Living Donation is the Solution (page 2)

Living Donation is the Solution (part 2)

The Bishops have not done their research regarding the “significant” and “not well established” mortality rate of living liver or lung donation. Nigel Heaton, Professor of Liver Transplant, Hepatobiliary & Pancreatic Surgery, at one of the world’s leading centres for liver transplantation, Kings College Hospital, London, informed me before my liver donation in 2013 that living left lobe liver hepatectomy had a mortality rate of 0.1% and was improving with medical advances in the field. A study in the United States back in 2008 put the mortality rate slightly higher at 0.15%.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654217/

In 2006 there was a British study done of living lung donation and there had been NO deaths of donors but the following complications were noted, including an understandable loss of lung function, due to 20% of a donor’s lung being removed.

There were no reports of donor mortality following lobectomy. In one study it was reported that 20% (50/253) of donors had one or more perioperative complications following lobectomy. The most common complication was the need for a thoracostomy tube in 30% (15/50), either for persistent drainage or for air leaks. The most significant complication was pulmonary artery thrombosis, which occurred in two patients (1%). Eight patients (3%) also required reoperation because of bleeding (1.2%), bronchopulmonary fistula (0.4%), unresponsive pericarditis (0.4%), loculated pleural effusion (0.4%), a sterile empyema (0.4%) and a retained sponge (0.4%). In a study following 253 donor lobectomies it was reported that donors who could be contacted at 1 and 2 years had reduced pulmonary function compared with preoperative values. For more details, refer to the 'Sources of evidence' section.

Source: Living-donor lung transplantation for end-stage lung disease

NICE interventional procedure guidance [IPG170] Published date: May 2006

Also refer to the excerpts below from the article by a Professor of Respiratory Medicine and Honorary Consultant Physician from The Royal Brompton and Harefield Hospitals about living lung donation which state that up until the year 2000 no-one who had donated a lobe of their lung had ever died, either in the UK or the USA. In comparison, in the UK there is a 50% mortality rate for people waiting for a lung transplant due to not enough organs being available from deceased donors. Living lung donation recently was stopped in the UK for reasons unknown to me.

Humans have five lung lobes and the patient receives one lower lobe from each of two donors. The donor is left with four lung lobes. The recipient has both his/her diseased lungs removed and receives two new lung lobes, one from each of two donors. However, the lung function of these recipients at two years is comparable with those receiving conventional transplantation from a brain stem dead donor with five lobes. The tissue transplanted from a living donor is deprived of its blood supply for a shorter period of time than when a brain stem dead donor is used. In the latter situation there is always delay, sometime of three to four hours, while the tissue is being transported from the donor hospital to the recipient. The use of lobes from a living donor also has the advantage that the operation can be done electively during the day, not in the middle of the night as an emergency, as so often happens with transplants from brain stem dead donors.

Initially surgeons found this a difficult operation to contemplate. Surgeons usually operate on sick patients with the hope of making them better. In this situation they are being asked to operate on two fit people, leaving them with four, instead of five, lung lobes, in the hope of saving the life of a critically ill third person. However, after much thought and consideration, including discussion with the ethics committee, the team at Royal Brompton and Harefield Hospitals thought they no longer had a right to refuse. There was also considerable pressure brought by the relatives of sick CF (Cystic Fibrosis) patients for this procedure to be made available. The first living lobe transplant for CF in the UK was performed by Professor Magdi Yacoub in July l995, at Harefield.

Donors must have extensive counselling to make sure they understand the risks, both in terms of morbidity and mortality. The risks are small but should be spelt out in detail and written information given to the donor. The results of previous surgery for living lobe donation should be discussed. All donors will experience some post-operative pain and will have a chest tube in situ for at least a few days after the operation. The chest tube is usually only in place for one to three days but the occasional donor may have a chest tube for as long as three weeks. There is also a risk, again small, of postoperative infections and other, rare, postoperative complications. As this is a new procedure it is impossible to give exact estimates as to risk. Nobody who has donated a lung lobe in the USA or UK has died. In the UK no donor has experienced major or life-threatening complications. We know, however, that all general anaesthetics and surgery have some risk and removal of a lung lobe for cancer has a mortality rate of about one per cent. If donation of living lung lobes becomes widespread then eventually a donor will die. A donor with four lung lobes instead of five lung lobes will have less exercise tolerance for competitive sports, but will be able to live a normal life in all other respects. If, however, he/she later develops severe chest infection or lung cancer he/she will have less lung tissue in reserve.

Potential donors should understand there is 20-30% mortality in lung transplant patients in the first year, although approximately 70% of patients receiving conventional transplantation do well, with greatly increased quality of life and a chance of survival for ten years or longer.

Young people are dying because of the shortage of donor organs. Do the physicians have the right to say no to those who love them and wish to donate an organ to help save their lives? We think not. Not all patients have family members who are fit enough and willing to donate organs, but if 25% of patients could be treated in this way there would be more brain stem dead donors for other patients on the waiting list. It is essential that no pressure is put on a family member either by the patient, another family member or members of staff. When preparing a patient for routine transplantation we inform the patient that this option is available without pushing the issue.

Source: Transplantation using Lung Lobes from Living Donors. Journal of Medical Ethics by Margaret E Hodson, MD, MSc, FRCP, DA Professor of Respiratory Medicine and Honorary Consultant Physician, Royal Brompton and Harefield Hospitals, http://jme.bmj.com/content/26/6/419.full

Consultant Respiratory and Transplant Physician Martin Carby from The Royal Brompton and Harefield Hospital wrote to me that he and others at the hospital were advocates of living donor lung lobar lung transplantation. The chair of CRG for cardiothorac transplantation, however, told Martin that he believes that this procedure should not be commissioned for NHS patients on the basis that “there are enough lungs in the UK to offer patients treatment with lungs from deceased donors”. Meanwhile 50% of people waiting for a lung transplant are dying. Martin said:

“This is somewhat at odds with current statistics but his assertion is that there is under utilisation of organs by transplant surgeons. …Whether the deficit is enough to plug the current gap between organ donation and demand for lung transplantation will remain to be seen.”

Source: Living-donor lung transplantation for end-stage lung disease

NICE interventional procedure guidance [IPG170] Published date: May 2006