Living related liver donation and transplantation has been the focus of numerous news stories in this area during the last few weeks. This increased public awareness has generated numerous calls to our office from patients with questions about this topic and liver transplantation in general. This column will try to answer some of the most common questions posed to our staff.

Before we can discuss living related donation, we need to start with the standard liver transplantation from a cadaveric donor. There are more than 18,000 people waiting for new livers in the United States with about 4,500 liver transplants performed each year. Based upon these numbers, significant numbers of people will die waiting for a new liver, as there are simply not enough organs for everyone. The donor organs come from a healthy person who died suddenly or tragically and had previously agreed to be an organ donor upon their death. Over the past several years, the number of organ donors has declined. As the need for liver transplantation increases and the lists of people waiting grow longer, the decline in organ donors translates into more people dying each year without the chance for a lifesaving operation. Unfortunately, none of the many campaigns in the United States to raise public awareness about organ donation have led to increased donation. Based upon this fact, other sources of donation need to be considered to save lives.

The choices come down to artificial livers or living related donation. Artificial livers, although a fantastic concept, are not going to be a reality in the foreseeable future. Therefore, living related donation would appear to be the quickest way to increase the number of transplants performed and, in fact, this is what has happened. Is the quickest way to increase the number of transplants the best way? This is a tough question without easy answers.

Living related liver donation means that a healthy person, usually a relative, agrees to undergo surgery and donate a portion of their liver to a person with end stage liver disease. This enables liver transplant operations to be regularly scheduled and also enables patients who may die waiting for a new liver to have another chance at life. The portion of removed liver grows back in a short period of time. However, the process of living related donation requires an extensive medical and psychological evaluation of the donor and it is not risk free for the donor. Living related donation requires that a healthy person undergo a difficult and complicated surgery without any benefit to himself or herself. The mortality to the healthy donor has been quoted as 0.5 percent, meaning that one in every 200 healthy donors may not survive the donor operation. The recent publicity has questioned this number and, in fact, it may be as high as 1-3 percent. In addition to mortality, morbidity also increases in the donors. As many as 5-10 percent may need re-operation for various reasons and significant numbers of donors complain of abdominal pain after surgery related to the extensive surgical wound that must heal.

These risks need to be weighed against the benefit of saving a loved one's life. We must carefully review this procedure and not be too quick to judge either for or against it. There are many moral and ethical issues to be addressed. Ethicists must be involved in the development of these programs and national guidelines need to be written to standardize procedure across the nation. The bottom line, however, is that we need to do something to increase the supply of donor organs in order to save lives.

Dr. Bernstein is the director of Hepatology for the North Shore-Long Island Jewish Health System. You may write to: Dr. Bernstein, c/o Anton Newspapers, 132 E. Second Street, Mineola, NY 11501 or email:dbernste@nshs.edu

(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)