Fla. — Patients with liver cancer can be cured with a liver
transplant. But because of the shortage of donated organs,
these patients often die waiting for a liver. That’s because
most transplant centers predominantly use livers from donors
who die from brain death.
the largest study of its kind, transplant physicians at Mayo
Clinic in Florida have found that liver cancer patients have
the same beneficial outcomes using organs donated by patients
who died of cardiac death. The study was recently published
online in the American Journal of Transplantation.
program has one of the largest experiences in the world with
liver transplants using donations after cardiac death,"
says the study’s lead investigator, transplant surgeon
Kristopher P. Croome, M.D. "We now know that these organs
effectively offer new life for patients with liver
believe this study firmly and finally answers the question as
to whether liver donations after cardiac death are as viable
for patients with liver cancer as livers from donors who die
from brain death," he says. "They are."
organs after cardiac death for liver transplants could
increase the number of transplants performed by 10 percent to
15 percent nationwide, Dr. Croome says. "One reason why
the wait time for liver transplant is short at Mayo Clinic in
Florida is that we efficiently and successfully use both types
of donated livers. But nationwide, over the last decade, the
transplant list and the number of liver cancer patients are
studies, including both human and animal, have suggested that
donations after cardiac death have inferior results in
patients with liver cancer because the liver has suffered some
damage due to loss of oxygen during organ recovery.
purposes of transplantations, a person who dies from a heart
attack is not considered for donation. Instead, cardiac death
is controlled in a patient who will donate organs. "This
can occur, for example, in a patient who has had a bad brain
injury and will not recover. In this controlled setting, with
the purpose of donating organs, a patient is taken off life
support, and will pass into death. Then after a short time
period, the organs will be recovered and donated," says
ischemia — lack of oxygen — will occur in the organs
during this procedure. The concern has been that these livers
may not be healthy enough to fight off development of new
cancer," he says. "There may be circulating tumor
cells in a patient whose cancerous liver is removed at the
time of transplant, so the question had been whether these
livers donated from cardiac death donors are as healthy and
resilient as those obtained after brain death."
after brain death occur in patients with absence of brain
activity, but whose heart and other organs are still active.
Due to absence of brain activity, which is an irreversible
condition, these patients are considered legally dead.
2003 and 2012, the team from the Department of Transplantation
at Mayo Clinic in Florida transplanted 1,633 livers using
donor brain death organs and 241 livers obtained from donors
after cardiac death.
study, the investigators identified 397 liver cancer patients
who received a new liver — 340 patients who received a liver
after brain death and 57 patients whose organ was donated
after cardiac death. They found no difference in liver cancer
recurrence between the two groups — liver cancer recurred in
about 12 percent of patients in both groups.
gap between patients who need a new liver and the number of
organs available has been widening, but the use of donations
after cardiac death could potentially alleviate some of the
organ shortage," Dr. Croome says.
Clinic is a nonprofit organization committed to medical
research and education, and providing expert care to everyone
who needs healing. For more information, visit mayoclinic.com