Years of living with chronic hepatitis C virus
infection (HCV) destroyed my friend Rick’s liver. Last year, a liver
transplant saved his life. A motor vehicle accident killed a
19-year-old man, and now Rick is healthy. Not a day passes, that Rick
doesn’t say thank you for the life of the man whose liver restored
The same year Rick received his liver, I lost
three friends who would have lived had hepatitis C been diagnosed
earlier and they could have had a chance at liver transplantation. Rick
was incredibly fortunate to have received a liver, because there is a
major organ shortage in the U.S. According to the American Liver
Foundation, approximately 17,000 people are on the liver transplant
list. Of these, 6000 people were transplanted; 1500 to 1700 people died
before they could receive a liver.
Chronic liver failure caused by complications
from HCV is the most common reason for adult liver transplantation in
the United States. Cirrhosis caused by long-term alcohol abuse is the
second leading cause. The majority of people living with HCV will never
progress to the point where transplantation will be necessary. Liver
transplantation is a complicated surgery, requiring lifelong follow-up
care. Liver transplant patients have an approximately 86% one-year and
78% three-year survival rate.
Most liver transplants use deceased donors.
However, the liver’s remarkable ability to regenerate allows us to use
partial livers from living donors. A living donor doesn’t have to be a
blood relative, but must have a compatible blood type. About 40% to 60%
of the donor’s liver is removed. Within eight weeks, the livers of both
the donor and the recipient are usually completely regenerated. The
average donor recovers in about two months; recipients recover in
roughly six to 12 months.
Although living liver transplantation sounds like
the perfect way to address the organ shortage, it isn’t. The
potential risk to the donor is so high that live liver donations are
done only when the potential risk to the donor is small and the
potential benefit to the recipient is unquestionable. It is difficult
to find current data on live liver transplantation, but it appears that
there are 250 to 400 liver donor transplants a year. One in 300 donors
die and about 30% suffer a complication. Many living donors who die
are relatives of the recipients. One can only imagine how difficult it
might be to live with the knowledge that you are alive, but your
otherwise healthy donor is not.
Although increasing the donor organ pool is
important, a better plan is to reduce the organ demand. Screening,
linkage to care, and treating hepatitis C patients will reduce the
number of liver transplant procedures needed. When I began working in
this field, hepatitis C patients who were transplanted would still have
HCV. This meant the transplanted liver was reinfected, and in some
cases, it too would progress to cirrhosis. Now we can cure hepatitis C,
which greatly cuts down on the stress to the transplanted organ and
diverts the need for a second transplant.
Other strategies that will reduce the demand for livers are:
Immunizing all children against hepatitis B
Implementing awareness programs to reduce liver-injury risk, such as from alcohol, drug, and dietary supplement use
Raise awareness of the impact of diet on the
liver. Fatty liver disease is on the rise in the U.S., which in turn
causes a decrease in the number of viable livers.
Increase the organ donor pool. For instance,
countries that use an “opt-out” strategy have much higher donor rates.
“Opt-out” means that everyone is a potential donor unless otherwise
indicated. For instance, Germany uses an opt-in system and 12% of its
population consents to donate. Neighboring Austria uses an opt-out
system, and has a consent rate of nearly 100%. The U.S. uses an
In some cases, patients whose hepatitis C is
cured, may be potential organ donors. This situation is considered if
the organ is in good shape, and the recipient would otherwise die. The
recipient is given the option to decline the HCV antibody-positive
organ. Compared to HCV antibody-negative organs, the long-term survival
rate in patients who received an HCV antibody-positive/viral
load-negative organ are similar. So, if you are cured of HCV, celebrate
by filling out your organ donor card. Ask family and friends to fill
theirs out too.
Lucinda K. Porter, RN, is a long-time contributor to them HCV Advocate and author of Free from Hepatitis C
and Hepatitis C One Step at a Time
. Her blog is www.LucindaPorterRN.com
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