Role of living liver donation

Editor—Neuberger and Price make a good case that living liver donation should be available in the NHS, and one might well ask why this is taking so long when the procedure has been in use so widely over the past five years.¹

There is certainly a need for more liver transplant operations as the figures quoted for 2002 show: 62 deaths in patients on the waiting list and another 25 patients removed from it because they had become too ill. The waiting list for recipients requiring blood group O cadaver organs in some transplant centres is now around 12 months, which is unacceptable.

The UK transplant rate is already one of the lowest in the West, and the chief medical officer in his annual report two years ago drew attention to the substantial and worrying increase in the number of deaths from cirrhosis in men of working age. Cases may not be referred for a variety of reasons. Eligibility criteria are strict, and many believe it is reasonable that these should be relaxed in the context of living liver donation.

The small number of transplant centres in this country also perpetuates the view that liver transplantation is a very difficult procedure, whereas in many countries elective grafting with cadaver organs has become almost a routine procedure.

Neuberger and Price also refer to “a few” living liver transplants having been done in the United Kingdom. In the programme at the Cromwell Hospital, which I started in October 1998 with Nigel Heaton, Mohamed Rela, and the surgical team from King's College Hospital, we have now treated 17 patients. Survival among recipients is 77%, and no major complications have occurred in the donors.² It was set up for overseas patients because of the time they were having to wait for a cadaver organ graft.