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University Transplant Center will relocate when the new 1 million-square-foot tower at University Hospital is completed next year. The entrance to University Transplant Center at University Hospital Patient photos line the walls of University Transplant Center. LIVI N G LIVER DO N O RS C AN O FFER A LI FELI N E TO TR AN SPL ANT C AN DI DATES WITH THE DEMAND for liver transplants climbing and the supply from deceased donors PHOTOS COURTESY OF UNIVERSITY HEALTH SYSTEM flat, University Transplant Center is one of only two programs in Texas that offers another option — a living donor program — for patients with advanced liver disease and in need of transplantation. Because the liver will regenerate after being split, living donors can donate just a portion of their livers, and the organ will regrow in both the donor and the recipient. "A healthy liver is like the skin," says Kenneth Washburn, M.D., Director of the Liver Transplant Program at University Hospital and a professor of surgery at the University of Texas Health Science Center. "It will grow back within a period of a few weeks to a month or two at the most." Living donors are often related to the recipient. If a donor is a caregiver, such as a spouse, the matter can be complicated by the need for support at home as the donor and recipient recover. Recovery after hospital discharge can take six to 10 weeks. Dr. Washburn also proceeds cautiously in another matter. "The primary challenge is the safety of the donor," he says. "That's the paramount issue we face in any living-donor procedure. You're taking a healthy person and subjecting them to an invasive procedure. The risk is justified in everybody else that we operate on, because you're trying to help them, but a living donor is a healthy person with no inherent medical problems." For this reason, the University Transplant Center team thoroughly considers multiple factors before concluding that living liver donation is the appropriate decision. "They go through an intensive evaluation process to define if there are underlying medical problems that may preclude that they're an acceptable donor," Dr. Washburn says. "They undergo extensive medical testing. They also go through social evaluation to see if it's appropriate in our eyes for them to go through a donation." Yet for many of those on transplant waiting lists, a living donor is a lifesaver. "Living donation is an option for some patients," Dr. Washburn concludes, "and it often allows patients to get transplanted at an earlier stage in their disease process before they get critically ill." was so supportive to start with and has been for the last 20 years," Dr. Halff says. In 1992, only four liver transplant programs existed in Texas. Now, there are 14. At the same time, the number of donors nationally has remained flat — and actually declined a bit in south Texas — as safer cars and highways, advanced trauma systems, and other factors have narrowed the pool of eligible donor candidates. That's meant far fewer donor organs for each program. And while large academic transplant programs such as University Transplant Center have traditionally focused on innovation and pushing the envelope — accepting patients and donors Glenn Halff, M.D., Director of University Transplant Center and professor of surgery at The University of Texas Health Science Center San Antonio Kenneth Washburn, M.D., Surgical Director of the Liver Transplant Program at University Hospital and professor of surgery at The University of Texas Health Science Center San Antonio that other programs turn away — stricter federal regulations and changes in reimbursement have forced all programs to become more selective about the patients they transplant. Dr. Washburn chaired a national committee of the United Network for Organ Sharing — the national governing body MDNEWS.COM I MD NEWS San Antonio |7