Going live

THE region’s leading football teams may be languishing near the foot of the Premiership, but when it comes to being willing to donate their organs for transplants the North-East is consistently top of the league.

“People up here are very generous with their organs. Unlike the football teams, we have been top of the league for about 15 years when it comes to donating organs,” says Professor Derek Manas, who heads the region’s liver, kidney and pancreas transplantation team. “The rate of donation is the highest proportion per million in the country.”

That is one of the main reasons why Prof Manas believes it is time to start the North-East’s first live donor liver transplant programme this summer.

With the number of patients waiting for liver transplants rising and the number of organs from deceased donors falling – largely due to a reduction in fatal road accidents – the transplant team at the Freeman Hospital in Newcastle is talking to potential donors across the region who are willing to undergo major surgery to help a relative or a friend. Prof Manas is hoping that the generous spirit of the North-East will be reflected in the number of people who will donate part of their liver to save a life.

While there are relatively few liver transplants performed in the UK, compared to kidney transplants, the unique thing about this vital organ is that it has the capacity to regenerate within the body.

This means that a donor can have a substantial part of their liver removed and transplanted to someone with liver failure and have a very good chance of making a full recovery.

Prof Manas recalls that, only a few years ago, transplant specialists in the UK hesitated to embrace a live liver transplant programme because of the ethical dilemma of carrying out major surgery on a perfectly healthy patient. But the professor says the time is now right for such a programme to be pursued.

“The mortality rate among those waiting is going up and more and more people are joining the list,”

says Prof Manas. “Basically, the waiting time for patients before they can expect to receive a donated liver from a deceased donor is becoming unacceptably long. Patients are becoming sicker and sicker on the waiting list and having longer to wait.”

The outlook for patients waiting for a new liver, where one in five can expect to die before being transplanted, contrasts with the excellent prospects for live donors.

“What is really crucial for the potential live donor is that the mortality rate for surgery is 0.5 per cent, that is one in 200,” says Prof Manas.

The success of live liver transplants around the world has underlined how much this approach can transform the outlook for many patients waiting for a new liver. Pioneered in Australia in the Eighties, live donor liver transplants are now relatively common in many countries.

But until very recently, there were no adult live donor liver transplants being carried out by the NHS.

Doctors in Leeds performed the first NHS live donor liver transplant in July, 2007.

In an eight-hour operation, which involved two teams of surgeons working in separate operating theatres, Stephen Lomas, 51, from Ulverston, in Cumbria, received part of his son, David’s, liver.

When both had recovered, David, 20, told the BBC: “I’m just so relieved that I’ve been able to help my dad.”

His father replied: “He’s a top man, a top man.”

At the time of that first live liver transplant, consultant hepatologist Dr Charlie Milson told the BBC: “The liver has two important features that make living-related donations possible – it is much larger than we need and it can regenerate within weeks if part of it is removed. In this procedure we remove part of the liver of a healthy donor and transplant it into a patient with liver failure. The remaining liver in the donor will regrow within weeks to almost its normal size. This development means many lives will be saved. It is really a massive step forward.”

SINCE that first transplant on the NHS, the team at St James’ Hospital in Leeds have performed 11 operations. So far, the only other NHS hospital to perform a live liver transplant is the Royal Infirmary of Edinburgh, where Jennifer Foster, 26, gave more than half her liver to her husband, Daniel, 28, in a ten-hour operation in February last year. But if Prof Manas has his way, Newcastle’s Freeman Hospital will join this exclusive club this summer.

“The plan is to go live in about June. Ideally we want to do ten a year,” he says.

While the Freeman already carries out around 50 liver transplants a year, using organs from deceased donors, the Newcastle-based surgeons need to build up their experience in this new form of transplant.

To ensure that they acquire this practical knowledge quickly, Prof Manas says the Freeman has formed what is known as the Northern Liver Alliance. This will mean that the liver transplant teams at Newcastle, Leeds and Edinburgh will work more closely together to develop the live donor programme.

PROF Manas has spent six months in Germany working alongside one of Europe’s leading live liver transplant surgeons, Professor Dieter Broering, to perfect the new technique.

Prof Broering, who is based in Hamburg, is expected to fly to the North-East to assist in the first live liver transplant this summer.

“We are also going to send three of our surgeons to South Korea, where all their liver transplants are from live donors because they don’t have a law which allows patients to be declared brain dead,” he adds.

Contrary to popular prejudice, the great majority of patients waiting for a liver transplant are not alchoholics.

“Alcohol is just one of the many causes of liver cirrhosis and only a tiny minority of alcoholics make it to the waiting list for a liver transplant,” says Prof Manas.

He estimates that 70 per cent of those on the waiting list for a new liver are there for reasons which are not related to alcohol. “The commonest indication for serious liver disease is actually Hepatitis C,” he says. “The beauty of live liver donation is that there is no need for a tissue match, the only significant factors are blood group and size. We really do think that live liver transplantation is the future.”