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    LIVER TRANSPLANTS
    Beacons of hope

    For most of us, waiting is just an annoying part of life. However, for people on an organ transplant waiting list, it's the most difficult part. Right now there are more than 60,000 people in the United States waiting for organ transplants. More than 13,000 are waiting for liver transplants.

    Some people on the liver transplant waiting list will receive an organ and live, but many others will not receive a liver in time. In 1998, only 4,868 donor livers became available, and 1,319 people died while on the waiting list.

    The demand for liver transplants is growing rapidly, largely due to an increase in the incidence of hepatitis C (HCV), which leads to chronic liver failure in 70 percent of cases. HCV is now the leading indication for liver transplants.

    But there are several beacons of hope. Promising developments in the field of liver transplantation include donations of liver segments from living relatives, splitting donated livers between two recipients, new organ allocation policies that benefit those with the most urgent need and new approaches to liver transplants for people with HCV.

    Splitting livers

    Child recipients require only a small section of a liver, so the larger section can either be retained by the living donor, or in the case of a cadaver donor, transplanted into an adult. In all recipients, the partial liver segment regenerates within months of the transplant.

    In June 1999, the United Network for Organ Sharing (UNOS) approved a policy establishing a national sharing arrangement for split livers in the United States. Under contract with the federal government, UNOS sets national organ transplant policy and maintains a registry of transplant candidates and recipients.

    The UNOS policy establishes a system for the distribution of split livers between participating transplant centers. Although the policy won't affect the number of cadaveric organs available for adults, experts believe it will increase access to segments of donated livers, which will improve transplant availability for children.


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