Materia Medica Malaysiana

New Straits Times Online :Not ready for such liver transplants

KUALA LUMPUR, July 16: Malaysia is not ready for living unrelated donor liver transplants in adults, especially in terms of possible complications for the donor.


Health deputy director-general Datuk Dr Ismail Merican said this was the consensus of the workshop on clinical practice guidelines on liver transplants held recently in conjunction with the Fifth Liver Update.

The workshop was organised by the Health Ministry and the Malaysia Liver Foundation with the collaboration of the Academy of Medicine of Malaysia, Malaysian Society of Gastroenterology and Hepatology and the Malaysian Society of Transplantations.

Dr Ismail said there was a lot of concern about living unrelated liver donors.

"Although world-renowned liver surgeon Professor Fan Sheung Tat, who had conducted living donor liver transplants, had talked about his experience and techniques used in the surgeries at the recent Fifth Liver Update, there were apprehensions on the repercussions on the living donor," he said in an interview.

Dr Ismail, who is also the president of the Malaysian Liver Foundation, said it was strongly felt that living donor liver transplants, especially if opened to unrelated donors, might lead to room for abuse and commercialisation.

He said there was no problem accepting genetically-related or emotionally-related living donors provided they were vetted by an independent professional committee comprising senior clinicians, psychiatrists and medical social workers.

"For the moment, we will stick to cadaveric organ transplantations," he said, adding that the ministry would soon release the much-awaited Liver Transplantation Guidelines.

The proposed guidelines, in the final stage of drafting, are expected to be submitted to the ministry for approval in two weeks.

"Depending on cadaveric organs alone may not be feasible in view of the acute shortage of such donors despite intensified efforts to get people to donate their organs upon death. That is why there is growing interest in living donor liver transplant to offset this acute shortage." He said the ministry was not against living unrelated liver donor transplants and might allow it, especially in children, because of the shortage of cadaveric donors.

"As for children, it is accepted, provided the liver is donated by those who are genetically or emotionally linked." In adults, he said, living unrelated liver donor was still a new area and needed to be studied further.

"We do not want the donor to die or become sick after donating part of his liver." As for those donating to children, he said, an independent vetting committee comprising, among others, senior surgeons and psychiatrists, would interview the donor and the recipient to evaluate their knowledge of the whole process and the implications of the transplant, its risks and impact.

When the liver transplant guidelines come into force, Dr Ismail said liver surgeons must be present at the hospital for at least 48 hours after surgery.

Only hospitals that meet criteria under the guidelines, which include, among others, having good infrastructure, international credential specialists, pathologists, and hepatologists, will be allowed to conduct transplants.

At present, the Selayang Hospital fulfils all the criteria to function as the National Liver Transplant Centre.

Dr Ismail said anyone qualified to carry out liver transplants could do so at the hospital.

He said the hospital, which has four liver surgeons and five hepatologists, handled acute liver failure and difficult cases.

Selayang Hospital, a tertiary centre for liver diseases, handles some 50 cases a month with two liver transplant patients awaiting implementation of the guidelines.

The proposed guidelines, drafted jointly with the Malaysian Society of Gastroenterology and Hepatology, Academy of Medicine Malaysia and Malaysian Society of Transplantation, will indicate who should go for liver transplantation.

It will also indicate timing of referrals and potential patients for transplants.

As for living liver donors, the guidelines stipulate that this is an effective life-saving procedure for selected patients with end-stage liver disease.

But such operations must have an expert surgical team and appropriate selection of recipient and donor.

Unrelated donors may be allowed provided they are vetted by an independent professional body.