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MMC Satisfaction outweighs risks for living organ donors

Tribune Media Services

DEAR MAYO CLINIC: My wife is having severe liver problems. If a transplant from a living person should be required, I'd be glad to donate some of my own liver. But I wonder if it would be better -- that is, less likely to cause problems -- if the donor were a blood relative such as her mother, father or daughter.

Fortunately, we don't lose very many liver transplants to rejection. As long as the patient takes his or her immunosuppressive medications, rejection is exceedingly rare, and the organ has an excellent chance of working well for a long time. All that is required is that the donated liver (or part of a liver) be from a blood-group-compatible donor of appropriate dimensions for safe and effective implantation in the recipient.

We would always prefer to use a liver from a deceased donor. Unfortunately, there aren't enough deceased-donor livers available for everyone in need. Living-donor liver transplantation is an attractive option for patients who are low on the waiting list and unlikely to receive a deceased-donor liver.

Because tissue typing has little influence on the risk of rejection, other factors in the selection of a living donor may actually be more important in your wife's case. First, the surgical procedure for the donor is a major operation that usually requires removal of the right lobe -- about 60 percent of the total liver mass -- and is not without risks. Although the risk to the liver donor's life is less than one-half of 1 percent, the donor is also at risk for temporary problems related to the surgical incision and the possibility of postoperative blood clots. The great majority of donors, however, experiences a complete recovery within a few months of their operations, and feel tremendous satisfaction from having given a loved one the gift of life.

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The donor must undergo extensive evaluation beforehand. Some risks of surgery are minimized if the potential donor is a very healthy young adult. Overall fitness of the donor will not only mean fewer operative risks and shorter postsurgical recovery, but also a healthier portion of liver for the recipient.

The size of the donated liver portion must also be considered. To live, people require a certain amount of liver mass. This could be an issue, for instance, if a small woman wanted to donate to a large man -- the 60 percent of her liver that she could safely donate might not be large enough to provide adequate liver function for him. Although liver tissue ultimately regenerates, both in the donor and recipient, such a mismatch could be critical in the period following the transplant.

Sometimes social factors come into play when trying to identify the best donor. For example, would a single mother of two small children be the best person to donate a portion of her liver? Considering the children, the risks of a complication might well be too high. -- Dr. Charles B. Rosen, Transplantation Surgery, Mayo Clinic, Rochester, and Dr. Christopher B. Hughes, Transplantation Surgery, Mayo Clinic, Jacksonville, Fla.

To submit a question, write to: medicaledge@mayo.edu, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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