A single-centre study on the long-term effects of donating a right lobe for transplant shows donors can experience physical and psychological complications years after the operation.
Almost half of the 83 liver donors surveyed had complaints ranging from pain and digestive problems to depression three or more years after surgery. But nearly all said they'd donate again, according to the study published this month in Annals of Surgery.
"There is a risk for some long-term complaints, which may be potentially controllable by workup modifications, improvements in surgical techniques and a thorough follow-up of donors at the transplant centres," lead author Dr Georgios Sotiropoulos at University Hospital Essen in Germany told Reuters Health in an email.
Prospective donors should be thoroughly informed of possible long-term effects of donation, Dr. Sotiropoulos' team wrote in their report, and many of the donors surveyed suggested a central registry of living donors to track how they fared over time.
The average age of donors in the German study was 36 and the average interval since donation six years.
31% of donors complained of diarrhoea or an intolerance to fatty foods. About 10% complained of gastroesophageal reflux and a small number had discomfort at the incision site or in the ribs. Three donors reported bouts of severe depression – two of them requiring hospitalisation – and one patient had worsening of pre-existing psoriasis.
Of the 83 donors surveyed, 39 reported no lingering symptoms or problems.
Turned down by insurance
Three young and otherwise healthy men, however, said they had been turned down for life insurance because there's so little data available on the long-term effects of living liver donation.
Dr Jean Emond, director of transplantation at New York Presbyterian/Columbia Hospital, said the findings are consistent with past research.
"I think the conclusions are cautious and reasonable," said Dr Emond. "We need to keep a close eye on these people."
Dr, Emond told Reuters Health that his team tries to bring donors back for checkups once a year.
"A lot of them don't want to come back because they feel good, because it's too much trouble, or their recipient died and they don't want to be reminded of the bad memories," said Dr Emond. The other thing is if they live far away it could be hard to do.
"In our centre we have a psychiatrist... to try and understand the makeup that may be exacerbated under the stress of donation," said Dr Emond.
About 4,500 liver donations have been made in the US by living donors since the first surgery in 1989, according to the national transplant database.
Dr Emond, who assisted with the first live-donor liver surgery, said the procedure slowly grew in the US until 2001. The following year an infection killed a donor at Mount Sinai Medical Centre in New York. According to Dr Emond, the high-profile case led to more stringent regulations for the procedure.
Last year two donors died after the operation, one in Massachusetts and another in Colorado.
"This year was a tough year," said Emond. "Unlike the first two deaths that happened in the U.S., these two deaths happened in centres that have superb safety programs in place. It really shook everybody in the community that's doing it." But he adds that doctors cannot expect everyone to survive the risky surgery.
"The ethical standard has to be that you do it because it's the right thing to do for the patient with full and informed consent," said Dr Emond.
(Reuters Health, November 2011)