UPMC To Promote Living Donor Liver Transplants

May 3, 2018

There are 14,000 people in the United States waiting for a liver transplant. And if the country's medical centers continue to draw the vast majority of viable livers from deceased donors, only half of those waiting will receive a transplant. Fifteen to twenty-five percent of those waiting never will.

The University of Pittsburgh Medical Center hopes to change that through Living Donor Liver Transplants (LDLTs), which the hospital says are underpromoted and underutilized across the world. 

The waiting list for liver transplants in the U.S. far outpaces the number of livers available. 95 percent of transplanted livers come from deceased individuals while only a small fraction come from living donors.
Credit UPMC

Currently, liver transplants from living donors constitute just 25 percent of the total livers donated, but UPMC is performing more transplantations of this type than ever before: over 300 since 2015 and more than any other medical center in the country, according to Dr. Abhi Humar, clinical director of the Starzl Transplant Institute. Last year, donations from living individuals at UPMC surpassed those of deceased donors.

That's because Living Donor Liver Transplants can happen quicker than the alternative, and they often go to patients who are less sick, increasing the recipient's survival rate up to 15 percent. 

"We can transplant these individuals before they're critically ill, before they're literally at death's door," Humar said. "Every individual that we transplant with a live donor, that's one individual that doesn't need a liver from the entire pool and that frees up a liver for someone who doesn't have a living donor. It benefits two patients, not just one, every time we do another transplant."

Transplants from living donors are possible in much the same way that kidney donations are done. Although humans have only one liver, it regenerates. So a donor who gives part of his or her liver and the person who receives it can both expect the livers to regrow to their normal sizes in just a few months.

"The liver has a lot of extra capacity built in. If you're a healthy person with a healthy liver, you actually only need about 25 percent of your liver to do everything the liver does," Humar explained to press at a UPMC Montefiore briefing. "The rest is just there for a rainy day, so to speak."

And liver donations can be performed without a blood type match, although it is preferred. 

Liver donations carry much more risk than kidney donations, said Dr. Humar, but UPMC has never experienced a donor fatality. Recovery time is usually a few weeks for the donor and a few months for the recipient. 

The one-year survival rate for liver transplant recipients is up to 93 percent. The 5-year survival rate is greater than 75 percent. 

Cranberry Township resident Erica Bednarowicz, 27, donated her liver to her father Frank Drew, 58, last year. Drew was diagnosed with liver disease in 2005, after developing back pain, he said during the press briefing. In 2015, he was told he would need a transplant and placed on the waitlist. 

"My daughter stepped up to the plate. She donated part of her liver and saved my life," Drew explained.

Erica Bednarowicz donated a portion of her liver to her father Frank Drew in October 2017.
Credit Courtesy of Erica Bednarowicz

Bednarowicz recalled that she immediately knew she should be the donor, and was confirmed as a match.

"It's the least I can do for somebody who has done everything for me. I show people my scar. It's my badge of honor," she said.

In October 2017, UPMC doctors successfully completed the transplant. Bednarowicz, a nurse in Shadyside, resumed light-duty work in a few weeks. An avid runner, she began her normal exercise routine again in five months. Drew went back to work in January as the head of a narcotics taskforce in Lawrence County.

The main barriers, Humar said, are awareness and patient hesitancy. There are a few misnomers about Living Donor Liver Transplants, like that they only go to children or that they're a last resort. But Humar explained that LDLTs actually make the system more efficient for extremely sick patients.

Most liver transplant patients receive their new livers from an acquaintance, like a family member or friend. And Humar said sometimes patients experience hesitancy to ask such a big favor from their loved ones. 

"Think of yourself in that situation: How difficult is it going to be for you to try to ask someone to be a donor to save your life?" Humar said. "That's a difficult ask."

"It's an intrusion," Drew added. "But I realized I had to do it because if not, I wasn't going to be here."

So UPMC is upping its educational efforts, creating a Champion Program that assigns a third-party mediator-- for example, the patient's spouse-- to facilitate the conversation between the recipient and a possible donor.

"Who can be their champion? Who can be the person who goes out and [asks a possible donor] to consider this as an option?" Humar asked. 

And Humar said there is a small pool of people who "come in off the street," who wish to donate part of their liver to a stranger. UPMC maintains a registration database of these prospective donors, although Dr. Humar noted it's much smaller than those a hospital might maintain for blood, bone marrow, or kidney donations. 

Overall, Humar hopes that the program will eliminate the liver waitlist. 

Dr. Thomas Starzl performed Pittsburgh's first-ever liver transplant in 1981 and established the UPMC program. Since then, the Transplant Institute has performed thousands of procedures. In 2018, UPMC is also launching the Immune Transplant and Therapy Center, which aims to reduce immunosuppressants as an anti-rejection tool. 

Liver transplantation is a viable option for patients with liver disease or failure caused by Hepatitis B and C, alcohol abuse, fatty liver, bile duct issues, some genetic conditions, and some cancers, according to the Mayo Clinic

90.5 WESA receives funding from UPMC.

For the first time, Living Donor Liver Transplants at UPMC have surpassed those from deceased donors.
Credit UPMC