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Between Friends: Living Donors

It's a trend that's changing transplant medicine. More and more people are willing to donate a kidney or part of a liver - while they're still alive.

By Bob Calandra
WebMD Feature

Reviewed By Michael Smith

Steven's voice filled with emotion when he talked about his long road to surgery. When he got to the part where his friend Michael offered him half of his liver, that's where he had to pause and collect himself.

"Having someone give you your life back -- it's hard to just say you're grateful," says Steven. "Gratitude doesn't do it. I don't know what the right word is."

The two men became friends over 20 years ago when Michael worked at a company managed by Steven. A few years later, Michael left his job and moved away. They stayed in touch, talking on the telephone a couple of times a year.

It was during one of those conversations that Michael learned that Steven had terminal liver disease brought on by hepatitis and needed a transplant. Steven was depressed because doctors had just disqualified a high school friend who had volunteered to be a donor.

"Right there in the middle of that conversation, I knew without a doubt what I was going to do," Michael recalled months later. "Something just came over me. It just felt right. I know it sounds strange, but that is just the way it was."

Without a word to Steven, Michael had his blood type tested and discovered that he matched his friend. "I called and asked if he'd like to have half of my liver," Michael says. "He said, 'You're crazy.' But I told him I wanted to do it."

The Rise in Living Donors

Just over a decade ago, this gift of life between two close friends would have been impossible. Partial organ transplants between adults were unheard of: People's immune systems typically rejected organs from nonrelatives, and doctors, for the most part, considered such operations not only risky but unethical. But today, Michael could be the poster boy for a trend that's changing the course of transplant medicine in the United States. There are more living donors today than deceased ones. And many of the living donors are unrelated to the patient in need; sometimes they don't even know them.

"Illustrating the altruistic nature of family, friends and even strangers, living donation rates have steadily increased. This increase has helped bring awareness to the critical shortage of organs." says Annie Moore, spokesperson for the United Network for Organ Sharing (UNOS), the nation's organ clearinghouse that matches donors to recipients. Consider the numbers: There were 6,618 live donors in 2002, a 230% increase over 1989, according to UNOS. By comparison, there were 6187 deceased donors, people who have died, often in the prime of life in an accident. Living kidney donors now account for nearly 52% of all kidney donors and the number of living donor liver transplants has doubled since 1999, according to UNOS.

Clearly attitudes are changing. A survey in 2000 by the National Kidney Foundation showed that 90% of Americans say they would consider donating a kidney to a family member while alive. That same survey reported that one in four Americans would consider donating a kidney to a stranger. Indeed, UNOS reports that living donors unrelated to the patients increased tenfold between 1992 and 2001.

Battling "The List"

Science can take some credit for this shift. New surgical techniques let doctors remove a kidney through small incisions that leave little scars and are easier to recover from. New anti-rejection drugs let patients receive organs that aren't close genetic matches.

But there has also been a shift in medical thinking. While anti-rejection drugs have been available since the 1980s, until several years ago doctors routinely rejected donors who weren't immediate family members. Placing a healthy donor at any risk from surgery -- no matter how small -- violated the physician's obligation to "first, do no harm," they argued.

So what has changed? It can be summed up in two words -- The List. As medical technology keeps people alive longer and improved transplant techniques offer new hope, the number of people on the waiting list for organs has swelled. Today, more than 83,000 people are waiting -- and hoping -- for an organ, compared to 60,000 six years ago.

"Living donors are a desperate move to compensate for the lack of organs," says Amadeo Marcos, MD, clinical director of transplantation at the Starzl Transplantation Institute and professor of surgery at the University of Pittsburgh School of Medicine. He was one of the first doctors to transplant a partial liver from one adult into another.


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