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Liver transplant oversight urged

Concerned about the increasing number of partial-liver transplants from living donors, some doctors are proposing an external regulator be appointed to certify hospital units to do the surgery.// According to a survey conducted at the Mount Sinai Hospital in New York, which was woefully inadequate post-surgical care, when a 57-year-old man died after donating 50 percent of his liver to his brother.

In their proposal, James Trotter and three colleagues at Denver's University of Colorado said an external regulator should carry out the task of certifying such units. They also urged adoption of uniform medical criteria for picking donors and recipients. The number of living-donor liver transplants, which were first performed in the late 1980s, rose to 500 last year. About 90 percent of livers still come from dead donors. According to doctors, the survival rate of recipients is close to 80 percent for both procedures.

Trotter and his colleagues said more live transplants could shorten waiting lists and offer medical advantages in some cases over the traditional practice of taking transplant livers from people who have just died.

``Living-donor liver transplantation is a remarkably effective lifesaving procedure for selected patients,'' they wrote. But they warned that it may pose a greater risk of bile leaks for some recipients. In an accompanying article, Dr. Owen Surman, a psychiatrist who works with transplant patients at Boston's Massachusetts General Hospital, estimated the death rate for such donors at 1 percent - far higher than for kidney donors. ``It is still not clear exactly how safe it is to donate a large part of one's liver,'' he wrote.


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