An acquaintance offers to donate a chunk of his liver to a fellow artist in need. It seems so generous, yet many surgeons in the country wouldn't perform the operation on ethical grounds.
"There are many people, and I fall into that group, who say to take a healthy person and expose them to any risk greater than zero is too high," says Paul Atkison, director of the Pediatric Liver Transplant Program at London's Health Sciences Centre in Ontario.
About 35 living liver transplants, as they are known, are done a year in Canada. Most Canadian transplant surgeons wouldn't consider performing the procedure, Dr. Atkison said, unless the donor is either related to the recipient, or a close family friend.
He and other liver-transplant surgeons, including some in B.C., fear that where there is no prior relationship, the donor may be being paid for a portion of his or her liver. The other concern is coercion.
But some U.S. hospitals allow liver transfers between strangers, as does the Toronto General Hospital.
Surgeons at the hospital, for example, gave author Tom Walmsley a chunk of liver from a man he barely knew, actor and playwright Michael Healey.
Eileen Young, manager of the ambulatory transplant program at the hospital, says Toronto General has a stringent screening process to make sure living organ donors are not being coerced or paid -- whether or not they are related or friends with the recipient. "There also can be coercion between brother-sister, mom and dad. Our main concern is that the donor is not being coerced in any way, shape or form."
She said surgeons at the hospital have done several living liver transplants between acquaintances, including between members of the same church. An assessment team that includes surgeons, a psychiatrist and a social worker interviews potential donors to make sure they aren't under pressure and aren't being paid.
Ms. Young said that only a few centres in Canada perform living liver transplants, and she believes that eventually most will allow donations from relative strangers, as long as careful screening is done. The liver performs many critical functions. It purifies the blood, helps regulate cholesterol and protects the body from harmful substances. However, its most remarkable attribute is the ability to regenerate. Researchers are not exactly sure how the organ does it. But scientists have found evidence that the liver is rich in growth factors that stimulate regeneration.
This ability to rebuild is the reason doctors can take a chunk of liver from a healthy adult donor and transplant it into a patient whose organ has been damaged. Both pieces will grow to a normal size within six to eight weeks.
The donor should be in good physical and mental health, and the donor and recipient must have compatible blood types. In the surgery, doctors take about 60 per cent of the liver, generally the right half, and transplant it into the recipient, attaching it to the organ's blood supply and drainage systems.
The surgery takes about five hours for the donor and 10 hours for the recipient. Both procedures are complex, however, and the donor has about a 20-per-cent chance of complications, including blood clots, a bile leak, infection and pneumonia.
Some donors require additional surgery, and it's unclear what the mortality rate is, Dr Atkison says. In the United States, at least half-a-dozen donors have died, including a brother who donated part of his liver to a sibling.
Recipients must take anti-rejection drugs for the rest of their lives.
Removing a kidney is considered a much less risky procedure than removing more than half of the liver. Living kidney transplants are far more common than living liver transplants, and more than 400 were done in Canada last year, according to the Canadian Institute for Health Information.
The B.C. Transplant Society has started a pilot program in which healthy strangers can donate a kidney to someone in need. Neither the donor nor recipient will know the other's identity.
The society did a research study called Living Anonymous Donors: Lunatic or Saint?, that found there are sane people who want to give up an organ or part of an organ for a total stranger.
"There does exist in society a group of people who for truly altruistic and healthy reasons, truly want to do this," says transplant society spokesperson Sally Greenwood.
Liver transplant from a living donor
In a liver transplant from a living donor, the donor gives approximately half of his or her liver, normally the right portion, to the recipient. This is made possible by the liver's ability to regenerate itself. Both half-livers (of donor and recipient) grow to full size in six to eight week.s
SOURCE: UNIVERSITY OF SOUTHERN CALIFORNIA