

There are currently 26 patients like Mrs Dunstan in Scotland waiting for a liver donation, ranging in age from their early 30s to 60s.

Meanwhile, the number of people dying has risen to more than one a month, as the NHS struggles to source healthy organs.

Even if a live donor was available, due to her condition Mrs Dunstan cannot benefit from the new procedure and must wait for a conventional transplant.

She urged more people to sign up to donate their organs after death.

Helen McNeil, from Port William in Dumfries and Galloway, said the conventional liver transplant she received eight weeks ago had transformed her life.

The 61-year-old said a living liver transplant, had it been available, might have speeded things up for her.

"Both my son and my brother said they would be happy to donate as soon as possible, but at the time it didn't exist," she added.

"But there are so many people waiting for livers, it's so important people do donate because we don't really need them when we're gone.

"Indeed, if more than one in five people in Scotland agreed to donate, there would be no need for risky live liver donations at all."

Copyright © 2005 Scotsman.com.

This article posted December 1, 2005.