New liver transplant policies set

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June 24, 1999
Web posted at: 5:39 p.m. EDT (2139 GMT)

ATLANTA (CNN) -- The United Network for Organ Sharing (UNOS) voted Thursday at a directors' meeting in Atlanta in favor of a national split liver transplant policy. The organization also approved a policy change that affects the way livers for transplant are allocated.

One donation can save two lives

In passing the split liver policy, the UNOS hopes to reduce the pediatric liver transplant waiting list significantly.

All centers that choose to participate will split all cadaver livers between a child and an adult. Studies show it's safe for recipients to receive just half a liver.

The liver is the only organ that regenerates. In a split liver transplant, both recipients' livers regenerate fully within a month. Although this strategy won't make a big dent in the organ shortage for adults, transplant surgeons believe it can help eliminate the waiting list for children.

"I think overall it will help children in the United States have less chance of dying on the list," said Dr. Thomas Heffron of Emory University and Egleston-Scottish Rite Children's Hospital in Atlanta.

There is a critical shortage of livers available for transplantation in the United States. Only one-third of the people waiting for a new liver received one in 1997.

"Seventy-five percent of the livers that would be obtained could be split, and then of course more children could receive their transplants," UNOS Dr. James Wolf said before the vote.

Children account for about 10 percent of those waiting for a liver.

Studies show there is no downside to the split-liver transplant for either recipient. But only a few doctors have expertise in performing the procedure, so fewer than a dozen centers nationally do this type of transplant routinely.

Transplant surgeons say parents of children who need transplants should put them on waiting lists at experienced centers.

Proponents of the measure said increasing organ donations and using novel transplant techniques are the only ways more lives can be saved.

Liver donation allocation

The UNOS also approved a policy change for allocating donated livers.

Under the new policy, more patients who suddenly become sick with liver disease will get donated livers before chronic liver disease patients who have been on the waiting list for months.

The patients with sudden liver disease fall into the UNOS category known as Status 1. These patients tend to be young, with viral hepatitis or liver failure from ingested toxins or medication overdose.

Under current policy, an available liver is offered first to the sickest or Status 1 patients in the local area, and if no match is found, the liver is offered to less medically urgent patients at the same center.

The new policy will still allow the liver to be offered first to Status 1 patients locally, but if no match is found, the liver would be offered to Status 1 patients at other centers in the region.

The next patients on the list are those with chronic liver disease, or Status 2. Under the new policy, some of these patients could have a longer wait or not get livers at all.

Currently, Status 1 transplants account for 10 to 14 percent of all liver transplants. It is expected the new policy will increase Status 1 transplants to 22 percent.

Although the policy will give more transplant opportunities to the sickest patients, Bob Spieldenner, UNOS spokesman, expects a slight increase in deaths.

The 125 liver transplant centers in the country are grouped into 11 regions. As of June 16, there were 13,197 patients waiting for a liver transplant. In all of 1998, only 4,450 liver transplants were performed.

The liver transplant waiting list is expected to increase fivefold in the next decade because of an increase in hepatitis C cases. In the past two months, 331 people were added to the national list.