By Dale Rowse
Conner Alvord set a record in February for the state of Utah. He is the youngest person to receive a liver transplant when he was seven weeks old.
Conner received a liver from a deceased donor in California; The donor?s name was not disclosed. The operation, performed at Primary Children?s Medical Center in Salt Lake City, appears to have been successful.
Ben Alvord, Conner?s father, told KSL news Conner is starting to try to talk, and he smiles sometimes.
Last year 161 infants received a liver transplant, said Annie Moore, spokeswoman for the United Network for Organ Sharing. The survival rate for these operations ranged from 88.8 percent chance for 3-month survival to 73.5 percent chance for 5-year survival.
In general, there is an overall shortage of organs for transplants. According to the UNOS Web site, 17 people die every day waiting for an organ. Part of the problem is finding a donor who matches the patient. The other problem is the lack of organs. There are more than 80,000 people on the donation waiting list, and fewer than 14,000 donors annually.
There is good news, however. In 2001, for the first time, living organ donations exceeded the number of deceased donations. Today there are nearly 7,000 living organ donations each year.
?There have been advances in the field of pediatric transplants, like the use of living donors,? Moore said. ?Sometimes the parents will donate a part of their liver. Sometimes, looking at the size of the patient?s body and the size of the donated liver, two transplants can be performed from the same liver.?
The liver has the unique ability to regenerate, making liver transplants one of the easiest and most successful types of transplants.
Debb Andersen, spokeswoman for the University of Nebraska Medical Center, said UNMC has been doing split liver transplants since 1990 and living donor liver transplants since 1994.
?Just like cadaveric [deceased] liver transplants, split and living donor liver transplants have around 90-95 percent survival rate,? Andersen said. ?UNMC is one of the premier transplant centers in the nation, if not the world, so some of the things we?ve been doing for a long time other centers are just starting to do.?
Moore said UNMC performed 13 of the 161 liver transplants on patients less than 1 year old last year. The transplant process is complicated she said. First a patient must be recommended by a doctor or treatment center to get on the waiting list, which UNOS maintains.
Then, the patient?s characteristics ? age, blood type, illnesses, etc. ? are compared with the characteristics of available live and deceased donors in the region. Deceased donors? information is kept in the UNOS computer system for real time comparison, making urgent need transplants more likely to occur.
From there a formula comes into play to determine priority on the list.
Patients classified as ?stage one? have a 7-day-or-less survival expectancy, unless they receive a liver transplant.
UNOS has developed a new system for prioritizing all other patients on the liver transplant waiting list.
The model for end-stage liver disease scores adult patients? priority based on the liver?s ability to excrete bile, the liver?s ability to produce blood clotting elements and kidney function.
The pediatric end stage liver disease model is used for patients 18-years-old or younger. In addition to bile and blood clotting functions, PELD scores take into account the liver?s ability to maintain nutrition and grow and the patient?s age.
In February 2002, the MELD/PELD formula replaced older methods of prioritizing patient?s needs. Older methods were more subjective, involving different symptoms of liver disease and failure. Each doctor used different factors and gave them different importance in determining patient?s needs.
The new system, explained in detail on unos.org, uses actual liver functions as a main determining factor of patient need and priority.
Higher scores indicate a greater need and higher priority on the waiting list. With the new system, time on the waiting list is used much less than before in determining who receives an organ. There are fewer patients with the same score under the MELD/PELD system because it is more specific and less subjective than the old system.
