At the Lahey, a stunning, rare tragedy
Donor dies in liver transplant attempt
A man who agreed to donate part of his liver to help a sick relative died while undergoing the transplant procedure at Lahey Clinic in Burlington two weeks ago, the hospital said yesterday.
It was only the third death of an adult living liver donor in the United States in the two decades since the first procedure was done, according to two leading transplant surgeons. A total of 4,036 have been performed.
While any surgery carries risks, specialists said the death of a living donor is especially upsetting because they are generally young and healthy and are undergoing an operation they do not need for the benefit of a family member or close friend.
Lahey, which has transplanted more livers from living donors than any other US hospital, declined to identify the donor or release further details of the May 24 fatality, including the condition of the recipient.
“Families have informed the clinic of their desire to grieve privately,’’ Lahey said in a statement.
“Our deepest sympathies are with the families involved,’’ Dr. David Barrett, the clinic’s chief executive, said in an e-mail to employees. “Our thoughts today are also with the surgical team. They are extraordinary caregivers dedicated to healing patients even in the most trying circumstances. While we are saddened by this loss, we must continue our mission to offer life-saving treatment options like this to our patients.’’
Lahey is conducting a review of what went wrong, and the hospital reported the death to the Massachusetts Department of Public Health, which has opened an investigation. Department spokeswoman Julia Hurley said officials could not comment until the review is complete.
Lahey also reported the death to the United Network for Organ Sharing, which oversees organ transplants in the United States and is conducting its own review.
Liver transplants from living donors are commonly done in certain parts of the country, including New England, where the number of ill patients awaiting transplants greatly exceeds the supply of cadaver donors. Doctors usually remove about 60 percent of the donor’s liver and transplant it into the recipient. Within several weeks, the liver in both patients almost completely regenerates.
Hospitals screen donors extensively for several months for physical and psychological health and to make sure they understand the risks and are making the decision without pressure and in an ethical manner.
“The safety of the donor is foremost in everyone’s mind,’’ said Dr. James Markmann, chief of transplant surgery at Massachusetts General Hospital. “It is a very safe operation, but the risk is not zero. If you do enough [of these operations], it will happen. Our thoughts go out to the donor’s family. They did a wonderful thing, and it’s tragic that it ended up this way.’’
Markmann put the risk of death at one or two in 1,000 operations and said the risks to donors are like those for any type of major surgery, including infection, but generally are less because patients are healthy. He said these risks are weighed against the benefits to recipients: 10 to 15 percent of people waiting for a liver donation die each year because of a shortage of cadaver donors. About 1,500 liver transplant candidates died last year across the United States.
Dr. Giuliano Testa, director of liver transplantation at the University of Chicago Medical Center, said there have been just three deaths of adult liver donors, the last in 2002 at Mount Sinai Medical Center in New York. He called the Lahey team one of the most “experienced and most expert’’ in the country.
In the New York case, a 57-year-old man died of an apparent infection after surgery to donate a portion of his liver to his brother. The New York Department of Health fined the hospital $48,000 and cited it for providing poor follow-up care to the donor, leaving his care to overburdened junior staff who did not recognize his deteriorating condition.
Until 2001, the number of liver transplants from living donors in the United States had been growing, reaching a peak of 524 that year. Since then the number has declined, with 219 operations performed last year. Of those, 24 were done at Lahey.
Surgeons said that the Mount Sinai death may have had a chilling effect on living liver donor transplants, but that in 2002 the cadaver liver allocation system was reorganized so that organs went to the sickest patients. This change reduced the need for living donors.
Of the 323 living donor liver transplants done in Massachusetts since 1994, 215 were performed at Lahey. This is the first donor death since the program began in 1999, the hospital said.
Transplant surgeons said they were concerned that the death might unnecessarily discourage potential liver donors.
“This should not stop the movement of doing the right thing for patients,’’ Testa said. “We should take this as a single episode and not a reason to completely destroy the living donor activity in the US.’’
Liz Kowalczyk can be reached at firstname.lastname@example.org.