Dorry L. Segev, M.D., Ph.D., lead author of the study, a transplant surgeon, and an associate professor of surgery and epidemiology at the Johns Hopkins University School of Medicine explains:
"The donor process is safer than some have previously thought. Live live donation is a serious operation with serious risks. However, in this largest study ever conducted in the United States, we have shown that it is safer than many previously believed, with a risk of death of 1.7 per thousand donors."
Transplantation is the only treatment currently available for end stage liver disease. Individuals with liver failure require a functioning liver in order to survive. The liver is an organ that regenerates itself relatively quickly. This allows surgeons to remove a small portion of the liver and transplant the segment into the recipient. Once transplanted, the segment grows large enough to carry out its vital roles in metabolism, blood detoxification, and digestion.
Furthermore, donors are able to survive with a smaller segment of their own liver, due to its regenerative ability.
10 years ago, an estimated 500 live liver transplants were performed in the United States. However, following the highly publicized death of a live liver donor in 2002, the procedure may have been perceived as more dangerous than it actually is. Currently, only 200-300 live liver transplants are performed each year, compared to 6,000 live kidney donations in the U.S. annually.
At present, there are only around 6,000 livers available from deceased donors and over 16,000 individuals in the country waiting for a liver transplant.
"For many, the risk of dying on the waiting list is higher than the chance of getting a deceased donor transplant. For the right patients, with the right needs and the right donors, live donor transplantation can be the best treatment option, and this study reassures us that the risk of a catastrophic complication remains low."
Segev and his team reviewed data from all 4,111 donors in the U.S. between April 1994 and March, 2011 in order to determine the safety of live liver donation. Patients were followed for an average of 7.6 years.
Over the study period, 7 donors died in the 90 days following the procedure. However, according to the team, long-term survival rates for donors was similar to that of live kidney donors, as well as a healthy control group selected from the National Health and Nutrition Survey.
Despite the relatively low mortality rate for the procedure, it is still five times higher than that of live kidney donors.
The mortality rate of live kidney donation in the U.S. is 3.1 in 10,000, according to a previous investigation by Segev published in The Journal of the American Medical Association in March, 2010.
Segev points out that the procedure for kidney donation is less complicated and donors are left with one healthy intact kidney. Individuals are generally able to survive with just one kidney.
However, live liver donors may need a transplant to survive if their liver is not healthy enough after donation to get through the regeneration process.
According to Segev, director of clinical research in transplant surgery at Hopkins, he was extremely interested in investigating the outcomes for donors, as the majority come into the process very healthy.
"The ideal risk of death from donating an organ is zero and we work as hard as we can to seek that ideal. But in these serious, major operations, it is unlikely the risk will ever be zero."
Other Hopkins researchers involved in the study include Abimereki D. Muzaale, M.D., M.P.H.; Nabil N. Dagher, M.D.; and Robert A. Montgomery, M.D., D.Phil.
Written by Grace Rattue