Are living liver donors at risk from life-threatening 'near-miss' events?

A study published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, reports that donor mortality is about 1 in 500 donors with living donor liver transplantation (LDLT). Research of transplant centers around the world found that those with more experience conducting live donor procedures had lower rates of aborted surgery and life-threatening "near-miss" events.

For patients with end-stage , transplantation is their only option to prolong life. However, more than 16,000 Americans are currently on the for a liver according to the Organ Procurement and Transplantation Network (OPTN). The critical shortage of deceased donor organs has increased LDLT—a procedure that uses a healthy portion of the liver from a living donor for transplant. Although prior research shows that LDLT is an effective treatment, a 2007 study by de Villa et al. found that LDLT accounts for less than five percent of in the U.S. and Europe.

"Donors who decide to provide a portion of their liver to a loved one in need are making an extremely difficult decision to save the life of another," explains lead author Dr. Elizabeth Pomfret, Professor of Surgery at Tufts University and Chair of the Department of Transplantation and Hepatobiliary Diseases at Lahey Hospital & Medical Center in Burlington, Mass. "It is our responsibility as transplant specialists to provide donors with comprehensive information and education relating to LDLT, including any risks, so they may make informed decisions about donation."

To extend understanding of potential risks for liver lobe donors, the team conducted a web-based survey of 148 transplant centers around the world that perform LDLTs. Center representatives were asked to provide donor demographics; morbidity and mortality incidence; "near-miss" event data, and number of aborted procedures. Potentially life-threatening "near-miss" events included severe intraoperative bleeding, reoperation for bleeding, biliary reconstruction and pulmonary embolism.

A total of 71 centers (48%) responded to the survey, representing 21 countries, and performing 11,553 LDLTs procedures. Analysis shows that donor morbidity was 24% including five donors who required . Donor mortality was 0.2% (23/11,553), with the majority of deaths occurring within 60 days post-transplant and 19 deaths were a direct result of transplant surgery. Researchers reported that "near-miss" event and aborted surgery incidence was 1.1% and 1.2%, respectively.

Dr. Pomfret concludes, "It appears that the 0.2% donor rate was consistent and independent of the center's experience performing LDLTs. However, increased experience—centers performing more than 50 total LDLTs—is associated with lower rates of aborted procedures and "near-miss" events. These potentially life-threatening complications must be discussed as part of the informed consent with any potential liver ."

In a related editorial, Dr. Daniela Ladner, Assistant Professor of Surgery at Northwestern University Feinberg School of Medicine in Chicago, IL agrees, "Living liver donation is arguably the most invasive operation we as surgeons perform in willing patients with no demonstrable medical benefit, allowing them to donate a portion of their liver to save the life of someone with end-stage liver disease. As Dr. Pomfret and colleagues suggest, transplant surgeons are obligated to fully disclose all potential risk to donors." Dr. Ladner also suggests that all complications as well as near-miss events that did not reach the patient should be captured and systematically examined to identify areas of improvement with LDLT procedures and reduce life-threatening events for living donors.

More information: "The Incidence of Death and Potentially Life-Threatening "Near Miss" Events in Living Donor Hepatic Lobectomy: A World-Wide Survey." Yee Lee Cheah, Mary Ann Simpson, James J. Pomposelli, Elizabeth A. Pomfret. Liver Transplantation; (DOI: 10.1002/lt.23575) Print issue date: May, 2013.

Editorial: "Near Miss Events–A Vastly Missed Opportunity." Daniela P Ladner and Talia Baker. Liver Transplantation; (DOI: 10.1002/lt.23616) Print issue date: May, 2013.

add to favorites email to friend print save as pdf

Related Stories

Living donors fare well following liver transplantation

Nov 01, 2012

Researchers in Japan report that health-related quality of life (HRQOL) for donors following living donor liver transplantation (LDLT) was better than the general Japanese population (the norm). This study—one of the largest ...

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments