From the graph in Figure 2, we can deduce that there is an overall increase in the cause of death only by liver disease. The amount of death from liver disease in 1991 has doubled in 2007.
The transplant
A liver transplant involves replacing a diseased or damaged liver from the body by a healthy one. Liver transplants have been available under the NHS since 1983. There are three types of liver transplant:
Living donor liver transplant: a section of a live donor’s liver is removed and is used for transplant. Both the transplanted section and the remaining section of the donor’s liver can re-grow into a normal size liver as a result of the organ’s dexterity to regenerate.
Cadaver-organ donation: recent dead person’s liver is removed and is used for transplant.
Split donation: recent dead person’s liver is removed and then divided into two sections - one small and large piece. The smaller piece is transplanted into a child and the larger piece of liver is transplanted into an adult.
Figure 3 shows in an animated version the section of donor liver to be transplanted and the donor section transplanted to recipient [4]
Procedure of the transplant
Considering the particular type of transplant chosen, the liver is taken out accordingly: removed from the dead or during alive. The transplant procedure must be carried out within 12 to 18 hours due to the period for which a liver can be safely preserved.
The patient will be under general anaesthetic, which will keep them asleep during surgery. An upright Y-shaped incision is made on the rib cage. A nasogastric tube that drains the fluids from the stomach is inserted via the nasal cavity until the bowel function returns to normal. A tube attached to a ventilator will aid patient’s breathing by expanding their lungs automatically. This tube is positioned in the trachea by means of the patient’s mouth. A special plastic called ‘Jackson-Pratt drains’ drain blood and fluid surrounding the liver just by the incision.
Figure 4 shows the incision made [5]
Figure 5 shows the entities given to recipient and entities remained with donor, for transplant [6]
The actual transplant operation which involves the replacing the liver is carried out in three stages:
- The diseased liver is cut away from the structures and blood vessels that hold it in place in the abdomen. This part of the operation may be very difficult and may result in a lot of bleeding.
- The new healthy liver is then put in place. The 4 major blood vessels - the suprahepatic vena cava, infrahepatic vena cava, portal vein, and hepatic artery - are connected to the liver and blood flow is restored. The surgeon checks carefully to see if there is major bleeding and makes sure that the liver is getting an adequate supply of blood.
- The final connection is made to the bile duct. This small tube carries bile made in the liver to the intestines. Once the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery. [7]
The graph in Figure 6 indicates that the success rates have increased by 30% within the 13 years, starting from 1985 and to 1998. This notes the significance of liver transplant as a treatment for curing liver disease.
Figure 6 is a graph showing the success rates of liver transplants [8]
Benefits and risks to humans, other organisms and the environment
What are the benefits of a liver transplant?
Subsequent to your recovery which should be roughly about 6 to 8 weeks, a successful liver transplant enables you to return to a normal life. You are permitted to resume all modes of occupation. In addition, your confidence can be boosted as you are now regarded as normal.
What are the risks of a liver transplant?
One major problem is that the liver may not grow enough and thus liver failure. Other numerous complications can occur instantly after the liver transplant operation is complete:
- excessive bleeding between the donor liver and the blood vessels it is connected to
- infections in the abdomen region by a severe leakage from the bile ducts that surround the donor liver connection
- prohibition the liver via blood clot in the hepatic artery that passes through the liver
- immune system is deteriorated; more vulnerable to infections
- short-term kidney damage
Are there any alternative treatments for liver disease?
Due to the wide range of source of liver disease, the treatment required is significantly concluded by this, in addition to the extent of the damage done.
One example is liver resection; an operation which is able to cure a liver cancer (Hepatocellular Cancer, HCC) requires removal of a fraction of the normal liver. As a result of the liver’s exclusive ability to regenerate, the remaining liver can grow back to the original size within one to two weeks. Nevertheless, it is restricted to patients with tumours involving only less than 3cm as well as patients excluding cirrhosis.
Once the liver has suffered extensive damage, only liver transplant stands as a cure. On the other hand, several treatments are available in order to alleviate the impact of the symptoms: ‘lactulose’ for hepatic encephalopathy, ‘diuretics’ for portal hypertension and ‘regular drains’ for ascites. Additionally, changes to lifestyle such as quitting smoking and alcohol consumption, mild exercise and a healthy balanced diet.
A potential alternative is the recent innovative stem cell research. “The technique involves inserting stem cells into the damaged organ so that it is encouraged to repair itself and create new tissue. According to the researchers, the treatment will allow patients to live long enough for a new organ to found and could even enable the liver to completely heal itself so a transplant is no longer needed.” [9] However, progress is really slow especially from ethical issues, the expense and as it is very new.
Ethical and Economical problems
A liver is collected from a donor whose brain is dead but their heart is still beating. This concept of "Brain Death" is now accepted by the majority of people. However, this view is not universally accepted. For example, Orthodox Jewish beliefs identify death as the end of the heart's function, not the brain. Therefore, the fact that the acceptance of the concept of brain death is essential for retrieving healthy viable organs; it makes it harder to get large numbers of donors.
Nevertheless, there is a solution to this ethical problem. The liver remains viable for up to 60 minutes after the heart stops, allowing transplant to be performed during this period.
Furthermore, equity is a major ethical issue when considering patient allocation on the waiting list. It is becoming an example of exploitation of the weak by the powerful. Livers are becoming more available to influential and important politicians or famous people and alternatively, patients with mental and physical disabilities rarely receive organs despite their need for transplant. The allocation should be based on fairness, justice and equity benefiting the needy rather than discrimination against some patients. The fact that the medication is biased towards superior people is simply because they are capable of affording the surgery.
The cost of liver transplant is very expensive plus the immunosuppressant drugs, averaging to approximately £40000+ for a patient. This discourages people from low income background and forces them to carry out desperate measures to obtain such high amount of money. In addition, it intensifies the ethical issue since the famous people are able to pay off the huge expense.
Bibliography
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The British Liver Trust. Summary of the liver's functions. Retrieved March 21, 2009, from http://www.britishlivertrust.org.uk/home/the-liver/summary-of-the-livers-functions.aspx
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HIV and Hepatitis.com. (2006, May 20-25). Eltrombopag Improves Thrombocytopenia in Patients with Cirrhosis. Retrieved March 21, 2009, from http://www.hivandhepatitis.com/2006icr/ddw/docs/060906_c.html
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The British Liver Trust. Facts about liver disease. Retrieved March 08, 2009, from http://www.britishlivertrust.org.uk/home/media-centre/facts-about-liver-disease.aspx
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WorldMedAssist. Liver Transplant. Retrieved March 08, 2009, from http://www.worldmedassist.com/Liver_Transplant_Cost_India.htm
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California Pacific Medical Center. An Overview of Liver Cancer. Retrieved March 08, 2009, from: http://www.cpmc.org/advanced/liver/patients/topics/LT-livercancer.html
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Opelz, G. (2000, June 01). Newsletters. Retrieved April 14, 2009, from http://www.ctstransplant.org/public/newsletters/2000/gif/2000-2.html?ts=6661635997536856
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Surgery, U. o. Liver Donor Transplant. Retrieved April 12, 2009, from http://www.surgery.usc.edu/divisions/hep/livedonorlivertransplant.html
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Robert Merion, M. (2000, February 17). Liver Transplant. Retrieved April 14, 2009, from http://www.uimc.discoveryhospital.com/main.php?id=882
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Borland, S. (2009, Sept 26). Stem cell therapy ‘could cut liver transplants’. Telegraph.
Evaluating references
The graph in figure 2 was actually obtained from The Government Statistical Service website. This is extremely reliable as the government is less likely to be biased than a business company because it does not operate to make profits. It exists to provide valid data for user purposes. In addition, the government would have hired professional statisticians to ensure the data is valid and reliable.
Furthermore the trend of the graph for liver disease in figure 2 correlates with an increase in the alcohol consumption in the UK. Alcohol consumption is one of the causes of liver disease. An increase in alcohol consumption has been claimed by articles and factsheets from renowned institutions:
- BBC: http://news.bbc.co.uk/1/hi/scotland/highlands_and_islands/6764803.stm
- Telegraph: http://www.telegraph.co.uk/health/3333411/Alcohol-consumption-doubles-since-the-1960s.html
- The Institute of Alcohol Studies: http://www.ias.org.uk/resources/factsheets/drinkinggb.pdf
Information on the functions of the liver was obtained from The British Liver Trust charity. Little is known about the actual reliability of the institution however, the information is very accurate when comparing it with other distinct sources for e.g.:
- University of Illinois Medical Center: http://uimc.discoveryhospital.com/main.php?id=882
- NHS: https://www.cks-nhs.net/patient_information_leaflet/liver_transplant
- Liver Trans plant support: http://www.livertransplantsupport.com/informationonlivertransplants/frequentlyaskedquestionsonliverdisease.asp#whatdoesmyliverdo
- http://www.patient.co.uk/showdoc/27000446/
Due to the nature of the information, invalidity is virtually impossible.
