Donor Risk Remains a Challenge in Liver Transplantation

Karen Dente, MD

June 25, 2007

June 25, 2007 (Rio de Janeiro) — Experts debated the aspects of donor morbidity and mortality associated with live liver donation at the 13th Annual International Congress of the International Liver Transplantation Society, where the risk for the donor is an issue of major concern.

With increasing shortages of available liver grafts from deceased donation, living donations have become an increasingly valuable commodity. These donations are associated with a considerable number of donor deaths and morbidity, although these deaths often go unreported by transplantation centers, with the risk–benefit ratio between donor and recipient in need of being reassessed, according to some experts in the field.

"Live donation is potentially morbid," said Timothy Pruett, MD, of the University of Virginia Health System, Charlottesville. Rehospitalization can occur in a significant number of people, and the complication rate is real, with about 40% of people having some sort of complication, according to estimates cited by Dr. Pruett. "There are some who have lots of complications, although in terms of the severity of complications most of these are fortunately not permanent. There is a subset of about 2% do develop long-term disability with it, and there are some people who do die," he said.

However, donor death confirmation and documentation remain under documented.

"Exact data on morbidity and mortality are not known," said Burkhardt Ringe, MD, of the Center for Liver, Biliary and Pancreas Disease at Drexel University College of Medicine in Philadelphia, Pennsylvania. Despite 4 independent reviews published in 2006, there are no accurate data on the number of donor deaths. Dr. Ringe also reported that there has in fact been a donor death at his center that is not reflected in the latest reports.

Dr. Ringe and his group reviewed the medical literature published since 1989, including anecdotal reports and substantial surveys, in an attempt to update the worldwide living donor mortality rate. Their goal was to assess the accuracy of the information assigning certainty levels to each source identified. These ranged from C1 to C3, with C1 signifying that a death had been directly reported by the center where it occurred, C2 referring to indirect publication by an author not involved in the case, and C3 pertaining to information being presented by verbal or personal communication.

Based on estimates of more than 10,000 living donor transplants having been performed worldwide, the donor death rate ranges from 0.1% to 0.3%.

"I think it is important to report every donor mortality, regardless of whether it occurs early or late," said Dr. Ringe.

Because of the discrepancy found between published and unpublished living liver donor mortality, the dilemma between reporting rumor vs reporting facts currently prevails.

To maintain truly informed consent and public confidence in the procedure, it is imperative that all deaths of living donors be reported by the transplant program where the fatality occurred, according to Dr. Ringe.

International Liver Transplantation Society 13th Annual International Congress. Presented June 21, 2007.