Branded Organs

Christmas is, of course, the season for gift-giving, but I've not seen a lot of coverage recently regarding organ donation as the gift of life. One story that has been in the news is that of a surgeon who carved his initials on a patient's liver. The BBC provides an ethical analysis here.

Regrowing Livers

The fact that livers can regrow means that it's sometimes possible to take a liver lobe from a healthy donor, transplant it to someone suffering liver failure, and for both to end up with a fully functioning liver - as reported here. Recent evidence, however, suggests that this same ability means that some people's need for a transplant is only temporary, since their damaged livers may repair themselves.

Despite the focus on transplants saving lives, it shouldn't be forgotten that it's preferable if people don't need a transplant at all, saving them from major operations and a lifetime of immunosuppressant drugs. Perhaps the gap between supply and demand can be reduced, in part, by reducing demand. And, of course, it's preferable that livers that are available for transplant go to those that really need them (long term).

Warm Transplants

Organs need to be transplanted very quickly, since they soon deteriorate when deprived of oxygen. The normal procedure is to cool them to prevent this deterioration, though this freezing may itself cause damage. Surgeons in London have recently achieved a first: the transplant of a 'warm' liver.

Here, the liver was kept alive, and at body temperature, artificially, being supplied with oxygenated blood and nutrients. This allows the liver to be preserved for up to 24 hours, rather than having to be transplanted within 10-12 hours: so speed is still important, but this is a considerable increase in the timeframe.

Altruistic Donation

The UK's first altruistic liver transplant (that is, one from a live donor to a stranger) was performed last month. The unusual thing about the liver is that one can donate a liver lobe and then one's liver can re-grow so, unlike donating a kidney, one may be no worse off in the long term. In the short term, however, the donor may suffer as a result of the operation, which in this case took four hours and left a 6" scar, as well as the risk of infection and/or psychological problems. This pieces also highlights the risk of death: approximately 0.5%.

Given these costs, it's unsurprising that Dr Aluvihare - transplant specialist at King's College Hospital - is quoted as saying "I personally have some reservations about altruistic donations. I believe if we did everything we can to improve the supply of donations after death we wouldn't have a need for this type of donation". So the case for favouring posthumous donation isn't simply that people's organs are of little use to them after they die, but also that the costs of removing those organs are much lower.

Manipulating Waiting Lists

There's controversy in Germany over allegations that waiting lists for liver transplants were manipulated by doctors falsely listing patients as dialysis cases.

As noted in the BBC article "Competition between transplant centres may be to blame, experts say. There is a worldwide shortage of organ donors - a factor that may have exacerbated competition". Unfortunately there's a danger that negative publicity surrounding donation and transplants may put some people off registering as donors. This is a more serious problem where stories concern things like taking organs without proper consent, but even knowing organs won't necessarily go to the neediest cases may discourage altruistic donors. This, of course, creates a Catch-22 situation, since it's the shortage of organs that leads to nefarious practices in the first place.

My interests are primarily in the acquisition of organs, but it's important to remember that this may be linked with the distribution of said organs in practice, though of course analytically distinct.