Aa
Building Organs
Not a question...just some info...saw this on the 17th on MSN and some of the other media outlets:
On June 17th a story ran carried on AP and most media coverage that covered a story about Dr. Anthony Atala
of Wake Forest North Carolina was in a photo showing him holding a prototype of a kidney.
Growing lungs and other organs for transplant is still in the future, but scientists are working toward that goal.
A 3-D printer builds prototype kidneys. In several labs, scientists study how to build on the internal scaffolding
of hearts, lungs, livers of people and pigs to make custom-made implants.
There's a really long web address....I found it just by searching "growing organs in lab in north Carolina".
Then of course there is the usual reiterate... should this really be done...isn't against this and that...you know
those people are sitting on a transplant list waiting.
On June 17th a story ran carried on AP and most media coverage that covered a story about Dr. Anthony Atala
of Wake Forest North Carolina was in a photo showing him holding a prototype of a kidney.
Growing lungs and other organs for transplant is still in the future, but scientists are working toward that goal.
A 3-D printer builds prototype kidneys. In several labs, scientists study how to build on the internal scaffolding
of hearts, lungs, livers of people and pigs to make custom-made implants.
There's a really long web address....I found it just by searching "growing organs in lab in north Carolina".
Then of course there is the usual reiterate... should this really be done...isn't against this and that...you know
those people are sitting on a transplant list waiting.
Best Answer
As I said before, I have not done a lot of research on living donor liver transplants, since my husband is not in need of a transplant at this time and our transplant center does not perform living donor liver transplants. I did a little bit of research on this topic.
Hopefully Hector, who has much more knowledge regarding liver transplantation in general, or OH, who has first hand experience with living donor liver transplantation will offer some information when they can.
From what I learned in my quick perusal of this topic, living donor liver transplants, also known as LDLT, were first initiated in 1989, available as a procedure by which parents could donate a portion of their liver to their child in need of a transplant (adult to child). Later, adult to adult LDLT was made available to adults (in Hong Kong-1993; in the US- 1998).
Currently, there are far more cadaveric donor liver transplants than living donor liver transplants performed in the US. Again, all I did was a quick look at information, but I found about 70 transplant centers that appear to be approved to do LDLTs; however, many of them are children's hospitals and so, presumably, only perform adult to child LDLTs. Some are comprehensive transplant centers and, presumably, do perform adult to adult LDLTs. Just as there are many criteria that a transplant center must meet in order to be approved to do cadaveric donor liver transplants, there are also many criteria that a transplant center must meet in order to be approved to do LDLTs. Additionally, of course, there are requirements that the recipient must meet to be approved for a transplant and requirements that the donor must meet to be eligible to donate a portion of his/her liver.
Advocate1955
Hopefully Hector, who has much more knowledge regarding liver transplantation in general, or OH, who has first hand experience with living donor liver transplantation will offer some information when they can.
From what I learned in my quick perusal of this topic, living donor liver transplants, also known as LDLT, were first initiated in 1989, available as a procedure by which parents could donate a portion of their liver to their child in need of a transplant (adult to child). Later, adult to adult LDLT was made available to adults (in Hong Kong-1993; in the US- 1998).
Currently, there are far more cadaveric donor liver transplants than living donor liver transplants performed in the US. Again, all I did was a quick look at information, but I found about 70 transplant centers that appear to be approved to do LDLTs; however, many of them are children's hospitals and so, presumably, only perform adult to child LDLTs. Some are comprehensive transplant centers and, presumably, do perform adult to adult LDLTs. Just as there are many criteria that a transplant center must meet in order to be approved to do cadaveric donor liver transplants, there are also many criteria that a transplant center must meet in order to be approved to do LDLTs. Additionally, of course, there are requirements that the recipient must meet to be approved for a transplant and requirements that the donor must meet to be eligible to donate a portion of his/her liver.
Advocate1955
Lets keep in mind sometimes posts like these will motivate a senior member to come along and break things down into layman s terms. This was a good thread for me! The liver is such a complicated organ!
HEART: this really led to some conversation hear at home, my hubby said last night,,,Hey I read something about organs,, I said you mean "Rebuilding Organs" . He said ya that's it. Ha! So that plus this thread launched are conversation. I think this is just great that we have each other to share this stuff. Thanks for the post!!! :) Kitty
HEART: this really led to some conversation hear at home, my hubby said last night,,,Hey I read something about organs,, I said you mean "Rebuilding Organs" . He said ya that's it. Ha! So that plus this thread launched are conversation. I think this is just great that we have each other to share this stuff. Thanks for the post!!! :) Kitty
Well to me it's all pretty simple as I had posted this in the thread.
Since all transplant centers cannot do a living donation my guess would be why you were told this???
" It is their protocol at this point, for me, to do a whole liver transplant." and not because " At stage 4 with decompensated liver I would need a whole liver transplant not a partial."
Wishing you the best...
-------------------------------------------
How do I know this, well I go there and I know Doctor Kwo . But one can also find out by going here on what places do and do not. Now I should add unless things have changed in the last year or year in a half this is still correct.
--------------------------------------
Here is a place one can go and find out where they do these.
http://optn.transplant.hrsa.gov/members/search.asp
Good day.
Since all transplant centers cannot do a living donation my guess would be why you were told this???
" It is their protocol at this point, for me, to do a whole liver transplant." and not because " At stage 4 with decompensated liver I would need a whole liver transplant not a partial."
Wishing you the best...
-------------------------------------------
How do I know this, well I go there and I know Doctor Kwo . But one can also find out by going here on what places do and do not. Now I should add unless things have changed in the last year or year in a half this is still correct.
--------------------------------------
Here is a place one can go and find out where they do these.
http://optn.transplant.hrsa.gov/members/search.asp
Good day.
For anyone researching Living Donor Liver Transplants (LDLTs), here are some additional resources.
1. Medhelp has a forum called the Liver Transplant Expert Forum. Dr. Thomas D. Schiano answers questions on that forum. The link is: http://www.medhelp.org/forums/Liver-Transplant/show/274. I did a search on Medhelp regarding Living Donor Liver Transplants and found a number of posts from people either looking into donating or looking into the possibility of receiving a LDLT. Dr. Schiano replied to them or replied to other posters who answered them. It appears that one must have a MELD score around or below 25 in order to be considered as a potential recipient of a LDLT. Higher than that presents additional risks for the recipient and he/she may be too ill for a LLDT. It is a very extensive procedure since two surgeries are being performed. Again, I’m not sure about the exact MELD score which would be considered to be too ill for LDLT, and it may vary in different transplant centers, and/or other factors may be taken into consideration as well.
2. The United Network for Organ Sharing (UNOS) seems to be a good resource for information regarding Living Donor Liver Transplantation. The website is: http://www.unos.org/. Here is a link to a booklet on the UNOS website with some information that potential living donors may need: http://www.unos.org/docs/Living_Donation.pdf
3. I read an article on-line in which the investigators studied mortality and hazard rates in 9 transplant centers that performed LDLTs between 1998-2007. According to this article, there was no significant difference in mortality rates, higher hazard ratios were related to donor age and/or recipient age, and outcomes varied based on the experience of the transplant center in performing LDLTs. I believe the article was written in 2011. Here is the title of the article:
“Outcomes for Adult Living Donor Liver Transplantation: Comparison of A2ALL and National Experience”, Kim M. Olthoff, MD,4 Michael M. Abecassis, MD,5 Jean C. Emond, MD,6 Igal Kam, MD,7 Robert M. Merion, MD,8 Brenda W. Gillespie, PhD,9 Lan Tong, MS,8 and the A2ALL Study Group. Here is a link to the article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116058/
4. Here is a post from a recipient of a LLDT that I found on the Liver Transplant Expert Forum that may be of interest. Please keep in mind that it was posted in 2009. Here is the link to the thread:
http://www.medhelp.org/posts/Liver-Transplant/Live-liver-donor/show/948098
gilmane
May 17, 2009
To: Hi5
Hi5, As a recipient of a liver donor liver transplant I have followed this issue for the last 10 years. I have not seen any large scale follow-up studies of the effects on the donor. Maybe the doctor knows of some. I have found a few articles and single transplant center discussions on the subject and have listed the references below:
"What Is The Quality-of-Life After Live Liver Donation?"
http://www3.interscience.wiley.com/cgi-bin/fulltext/118820618/HTMLSTART
"Live Organ Donation: One Step Forward, Two Steps Back: Increasing the Organ Supply With Live Donors"
http://cme.medscape.com/viewarticle/445640_2 (You need to register and sign in for Medscape, it is free.)
They seem to list three main issues:
Depression a Predictable Consequence
Preparing Donors for Financial Hardship
"Lack of Clarity" Obscures Ethical Considerations
Echoing a concern expressed by several others the author decried the lack of a national registry to monitor the health of living donors as "a scandal." Risk is a part of all surgeries required to donate an organ, and the transplant community must do a better job of "stewarding the donor" as he or she resumes life after the surgery. "The field is very perilous" the author noted. Therefore, candid discussions and disclosure policies about potential risks and benefits of live donations are essential to protect the interests of the donor and the recipient.
I would have much rather have received a cadaveric liver, but as we all know there are not enough to go around and sometimes the transplant team will suggest live donation if time is of the essence. Receiving a living donation requires someone you know and love to undergo major surgery that for them is unnecessary. There is a lengthy recovery time of 6 to 8 weeks or even longer in a few cases before they can go back to heavy work.
There are statistics that show how low risk the donor is, but as a recipient you worry that something could go wrong. I my case it worked wonderfully well and both I and my donor are totally fine. I will never be able to totally repay him for such a loving gift.
Best wishes whichever way you finally go.
5. Here is a post from orphanedhawk about her experience with LDLT. It was posted in 2011 in the Hepatitis C Community. The link to the thread is: http://www.medhelp.org/posts/Hepatitis-C/Living-Donor-Transplant-/show/1627626
orphanedhawk
Nov 13, 2011
To: nan535
Although Hector is right about the claims about rejection, not everyone agrees.
There is so much that people, including the surgeons, scientists and other doctors don't know about transplantation (among other things!)
My heptaologist is conservative. Yet, he thinks there is a possibility that the genetic link may make rejection less likely. He also thinks it may make me a good candidate for going off immune suppression meds, I controversial topic amongst the transplant community.
I have had no rejection episodes. I'm on a very minimum of immune suppression meds, .5mg prograf twice daily.
Many people years out are taking more meds than me.
However, our children are not our clones.
I went into surgery with no health problems other than my liver.
And I feel this is very important, I walked as much as I could up until surgery and afterwards. Granted my energy was ebbing away prior to my transplant and I had days I made it from the bed to the couch and back again. But if I could, I got out and walked.
With people dying from the lack of cadaveric livers, live liver transplantation is an excellent choice.
And, I think there are many advantages to it over a cadaveric liver.
You will know his liver will be younger and healthy. The cells haven't gone through the shock of death or disease.
Now, I'm not a scientist, I have no data to back me up. I only have my gut feeling, or maybe, its my daughter's gut feeling!!
OH
5. There seem to be both similar and different risks and benefits to both, much to consider for both, and eligibility requirements for both cadaveric and LDLT. One advantage of a cadaveric transplant is that more centers perform them. One advantage of a LDLT is that it can be scheduled at a time that is mutually convenient vs. being “on call” and “waiting”. Also one can be assured that the portion of the donor liver to be transplanted is healthy. Additionally, if it is a family member who is donating, there may be some genetic advantage, although live donors do not have to be blood relations. The risks include risk of infection, hemorrhaging, or other medical risks for the donor who otherwise would not be undergoing surgery. Another disadvantage to LDLT is the additional financial cost of the donor’s surgery and recovery period for the donor. Much to consider.
Advocate1955
1. Medhelp has a forum called the Liver Transplant Expert Forum. Dr. Thomas D. Schiano answers questions on that forum. The link is: http://www.medhelp.org/forums/Liver-Transplant/show/274. I did a search on Medhelp regarding Living Donor Liver Transplants and found a number of posts from people either looking into donating or looking into the possibility of receiving a LDLT. Dr. Schiano replied to them or replied to other posters who answered them. It appears that one must have a MELD score around or below 25 in order to be considered as a potential recipient of a LDLT. Higher than that presents additional risks for the recipient and he/she may be too ill for a LLDT. It is a very extensive procedure since two surgeries are being performed. Again, I’m not sure about the exact MELD score which would be considered to be too ill for LDLT, and it may vary in different transplant centers, and/or other factors may be taken into consideration as well.
2. The United Network for Organ Sharing (UNOS) seems to be a good resource for information regarding Living Donor Liver Transplantation. The website is: http://www.unos.org/. Here is a link to a booklet on the UNOS website with some information that potential living donors may need: http://www.unos.org/docs/Living_Donation.pdf
3. I read an article on-line in which the investigators studied mortality and hazard rates in 9 transplant centers that performed LDLTs between 1998-2007. According to this article, there was no significant difference in mortality rates, higher hazard ratios were related to donor age and/or recipient age, and outcomes varied based on the experience of the transplant center in performing LDLTs. I believe the article was written in 2011. Here is the title of the article:
“Outcomes for Adult Living Donor Liver Transplantation: Comparison of A2ALL and National Experience”, Kim M. Olthoff, MD,4 Michael M. Abecassis, MD,5 Jean C. Emond, MD,6 Igal Kam, MD,7 Robert M. Merion, MD,8 Brenda W. Gillespie, PhD,9 Lan Tong, MS,8 and the A2ALL Study Group. Here is a link to the article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116058/
4. Here is a post from a recipient of a LLDT that I found on the Liver Transplant Expert Forum that may be of interest. Please keep in mind that it was posted in 2009. Here is the link to the thread:
http://www.medhelp.org/posts/Liver-Transplant/Live-liver-donor/show/948098
gilmane
May 17, 2009
To: Hi5
Hi5, As a recipient of a liver donor liver transplant I have followed this issue for the last 10 years. I have not seen any large scale follow-up studies of the effects on the donor. Maybe the doctor knows of some. I have found a few articles and single transplant center discussions on the subject and have listed the references below:
"What Is The Quality-of-Life After Live Liver Donation?"
http://www3.interscience.wiley.com/cgi-bin/fulltext/118820618/HTMLSTART
"Live Organ Donation: One Step Forward, Two Steps Back: Increasing the Organ Supply With Live Donors"
http://cme.medscape.com/viewarticle/445640_2 (You need to register and sign in for Medscape, it is free.)
They seem to list three main issues:
Depression a Predictable Consequence
Preparing Donors for Financial Hardship
"Lack of Clarity" Obscures Ethical Considerations
Echoing a concern expressed by several others the author decried the lack of a national registry to monitor the health of living donors as "a scandal." Risk is a part of all surgeries required to donate an organ, and the transplant community must do a better job of "stewarding the donor" as he or she resumes life after the surgery. "The field is very perilous" the author noted. Therefore, candid discussions and disclosure policies about potential risks and benefits of live donations are essential to protect the interests of the donor and the recipient.
I would have much rather have received a cadaveric liver, but as we all know there are not enough to go around and sometimes the transplant team will suggest live donation if time is of the essence. Receiving a living donation requires someone you know and love to undergo major surgery that for them is unnecessary. There is a lengthy recovery time of 6 to 8 weeks or even longer in a few cases before they can go back to heavy work.
There are statistics that show how low risk the donor is, but as a recipient you worry that something could go wrong. I my case it worked wonderfully well and both I and my donor are totally fine. I will never be able to totally repay him for such a loving gift.
Best wishes whichever way you finally go.
5. Here is a post from orphanedhawk about her experience with LDLT. It was posted in 2011 in the Hepatitis C Community. The link to the thread is: http://www.medhelp.org/posts/Hepatitis-C/Living-Donor-Transplant-/show/1627626
orphanedhawk
Nov 13, 2011
To: nan535
Although Hector is right about the claims about rejection, not everyone agrees.
There is so much that people, including the surgeons, scientists and other doctors don't know about transplantation (among other things!)
My heptaologist is conservative. Yet, he thinks there is a possibility that the genetic link may make rejection less likely. He also thinks it may make me a good candidate for going off immune suppression meds, I controversial topic amongst the transplant community.
I have had no rejection episodes. I'm on a very minimum of immune suppression meds, .5mg prograf twice daily.
Many people years out are taking more meds than me.
However, our children are not our clones.
I went into surgery with no health problems other than my liver.
And I feel this is very important, I walked as much as I could up until surgery and afterwards. Granted my energy was ebbing away prior to my transplant and I had days I made it from the bed to the couch and back again. But if I could, I got out and walked.
With people dying from the lack of cadaveric livers, live liver transplantation is an excellent choice.
And, I think there are many advantages to it over a cadaveric liver.
You will know his liver will be younger and healthy. The cells haven't gone through the shock of death or disease.
Now, I'm not a scientist, I have no data to back me up. I only have my gut feeling, or maybe, its my daughter's gut feeling!!
OH
5. There seem to be both similar and different risks and benefits to both, much to consider for both, and eligibility requirements for both cadaveric and LDLT. One advantage of a cadaveric transplant is that more centers perform them. One advantage of a LDLT is that it can be scheduled at a time that is mutually convenient vs. being “on call” and “waiting”. Also one can be assured that the portion of the donor liver to be transplanted is healthy. Additionally, if it is a family member who is donating, there may be some genetic advantage, although live donors do not have to be blood relations. The risks include risk of infection, hemorrhaging, or other medical risks for the donor who otherwise would not be undergoing surgery. Another disadvantage to LDLT is the additional financial cost of the donor’s surgery and recovery period for the donor. Much to consider.
Advocate1955
"Sorry Can-do if I upset you...didn't mean to. My heart was in the right place."
No problem here, I answered your PM so you've got mail...:) Since were both here in the Hoosier state we can work together. Hope your having a good day.
BTW, sorry your thread got off track as it is interesting....... Take care
No problem here, I answered your PM so you've got mail...:) Since were both here in the Hoosier state we can work together. Hope your having a good day.
BTW, sorry your thread got off track as it is interesting....... Take care
I haven't the patience to read all of this but since I'm mentioned here, I'll throw out a little bit of my knowledge.
Yes, once a liver is too far gone, it will not regenerate.
I did indeed receive a part of my daughter's live liver ( 66%) and we both are doing great.
My current hepatologist tells me due to the shortage of donor livers, they are now doing partial liver transplants with cadaveric transplants or rather, in his medical center, brain dead transplants, as well.
In other words, they use the donor liver for two transplants as the liver can and does grow.
Aren't livers amazing !!!
Yes, once a liver is too far gone, it will not regenerate.
I did indeed receive a part of my daughter's live liver ( 66%) and we both are doing great.
My current hepatologist tells me due to the shortage of donor livers, they are now doing partial liver transplants with cadaveric transplants or rather, in his medical center, brain dead transplants, as well.
In other words, they use the donor liver for two transplants as the liver can and does grow.
Aren't livers amazing !!!
Have an Answer?
You are reading content posted in the Hepatitis Social Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Heart, I think you could have either a live donor liver transplant or a cadaver liver transplant, but many centers, perhaps yours, do not do live donor transplants. I think you may have misunderstood something regarding the reason why you can't have a live donor liver transplant. In your post above you said you were told that "your liver was too far gone and it would be too dangerous". So far as I know, having your liver be too far gone would not prevent you from having a live donor liver transplant. It is more likely that your center simply does not do live donor liver transplants. However, "it would be too dangerous" probably refers to the risks involved for the live donor. I believe that the primary reason that many transplant centers choose not to do live donor liver transplants is the risk to the live donor, at least that is what a transplant hepatologist at the University of Washington Medical Center explained to me.
Can-do, I think Heart is using the word "partial" to explain that OH's daughter donated part of her live liver to OH, so OH received part of her daughter's liver. I suspect that her liver transplant center does not do live donor liver transplants, and that's likely why a live donor transplant is not an option for her (don't know for sure, but that's what I am speculating). As Heart said above, she has decompensated Cirrhosis/ESLD, so remember that with her symptoms at that stage, it may be difficult at times to process, understand, remember, and express some details of a lot of information. Patience, grasshopper!
I will check around and see which centers in the US do live donor liver transplants just to clarify this question. In the meantime, Heart, you are doing everything right for your specific situation. For you, it's hurry up and wait!
Now both of you chillax (please)!
Advocate1955