UCSD Offers Living Donor Option For Liver Transplantation

This is KPBS Midday Edition. I am Maureen Cavanaugh. More than 15,000 Americans are on the waiting list for a liver transplant. Each year nearly 6300 people get a new liver from someone who has donated organs after death. But about 1400 people die waiting for one. Over the last few years another option has emerged, getting a liver from a living donor. As it turns out surgeons can remove half the liver of a healthy person and transplant it into a recipient. It is the only organ that can regenerate. And UC San Diego is the only hospital performing live liver transplants. Earlier today KPBS reporter Kenny Goldberg spoke with UC San Diego. Ashley Ray who received a life transplant last spring, and Keith Garcia who donated part of his liver to Ashley. Ashley let's start with you, prior to your liver transplant what which are condition? I was diagnosed with with ulcerative colitis and a liver disease. Well kind of shape were you in that led you to have to get a transplant in the first place? I was stable for about 11 years. The estimated me to have a transplant at the age of 18. After the age of 18, is still -- slowly started to deteriorate until he needed a transplant. How are you feeling prior to the transplant? I was sleeping for about 15 hours a day. I was very yellow and not eating a lot. Did you hear about the life donor option for the new liver? Dr. Hemming introduce me to the new idea. We heard about it from the pediatric doctor a while back. But Dr. Hemming told us about us in depth when I first visited him. I was that a good alternative for you? Because we would've had to go to Indiana to get a transplant. I would never been able to wait on the list here. He told me would not have survived waiting in the list in middle life donor was a better option. Did you go about finding a live donor? My uncle ordered testing kits off of Amazon. And we had a testing party. How many people were applied testing party? About 16 or 15. It was actually a party. This is the first time I've ever heard this. So you got to Lance people and test their blood? Yes. Yes we did. And what did lead you to that? Well against take blood. In forget to give everybody the pizza. Keith what prompted you to step forward for Ashley and donate your liver? It wasn't just me. It was my wife and Ashley's mother and her stepfather. We didn't want to see her suffer. We wanted to see her survive so we all stepped up to the line. It was a matter of who was imagine who was healthy enough to go through the process. How daunting was the prospect for you of going through the surgery? I'm sure wasn't a walk in the park for you. The testing was more of an issue than anything else because it lasted so long as far as days, the number of test and waiting. As far as the surgery call I really had to do was show up. There wasn't a lot of hoopla around that. Showed up, counted backwards from three, and woke up. Dr. Hemming went of life -- live liver transplants become available? That started in the early 1990s. In this country, didn't really take off. It started to be more in use in the late 90s and early 2000's. But there were issues with North America with donor to. In Asia, where there are very few can of air donor Scott it is predominantly the large way of doing liver transplants. It has been around since 2000. In San Diego there were a couple done in about 2004. That it really wasn't done again until we start of the program here about a year and a half ago. It is an option for patients now. With some of the challenges with doing a live liver transplant? Back from the technical side, when you are putting in half of the liver, all of this vessels are shorter cost smaller, and there is less room for a. That is on the implanting side. The surgery on the donor is also technically demanding in terms of being very precise. Normally when we do a liver resection and take half of the liver outcome we are taking it out for cancer and it goes away. It goes to pathology. When we are doing a live donor transplant how we have to come right down the middle of the liver and have two pieces of liver that work well. Who can donate part of their liver to someone else? It does not have to be a relative. It does have to be someone you know or have some connection to although there are such a thing as altruistic donors who donate to just about anybody. You have to be a compatible blood type but not the same. You have to have -- our current cutoff for ages under 60 years old. You have to be in very good health and have no underlying health conditions. What we stress completely is the safety of the donor. There are risks to this operation and we want to minimize them as much is possible. What are the risks to the donor? What are some of the risks the recipient? Back risk to the donor is the rate of mortality to the donor, which is the risk of death, is one of 250. It does not matter how many transplants the centrist on. -- The center has done. Complication rate is also about 25%. The distally to mortality but does put on the course of the care, postoperative care. It is no small undertaking. On the recipient side it is very similar to standard for transplantation. Keith how his recovery going for you? It is gone unbelievably smooth. This Tuesday ran my fastest 3.5 miles. I am back to jujitsu. I have zero issues. Ashley, talk about your recovery. At first it was very difficult because I was so sick prior to the transplant. It was hard to recover and I had to recover a lot of muscle mass back. I relied so much on the help of others when I was sick. Learning to do everything again on my own was very hard for me. Other than that it is gone very well. I am back at school. I am working. I couldn't be happier. That is amazing. How is your health now? It is actually really good. No major complications. My health and my personal life are both in a good place at the same time. And that is the first time that his ever happened for me. What kind of medication do you have to take and how long we have to take it? I will be an antirejection medications for the rest of my life to prevent my liver from being rejected by my immune system. Dr. Hemming is persistent on keeping me on immunosuppression so I don't rejected. I will be on vitamins because I have a lot of vitamin deficiency when I was sick as well as my colitis medication. Key to giving any ongoing therapies medication? No. At this point I just have to pop and want to your and say hello. Ready much we see about every six months. And after six months, one year. And many year later. Dr. Hemming, these transplants are not that common in the United States as I understand it. Why not? Again that is partly use -- to do with the donors and the risk. If we had enough donors go around, we would not put anyone at risk. It's about one in 10 nationally that die waiting for a liver transplant. California is about one in five because of lack of access to organs and the mismatch of organs to recipients. Really, it is related to the technical problems in the risks to the donor. If someone wants to have a life -- live liver transplant as opposed to waiting how do they bypassed the waiting list? Patients don't actually bypass the waiting list. For a living donor transplant they have to go through all the same processes. They do have to get listed in put on the Whately -- waiting list before we work up the life donor. At that point there is not of the situate, once the living donors were not kind you can go ahead with the transplant. That cuts off the risk of mortality while reading for a liver and the poor quality of life while on the waiting list. Dr. Hemming there are still not enough the first go around. What are some of the possible long-term futuristic solutions you foresee to this problem? The first thing I see about this is one of the first things that live donation brings, if everybody would agree to donate when they die a lot of the organ shortage go away. Please sign your donor card. Other things more futuristic things that we are working on right now are Zeno transplantation where we take animal organ and modify them to be able to put into humans without major rejection or develop new drugs to avoid what is called Zeno rejection. The others in your thing we were trying to work on and develop 3-D printing of liver tissue. We are Ewing that a UST. Where we can -- UCSD. We are doing that with livers that might in the future might be able to put in. That would be a great way to do it. We could take stem cells from our recipients and make them differentiate into liver cells grow them into a new liver and avoid the issues of rejection. That is obviously a huge way away. But if I had livers in the fridge I could just pull out I would be a very busy person. That is fascinating. Enqueue for coming in. I would like to thank Ashley Ray, thank you and Keith Garcia we appreciate you coming in. I'm Kenny Goldberg thanks very much.