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Hospital Halts Liver Transplants After Donor Death

Brother dies days after giving part of organ to brother

WEDNESDAY, Jan. 16, 2002 (HealthDayNews) -- A New York City hospital has suspended live-donor liver transplants after the death this week of a journalist who underwent the procedure to save his dying brother.

Mount Sinai Medical Center, one of the nation's leading live-donor transplant centers, says it is investigating why 57-year-old Mike Hurewitz died Jan. 13, three days after donating much of his liver to his brother, Adam, who is 54. The two men underwent the operation Jan. 10, according to the Albany Times-Union, the newspaper Mike Hurewitz worked for.

Hurewitz, whose brother survived, is the first live liver donor to die at the hospital, and only the second such patient to die in the United States since the live-donor liver procedure became relatively widespread in the late 1990s.

"Until its internal review is complete, Mount Sinai believes the most prudent course is to put a hold on all of its adult-to-adult living donor liver transplants, which represent about 35 cases at this hospital annually," the hospital says in a statement. Living donor transplants to children, those involving kidneys, and all grafts from dead donors aren't affected by the suspension, which the hospital is calling "temporary."

Joan Lebow, a Mount Sinai spokeswoman, says the Hurewitz family asked hospital officials not to discuss the details of his death with the news media. One doctor familiar with the case says Mike Hurewitz had appeared to be making a strong recovery from the operation and had been making phone calls on the day he died.

Mount Sinai doctors, considered the most active live-donor liver surgeons in this country, had performed 158 of the procedures through September 2001, according to the United Network for Organ Sharing (UNOS).

The first successful live-donor transplant in this country occurred in 1989. Since then, doctors have performed approximately 1,400 such transplants in adults and children.

Jon Nelson, director of the office of special programs at the federal Health Resources and Services Administration, which collects information on organ donation, says live-organ donors, of both livers and kidneys, "are clearly the most rapidly increasing part of the donation sector."

Nelson's office is part of the U.S. Department of Health and Human Services, which has aggressively promoted organ donation. Yet the agency has been reluctant to encourage this practice because of its risks to donors. "The department has never really been a vigorous supporter of live donation," Nelson says. However, he says, HHS encourages medical societies whose members perform the operation to create standards that minimize risks to patients.

Experts estimate the risk of death associated with the donation falls between 0.5 percent and 1 percent. But that range, if accurate, would have produced between seven and 14 fatalities, far more than the two reported deaths in this country. Nelson agrees that the death risk numbers appear inflated. Even so, he adds, donors also face nonfatal complications, prolonged hospitalizations, and lost time from work while recovering.

In live-donor liver transplants, doctors graft a large chunk of the organ from a healthy person into a sick patient. Both procedures are performed at approximately the same time. Because the liver regenerates, if all goes well, each person has a full organ within a matter of months.

Live-donor transplants are intended to ease the severe shortage in available organs. But some medical ethicists have complained that the operation exposes a healthy person to substantial risk of death while offering them no benefit -- other than moral, perhaps -- in return. In Latin, they point out, the phrase is Primum Non Nocere: First, do no harm.

More than 18,700 Americans are awaiting liver transplants, according to UNOS. In 2000, surgeons performed 4,954 liver transplants, the group says, while 1,687 people died that year before an organ became available.

UNOS says 378 people, about two-thirds of whom were adults, underwent live-donor liver transplants in 2000. Adult donors accounted for 737 of the 1,400 transplants between 1988 and September 2001.

Dr. Cosme Manzarbeitia, director of the transplant program at the Albert Einstein Medical Center in Philadelphia, says Hurewitz probably died from complications arising from the surgery, not the liver resection itself. "The association may be more incidental," says Manzarbeitia.

In the last few years, Manzarbeitia has participated in about a half-dozen live-donor liver grafts, though not at his hospital, which has yet to perform one. The operations are technically difficult, he says, and they can be "ethically debatable."

However, Manzarbeitia says his hospital intends to offer the surgery and will perform one as soon as they are presented with the "ideal couple." The live-donor transplants have strict requirements for compatible blood types and liver size.

What To Do

For more on live-donor transplants, see Stanford University, which has a large liver program.

To learn more about organ transplants, check out the United Network for Organ Sharing or the U.S. Department of Health and Human Services.

SOURCES: Interviews with Joan Lebow, spokeswoman, Mount Sinai Medical Center, New York City; Cosme Manzarbeitia, M.D., director, transplant program, Albert Einstein Medical Center, Philadelphia; Jon Nelson, director, Office of Special Programs, Health Resources and Services Administration, Washington, D.C.; Anne Paschke, spokeswoman, United Network for Organ Sharing, Richmond, Va.; Mount Sinai Medical Center statement; Jan. 14, 2002, Albany Times-Union
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