In the wake of the New York death of 57-year-old Mike Hurewitz, who died this week as a result of donating part of his liver to his brother, ABCNEWS.com ethics expert addresses the unknown risks of "live" organ donation.
Since 1997, more than 800 people have given portions of their livers to loved ones and friends who would have died without a transplant. These procedures have been performed at dozens of hospitals all over the United States.
The need for organs is dire: Nearly 19,000 Americans are waiting for liver transplants, but less than a third will get them. There are simply not enough cadaver livers to go around, and approximately 2,000 people will probably die waiting for organs.
But the death of a Hurewitz highlights the need to take a closer look at the procedure, which involves taking a portion of the liver from one adult and putting it into another. The surgery is also been done in children.
The approach works in livers because unlike other major organs, such as the heart, liver tissue regenerates itself. Within only weeks after donation surgery, both the donor and the recipient grow back complete livers.
A Calculated Risk
While most of these surgeries are successful, it has been estimated that the chances of liver donor death are as high as one percent, so that out of 1,000 transplants there could be 10 deaths. This is a far higher death rate than for live kidney donors.
Hurewitz, who died from complications several days after the donation, was only the second live liver donor known to have died in the United States, along with several in Europe.
Because the donor is always a healthy person and the recipient is gravely ill, the ethical problem is a serious one that raises many questions. How much risk should a healthy person be exposed to for the sake of someone who will almost certainly die, and soon, if that risk is not taken?
And while the donor may be willing to take a chance, should the surgeon participate? The donor, after all, is a healthy person who will benefit emotionally, but not medically, from the surgery.
Calculating the actual risk of death to the healthy donor has been difficult because of numerous medical uncertainties:
Exactly how many of these surgeries have been done? How many deaths have there been, and what other kinds of problems have cropped up? What variables seem to make the most difference in the outcome for the donor? What kinds of staffing, surgical approaches, and post-operative care are most appropriate? And should surgeons and hospitals be required to have a certain level of experience for these kinds of live transplants?
We don't know the answers to these questions partly because, unlike drugs and devices, new surgical techniques are not regulated by the Food and Drug Administration. However, the Health Care Finance Administration, which runs Medicare, could set requirements for transplants from living donors.
In the absence of government regulation, the surgical community should impose a rigorous system of self-reporting of deaths and other adverse events associated with live liver grafts. This would at least provide information that could lead to minimizing the rate of death and other complications.
People will not be discouraged from doing whatever they can to help save the life of someone close to them. Nor should they be. But at least we should reduce the chances that they will pay too high a price for giving the gift of life.
Jonathan D. Moreno, Ph.D. is Director of the Center for Biomedical Ethics at University of Virginia.
To learn more about issues in medical ethics go to: http://www.med.virginia.edu/bioethics/