In the last ten years, the demand for liver transplantation has increased dramatically. The supply of available livers from organ donors has not kept up with this increasing demand. In 1999, more than 14,000 patients were on the waiting list for liver transplantation in the United States. In the same year, only 4,700 liver transplants were performed. This gap between demand and availability has increased the average waiting time for liver transplantation. Furthermore, more patients are dying while waiting for livers to become available. In 1999, more than 1,000 patients died while waiting for liver transplantation.
One potential solution to this critical shortage of livers from the standard brain-dead donor pool is the use of organs from living donors. In renal transplantation, living donors have been used widely and, now, account for 34% of kidney transplants. In liver transplantation, the use of living donors was originally not considered appropriate, largely because of the technical difficulty of the surgery and the serious risks (including death) to the voluntary organ donor.
In the early 1990's, the progressive rise in the number of deaths of children waiting for a liver transplant led to the development of living donor pediatric liver transplantation. Transplantation of the left lobe of a living adult to a child is now routinely accomplished with minimal risk to the donor. In 1998, living donors accounted for 12% of all pediatric liver transplants. This technique helped to alleviate the shortage of organs, shortening the waiting time, and decreasing the number of children who die while waiting for an available liver.
Living donor liver transplantation of adults was initiated in the United States after the development of the procedure for children and in response to the shortage of cadaveric organs. Improvements in the donor and recipient operations and the early success of this procedure has led to the rapid acceptance and increasing use of adult to adult living donor liver transplantation. Between 1998 and 1999, the number of living donor liver transplants in the United States tripled. This increase is largely due to adult operations.
The Hartford Hospital Transplant Program is committed to initiating a living donor liver transplant program. The liver transplant surgeons, coordinators, and other staff are currently obtaining the additional education and training that will be necessary to initiate this program. It is our hope that by providing living donor liver transplantation, we can help to alleviate the shortage of available liver donors in the greater Hartford area.