The surgeon behind the transplant in the US envies liver-availability here, writes Dr Muiris Houston, Medical Correspondent
The amazing story of Gary and Jonathan Egan represents the height of human generosity and brotherly love. We have become used to bone-marrow transplants involving family members, but the idea of permanently giving away half of a vital organ to save another person's life is nothing less than heroic.
"Live" liver transplantation does not take place in this country because we are lucky to have sufficient donations of organs following death, so we do not have a shortage of livers. In fact, we export livers, mainly to Britain and some other European countries. In return, we participate in a trans-national matching scheme, which means recipients do not have to wait as long for a matching liver. There were 63 livers donated in the State in 2002, of which 32 were used for transplantation here and the rest exported.
Dr Lewis Teperman, Director of Transplantation at New York University Medical School, the surgeon who operated on the Egan brothers, was amazed to learn of the ready availability of cadaver livers in the State, when he spoke to The Irish Times this week. "I would dearly like to see an arrangement whereby even 10 of your livers could be made available here," he says.
According to Teperman, the cruel reality for the 2,000 people with end-stage liver failure in the New York area is that, at most, 200 livers will become available each year. So 10 per cent of those waiting will receive a traditional transplant using a cadaver liver. For the rest, their only hope is to receive a "live" donation.
This process starts with the screening of family members to identify the best person to donate a lobe of liver. Blood type is examined, detailed liver function tests are performed to ensure the potential donor's organ is functioning well, and blood is screened for hepatitis and other infections.
Psychometric testing is carried out next to ensure the donor is psychologically prepared for donation. With a one-in-100 chance of dying, the risks to donors are significant. Issues such as the person's marital status and number of dependants are factored into the decision.
Next, a particularly detailed MRI (magnetic resonance imagery) scan is performed. The main aim of this investigation is to establish the blood and bile flow pathways in the liver. Certain anatomical abnormalities - present in 15 to 20 per cent of potential donors - mean that the surgical procedure cannot go ahead.
The two-stage operation requires a total of 16 hours and involves two operating teams in adjacent theatres. It takes seven hours to remove the right lobe of the donor's liver and to prepare it for transplantation. It is possible to live with just 20 per cent of the organ in place. Meanwhile, the recipient is simultaneously operated on to remove his organ before the liver transfer.
Dr Teperman and his team perform about 20 "live" transplants every year. With a total of 72 done to date, they have never lost a donor. And the success rate for the recipient is of the order of 90 per cent - similar to that when a cadaver liver is transplanted.
Will we ever see the "live" donor procedure in this State? Liver experts here think not.
"If a person needs a liver transplant in the Republic of Ireland there is generally no problem providing a cadaver organ," according to one hepatologist. But we need to remain as committed to organ donation as we are at present.
Live liver donation is a complex ethical, legal, and surgical field. One month post-op, and with Gary now out of intensive care, the Egan family have no regrets. They are simply glad to embrace the generous second chance given to Gary.