Depressing trends in liver transplants look set to continue

The length of time a patient in liver failure has to spend on the transplant waiting list is rising, and their chances of being among the chosen are diminishing. Almost one in five of those waiting for a liver never get one and die, just as 103 people did last year. Mortality from liver disease among men in the UK has gone up seven-fold since the 1970s. At the moment, 380 Britons, of whom 21 are under 18, are on the list.

Those lucky enough to be offered a new liver face an operation that can last up to eight hours. Last year, 701 patients had the procedure at liver transplantation centres around the UK, such as King's College Hospital in London and the Edinburgh Royal Infirmary (ERI), where Frank Deasy was treated. Each of those operations is a life-saver. While a patient with kidney failure can survive on dialysis for years, no such alternative is available for liver patients.

"It's a big operation – huge. When I describe it to patients beforehand I tell them that the surgeon is going to remove the biggest solid organ in their body, which usually weighs between one and one and a half kilos, put in a new one and make all the important connections between the veins and arteries," explains Dr Ken Simpson, a liver specialist at the ERI.

Three surgeons usually participate, reflecting the complexity of the task. However, complications are unusual. "It's very uncommon not to have someone survive the surgery," Simpson adds. Plus the risk of the body rejecting the new organ, a danger in most transplantation, is low.

The ERI's liver transplantation unit tells a national story. "At the beginning of 2000 there were five or six people on our waiting list at any one time, but a year ago it was 35," says Simpson. "Today it's 17 and usually it's between 20 and 30, so that's a five-fold increase in nine years." Why such a jump? More alcohol-related problems, more cases of fatty liver disease due to rising obesity and a growing number of cases of viral hepatitis, such as hepatitis B and C. The ERI's surgeons carry out about 60 liver transplants a year, but another 15 patients die because they do not receive an organ.

There are exciting developments in this area of medicine. In the past few years advances in surgery have meant that donated adult livers can be split between two patients. Typically, about 30-40% of one will go to a child and the rest to an adult. Both parts of such a liver grow to full-size within a month. But only livers that are large and healthy can save two lives in this way.

"There's a significant shortage of all organs," says Simpson. "The government has put a lot of resources into tackling the problem, but we still have a low rate of donation. As a consequence, the need is rising faster than the availability of organs. These depressing trends look set to continue for the foreseeable future."