2-For-1 Liver Transplant Saves Two

[Guest guest]

2-For-1 Liver Transplant Saves Two

By LAURAN NEERGAARD

AP Medical Writer

Split Transplant; Two Patients Share One Organ

WASHINGTON (AP) -- The transplant surgeon had good news: A donated

liver was on the way for critically ill Maggie Catherwood. Then he

asked: Would she let doctors cut off part of her new liver to share

with an equally sick baby?

" I can't imagine anyone saying no, " the 21-year-old college student

said last week as, teary-eyed, she met 8-month-old Brown,

carefully cuddling the wide-eyed baby so as not to bump each other's

healing incisions.

Actually, few ever get the choice - something the nation's transplant

network soon may change. There's a push to increase liver-splitting

that could have many more people who are awaiting transplants being

asked to share a piece of their new organ.

If the proposed changes are enacted, " I think it's safe to say we

could nearly eliminate death on the pediatric liver waiting list, "

said 's surgeon, Dr. Fishbein of town University

Hospital.

A liver is unlike any other organ: A piece of a healthy one can grow

into a whole organ in about a month. That's why some people receive

liver transplants from living donors who have just a portion of their

organ cut out and given away.

Split-liver donation is different. It divides an organ donated when

someone dies, to try to save two lives with one donation.

It doesn't happen very often, accounting for between 2 and 3 percent

of the more than 6,000 liver transplants annually. Just 123

split-liver transplants were performed in the U.S. last year,

according to the United Network for Organ Sharing, which runs the

transplant system.

Particularly rare, says Fishbein, is an adult agreeing to share a

liver that the waiting-list rules deem completely his or hers. Usually

when a liver is split, an organ too large for a baby or small child

had to be cut to fit anyway - and pediatric surgeons who don't want to

waste the rest offer it to the next candidate on the waiting list.

" I didn't even know it was possible " to split a liver, said

Catherwood. But she said yes, and her first question upon waking up

from surgery was, " How's the baby? "

" The fact that someone else was willing to give up part of that liver

they need is amazing to me, " said Terri Brown, 's mother, in an

emotional meeting with Catherwood 12 days after the transplants.

" Oh, she's adorable, oh my gosh! " exclaimed Catherwood from her

wheelchair as 's father, , handed her the baby, tiny white

dog slippers peeking from beneath her blanket.

Not every transplant center has the expertise or incentive to split

livers, especially those that treat only adults. It's a more

technically challenging operation. It poses a slightly higher risk of

post-surgery complications, such as maintaining the good blood flow

necessary for the organ to survive.

Nor is every donated liver splittable. It must be a very healthy

organ, not the marginal ones often transplanted; typically, the donor

was a young adult who died from an accident.

But a rough estimate from the United Network for Organ Sharing is that

more than 1,000 livers donated a year might qualify for splitting.

Fishbein is part of a the network committee charged with spurring

those transplants to try to save more youngsters. Between 10 percent

and 13 percent of young children die while on the liver waiting list,

including 41 babies last year.

Pending proposals would mandate that all transplant centers be

notified when a potentially splittable liver is donated, and that the

search for a matching recipient identify those willing to accept a

partial organ.

" This is a really important topic, " said Dr. Mazariegos,

transplant chief at Children's Hospital of Philadelphia, who says

liver-splitting today is too dependent on individual surgeons.

" We want to take it to ... a national type of initiative where it's

always thought of and always considered when there are certain

criteria that are met. "

Catherwood's symptoms started in the fall, when suddenly she couldn't

keep food down. The day after her 21st birthday, she learned she had

's disease - her liver couldn't properly dispose of the copper

in food. The quiet buildup was destroying it. In early February, the

Sterling, Va., woman joined the nearly 17,000 people on the waiting

list for liver transplants.

was 3 1/2 months old when doctors discovered her worsening

jaundice meant biliary atresia - the Waldorf, Md., girl was born

without all her major bile ducts. She joined the transplant list in

early December, the whites of her eyes turning canary yellow as the

months ticked by and her liver shut down.

Livers are distributed to the sickest patients first. Late on Feb. 27,

town's Dr. Cal Matsumoto got word that the transplant network

had flagged Catherwood to receive a liver from a teenager who had just

died. Knowing was a match, too, he broached the two-for-one

transplant.

Most surgeons insist on splitting the liver themselves to be sure it's

done right. Fishbein is used to middle-of-the-night trips to far-away

hospitals to retrieve one piece. This time, the organ was flown on ice

to town, for Fishbein and Matsumoto to divide. The left lobe -

just under 20 percent - went to , the rest to Catherwood in an

adjoining operating room.

Surgeons carefully calculate the minimum amount of healthy liver a

patient needs in the month it will take to regenerate. Indeed, the

slight risk associated with split-liver transplants is usually due to

not getting a big enough piece, problems with how the organ was

divided, or delays in transplanting, explained Philadelphia's

Mazariegos.

A liver also can be sliced into 60-40 sections for two adults, as is

done with living donors. But split-liver transplants between two

adults are controversial. It's harder to calculate the right volume

fast enough, before the organ deteriorates.

For Catherwood and , the transplant seems to be working,

although they have the same risk of long-term organ rejection as any

transplant recipient. Catherwood was recuperating at home, well enough

even before she was discharged to indulge in chocolate.

remained in the hospital for observation, but her liver was clearing

away the jaundice.

" It's so exciting to see what her eyes look like, " her father said.

" We got so lucky. "

_________________________________________________________________

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[Guest guest]

2-For-1 Liver Transplant Saves Two

By LAURAN NEERGAARD

AP Medical Writer

Split Transplant; Two Patients Share One Organ

WASHINGTON (AP) -- The transplant surgeon had good news: A donated

liver was on the way for critically ill Maggie Catherwood. Then he

asked: Would she let doctors cut off part of her new liver to share

with an equally sick baby?

" I can't imagine anyone saying no, " the 21-year-old college student

said last week as, teary-eyed, she met 8-month-old Brown,

carefully cuddling the wide-eyed baby so as not to bump each other's

healing incisions.

Actually, few ever get the choice - something the nation's transplant

network soon may change. There's a push to increase liver-splitting

that could have many more people who are awaiting transplants being

asked to share a piece of their new organ.

If the proposed changes are enacted, " I think it's safe to say we

could nearly eliminate death on the pediatric liver waiting list, "

said 's surgeon, Dr. Fishbein of town University

Hospital.

A liver is unlike any other organ: A piece of a healthy one can grow

into a whole organ in about a month. That's why some people receive

liver transplants from living donors who have just a portion of their

organ cut out and given away.

Split-liver donation is different. It divides an organ donated when

someone dies, to try to save two lives with one donation.

It doesn't happen very often, accounting for between 2 and 3 percent

of the more than 6,000 liver transplants annually. Just 123

split-liver transplants were performed in the U.S. last year,

according to the United Network for Organ Sharing, which runs the

transplant system.

Particularly rare, says Fishbein, is an adult agreeing to share a

liver that the waiting-list rules deem completely his or hers. Usually

when a liver is split, an organ too large for a baby or small child

had to be cut to fit anyway - and pediatric surgeons who don't want to

waste the rest offer it to the next candidate on the waiting list.

" I didn't even know it was possible " to split a liver, said

Catherwood. But she said yes, and her first question upon waking up

from surgery was, " How's the baby? "

" The fact that someone else was willing to give up part of that liver

they need is amazing to me, " said Terri Brown, 's mother, in an

emotional meeting with Catherwood 12 days after the transplants.

" Oh, she's adorable, oh my gosh! " exclaimed Catherwood from her

wheelchair as 's father, , handed her the baby, tiny white

dog slippers peeking from beneath her blanket.

Not every transplant center has the expertise or incentive to split

livers, especially those that treat only adults. It's a more

technically challenging operation. It poses a slightly higher risk of

post-surgery complications, such as maintaining the good blood flow

necessary for the organ to survive.

Nor is every donated liver splittable. It must be a very healthy

organ, not the marginal ones often transplanted; typically, the donor

was a young adult who died from an accident.

But a rough estimate from the United Network for Organ Sharing is that

more than 1,000 livers donated a year might qualify for splitting.

Fishbein is part of a the network committee charged with spurring

those transplants to try to save more youngsters. Between 10 percent

and 13 percent of young children die while on the liver waiting list,

including 41 babies last year.

Pending proposals would mandate that all transplant centers be

notified when a potentially splittable liver is donated, and that the

search for a matching recipient identify those willing to accept a

partial organ.

" This is a really important topic, " said Dr. Mazariegos,

transplant chief at Children's Hospital of Philadelphia, who says

liver-splitting today is too dependent on individual surgeons.

" We want to take it to ... a national type of initiative where it's

always thought of and always considered when there are certain

criteria that are met. "

Catherwood's symptoms started in the fall, when suddenly she couldn't

keep food down. The day after her 21st birthday, she learned she had

's disease - her liver couldn't properly dispose of the copper

in food. The quiet buildup was destroying it. In early February, the

Sterling, Va., woman joined the nearly 17,000 people on the waiting

list for liver transplants.

was 3 1/2 months old when doctors discovered her worsening

jaundice meant biliary atresia - the Waldorf, Md., girl was born

without all her major bile ducts. She joined the transplant list in

early December, the whites of her eyes turning canary yellow as the

months ticked by and her liver shut down.

Livers are distributed to the sickest patients first. Late on Feb. 27,

town's Dr. Cal Matsumoto got word that the transplant network

had flagged Catherwood to receive a liver from a teenager who had just

died. Knowing was a match, too, he broached the two-for-one

transplant.

Most surgeons insist on splitting the liver themselves to be sure it's

done right. Fishbein is used to middle-of-the-night trips to far-away

hospitals to retrieve one piece. This time, the organ was flown on ice

to town, for Fishbein and Matsumoto to divide. The left lobe -

just under 20 percent - went to , the rest to Catherwood in an

adjoining operating room.

Surgeons carefully calculate the minimum amount of healthy liver a

patient needs in the month it will take to regenerate. Indeed, the

slight risk associated with split-liver transplants is usually due to

not getting a big enough piece, problems with how the organ was

divided, or delays in transplanting, explained Philadelphia's

Mazariegos.

A liver also can be sliced into 60-40 sections for two adults, as is

done with living donors. But split-liver transplants between two

adults are controversial. It's harder to calculate the right volume

fast enough, before the organ deteriorates.

For Catherwood and , the transplant seems to be working,

although they have the same risk of long-term organ rejection as any

transplant recipient. Catherwood was recuperating at home, well enough

even before she was discharged to indulge in chocolate.

remained in the hospital for observation, but her liver was clearing

away the jaundice.

" It's so exciting to see what her eyes look like, " her father said.

" We got so lucky. "

_________________________________________________________________

Mortgage refinance is hot 1) Rates near 30-yr lows 2) Good credit get

intro-rate 4.625%*

https://www2.nextag.com/goto.jsp?product=100000035 & url=%2fst.jsp & tm=y & search=mor\

tgage_text_links_88_h2a5f & s=4056 & p=5117 & disc=y & vers=743