Question for liver lobe donors

[Donna Luebke]

Where did you donate?
When?
Right or left lobe?
Who was your surgeon?
Was procedure done open approach or laparoscopic?
If laparoscopic--what were you told about risks?
Were you and your recipient enrolled in the A2ALL study? enrolled in any studies?
How are you doing?
How is recipient doing?

Thanks. 

[Donna Luebke]

The reason for my questions: there are no OPTN criteria for live liver donor surgeons who are doing the liver resection via laparoscopic approach.  According to an article out of Northwestern in Chicago, they have been doing the live donor liver resection this way for about 3 years and are using a 'hybrid' approach for the adult-to-adult right sided resection.  NYU/Columbia/Presbyterian and Henry Ford Hospital (in Detroit) have come up on google alert regarding their live liver donor laparoscopic surgery program.     

Reporting on donor outcomes should be divided by open vs. lap procedure.  In the late 90-into early 2000s, the higher rate of kidney donor complications and deaths were associated with the 'learning curve' as surgeons moved from the traditional open nephrectomy to the laparoscopic approach.  In the last 15 years, the kidney donors who died in the perioperative period had the laparoscopic approach.  Knowing this, donors should all the more demand reliable and comprehensive data moving forward for both kidney and liver donors.  Did A2ALL (Adult-to-Adult Live Donor Liver study) separate out complications and death by those who had the open vs. lap approach?  Have not seen this in any articles to date.  What about the liver donors who died in 2010?  Were these open or lap approach?  If lap, what was the surgeon's experience not just with live donors but all types of liver patients?  The literature says the live donor liver lap requires an extremely skilled operator since if bleeding does occur, there is no time to convert to an open.  The bleeding needs controlled within the limited space.  If try to convert, the patient will die.  Since 2 surgeons are required for the live liver donor, does this mean both have to be skilled in open and lap?

Here is the language from the OPTN Standards for Live Kidney and Live Liver Donor Standards (not updated since 2007):

Program Standards
A transplant program must meet certain criteria to be qualified as a designated live donor transplant program to receive organs for transplantation.

Live Donor Kidney Transplant Centers
A live kidney donor transplant center must demonstrate the following:

a) That the center meets the qualifications of a renal transplant center as set forth in UNOS By-Laws Appendix B, Attachment 1, Section XII.; and

In order to perform open donor nephrectomies, a qualifying renal donor surgeon must be on site and must meet the criteria of (i) and/or (ii) below:

(i) Completed an accredited ASTS fellowship with a certificate in kidney, or
(ii) Performed no fewer than 10 open nephrectomies (to include deceased donor nephrectomy, removal of polycystic or diseased kidneys, etc.) as primary surgeon or first assistant within the prior five-year period.
b) If the center wishes to perform laparoscopic donor nephrectomies, a qualifying renal donor surgeon must be on site and must have:

(i) Acted as primary surgeon or first assistant in performing no fewer than 15 laparoscopic nephrectomies within the prior 5-year period.
If the laparoscopic and open nephrectomy expertise resides within different individuals then the program must demonstrate how both individuals will be available to the surgical team. It is recognized that in the case of pediatric living donor transplantation, the live organ donation may occur at a center that is distinct from the approved transplant center.

All surgical procedures identified for the purpose of surgeon qualification must be documented. Documentation should include the date of the surgery, medical records identification and/or UNOS identification number, and the role of the surgeon in the operative procedure.

Live Donor Liver Transplant Programs
A live liver donor transplant center must demonstrate the following:

a) That the center meets the qualifications of a liver transplant center as set forth in UNOS By-Laws B, Section III; and

b) That the center has on site no fewer than two surgeons who qualify as liver transplant surgeons under UNOS By-Laws B, Section III (C)(2)(a) and who have demonstrated experience as the primary surgeon or first assistant in 20 major hepatic resectional surgeries (to include living donor operations, splits, reductions, resections, etc.), seven of which must have been live donor procedures within the prior five-year period. These cases must be documented. Documentation should include the date of the surgery, medical records identification and/or UNOS identification number, and the role of the surgeon in the operative procedure. It is recognized that in the case of pediatric living donor transplantation, the live organ donation may occur at a center that is distinct from the approved transplant center.