Medical and Psychosocial Risk Profiles Important for Living Organ Donors

Karen Dente, MD

June 26, 2007

June 26, 2007 (Rio de Janeiro) — One of the major concerns in liver transplantation involves expansion of the pool of available liver grafts, with living donation playing a growing fundamental role in supplying organs.

Experts convened here for the 13th Annual International Congress of the International Liver Transplantation Society to discuss the issue of risk for the donor and to raise the crucial question of how much risk is acceptable and where the limits should lie.

Burckhardt Ringe, MD, of Drexel University College of Medicine, Philadelphia, Pennsylvania, presented a study examining possible preoperative medical and psychosocial risk factors and evaluating postoperative complications in 27 prospective adult donors. Of these individuals, 30% had no medical risks, 56% no psychosocial risks, and 22% no combined risks.

In 19 donors, however, the following medical conditions were identified: 15 were overweight, 8 had hypercholesterolemia, and hypertension, hepatic steatosis of 10% to 13%, and hypothyreosis were seen in 1 patient each. Five donors were heterozygous for factor V Leiden mutation.

In addition, psychosocial risk factors were present in 12 donors. These risk factors included smoking (n = 9), a history of alcohol misuse (n = 7) or illicit drug use (n = 4), a fragmented family (n = 6), psychiatric comorbidity (n = 3), and nonestablished occupation (n = 3).

A total of 24 donors underwent resection, with 16 undergoing right lobe resection. Postoperative complications were seen in a total of 63% of the donors.

"Preoperative risks correlated to some degree with postoperative complications," according to Dr. Ringe. Wound infections were seen more frequently in overweight individuals, a donor with factor V Leiden mutation developed deep vein thrombosis, and another died from cocaine use that was known of before surgery.

Although ideally living donors should be without any significant risk, a total of 78% of the donors involved had 1 or more medical or psychosocial risk factors in this center's study.

"Based on our experience, we think that the benefits for donor and recipients outweigh the risk associated with donation in transplantation," said Dr. Ringe.

In a discussion after the presentation, a member of the audience said that no matter how many recipients waiting for a donor organ die, not a single avoidable donor death is tolerable; the statement was received with much agreement among other attendees.

"I don't think a single donor death is justified," Felix A. Carrasco Mascaro, MD, a surgeon from the Guillermo Almenara National Hospital in Lima, Peru, told Medscape.

One of the key problems with examining living donor morbidity and mortality is the underdocumentation or lack of direct reporting of complications by the transplant centers, leading to a dearth of hard data on which to base transplant decisions and to an to inability to provide potential donors with true informed consent.

"I think the message here is that we have to analyze the data and know the details of these patients," Dr. Ringe concluded. He believes that more caution should be advocated under specific psychosocial circumstances. For example, at his center 1 donor died from illicit drug overdose 57 days after surgery.

"There is a serious psychological component to liver transplantation," said Timothy Pruett, MD, of the University of Virginia Health System, Charlottesville, at a plenary session. "Many people are unhappy about their donations and are depressed," he added. Dr. Pruett has reported on the fact that at his center there has been 1 suicide from an overdose of pain medication.

International Liver Transplantation Society 13th Annual International Congress: Abstract 161. Presented June 20, 2007.

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