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Donors Come First in Liver Transplants
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| Hopkins is committed to living-related liver transplants, says surgeon Luis Arrazola, but will not put donors at unnecessary risk. |
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All systems were go, almost. John Frain, who was going to donate the right lobe of his liver to his best friend, had gone through a thorough medical and psychological evaluation by a team of hepatologists, transplant surgeons and social workers. His blood type matched that of the recipient, and tests showed no liver abnormalities or diseases like hepatitis and HIV.
At age 28, Frain was well under Hopkins' donor age limit of 45, and appeared to be in good health with no signs of heart, lung, kidney or neurologic disease. Also, there were no signs that he was being pressured in any way to donate. Then, four days before the scheduled surgery, the results of a battery of additional special blood tests ordered by transplant surgeon Luis Arrazola, M.D., showed that Frain's blood was at a high risk of clotting during the surgery. The operation was cancelled.
"All of the tests kept turning out like I would be able to donate," Frain says, "but then we got the results back from these tests that Dr. Arrazola pushes for. I still wanted to go ahead, but he said no."
Arrazola explains that, in spite of Hopkins' commitment to living donor transplants, "We are not willing to take any chances to compromise the potential donor. This is an example of how meticulous we are."
In addition to the regular work-up for donors, a biopsy and sophisticated imaging studies are also ordered to rule out any abnormalities in the liver and the potential for biliary and vascular complications. Very subtle variations in the anatomy of the liver, if undetected, can compromise the function of the portion of the liver that remains with the donor.
Of course, precautions have to be taken during the procedure, too, especially when the donor liver is implanted-and the vessels and bile duct reconnected-in the recipient. The combination of the small size of the donated section-and the portal hypertension in the recipient-can cause the graft to swell and dysfunction.
"It's crucial that we have adequate outflow at the time of the surgery," Arrazola says. Because the liver can regenerate, both portions in the donor and recipient grow to full-functioning size within weeks after the operation.
Living-related transplants can bring advantages--less waiting time, lower costs and higher survival rates--especially in pediatric living-donor transplant recipients. But all patients must be carefully evaluated.
"The evaluation was very extensive, but honestly, I felt like I was very cared for in the process," Frain says. "The transplant coordinator and surgeon always put my interests and my wife's interests at the forefront."
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