Chances and Risks in Living Donor Liver Transplantation: Comprehensive Information for Prospective Donors

Abstract

The authors recommend offering living-donor liver transplantation to suitable recipients and their families as an alternative form of treatment. However, we would like to point out two problems, one of which was discussed inadequately in the article, the other not at all. With regard to the donor’s risk of death, the authors report that there have been ten early and three late deaths after partial liver donation by a living donor. Given that about 6,000 of these operations have been performed worldwide, they calculate that the risk of death is below 0.5%. Yet this estimate can only be viewed as a lower bound, as long as physicians are not required by law to report adverse events of this type. Thus, we would have wished to know the current figures for Germany alone. Furthermore, because problems arising from biliary tract injury can take a chronic course, the period of observation for the determination of late deaths after living donation should have been precisely defined. Persons willing to serve as donors are unlikely to be dissuaded by figures below 1%; thus, giving the correct lethality figure would seem to be less a practical question than a simple matter of honesty. More important for prospective donors, however, is the unsolved problem of insurance coverage (in Germany) above and beyond the costs of surgery and hospitalization associated with the partial liver donation. As the liver can normally regenerate very effectively, there is unlikely to be any major damage to health if the early postoperative course has been uncomplicated. Nonetheless, by the act of donation, the donor becomes a person who has undergone major surgery, and he or she must state that this is the case when asked to give such information by prospective employers, lenders, etc. Considering that the accident insurance system in Germany continues to regard people who have lost part of their liver as having a 20% to 40% diminution of their earning capacity because of impaired general performance, one cannot gloss over the potential bureaucratic disadvantages that may accrue to donors as a result of their donation. Rather, physicians ought to do as much as possible to clear up this long-recognized problem. In the meantime, the practice of splitting livers obtained by cadaveric organ donation can be pursued more vigorously in order to reduce the shortage of available liver tissue for transplantation.