Chances and Risks in Living Donor Liver Transplantation: In Reply

by Dr. med. Jessica Walter, Prof. Dr. med. Martin Burdelski, and Prof. Dr. med. Dieter C. Bröring in issue No. 6, 2008

The transplantation of AB0-incompatible organs from living donors has indeed become possible recently through the use of various immune modulation techniques and intensified immune suppression protocols, but the exceptional nature of this procedure needs to be emphasized. AB0-incompatible liver transplantation can be performed less restrictively in very young children who have not yet developed specific isoagglutinin antibodies. For adult recipients, however, the procedure itself and the immune suppression that it requires carry considerable risks. In countries with a sufficiently large pool of allogenic organs, this type of transplantation should be performed only in distinctly exceptional cases. The results reported to date are encouraging, yet the case numbers are small, and hardly any long-term follow-up data are available.

Our article dealt only briefly with the risks and harms of live partial liver donors. It is correctly stated that our estimate of the lethality rate should be considered a lower bound. Any discussion of this subject should be based on the available data in the literature; a uniform classification of morbidity would be desirable. There have been three donor deaths in Germany to date. The long-term results of this still very new technique will only be known in a few years. As far as we know at present, however, donors have not experienced any major health impairment. With regard to the financial disadvantages accruing to the donor as a result of the donation, a clarification and solution of this problem by the transplantation societies is indeed overdue. The occupational accident insurance carriers ought to reassess the notion that loss of part of the liver results in a 20% to 40% loss of earning potential, because these figures are derived from oncological liver surgery, where the results will not be comparable to those of partial liver resection in a healthy donor.

Living donation is an alternative transplantation technique that is only justified when all other techniques, including whole-organ transplantation, split-liver transplantation, and auxiliary transplantation are put to use as well. The further development of split-liver transplantation, in particular, would be highly desirable.
DOI:10.3238/aerztebl.2008.0616

Prof. Dr. med. Dr. Dieter C. Bröring
Clinic for General and Thoracic Surgery
Schleswig-Holstein University Clinic
Arnold-Heller-Str. 7, D-24105 Kiel
Germany
E-mail: [e-mail]

Conflict of interest Statement
The authors of all letters and of the reply state that they have no conflict of interest as defined by the guidelines of the International Committee of Medical Journal Editors.