WATCH ABOVE: Ottawa Senators owner Eugene Melnyk has had a huge response to his plea for a live donor. Dr. Samir Gupta discusses the health issues which can lead to needing a liver transplant, and the ethical aspects of the millionaire’s public plea.
A lot of people are talking about Ottawa Senators owner Eugene Melnyk’s plea for a live donor to come forth for a liver transplant, and we’ve heard that he has been admitted to hospital now and is need of an urgent liver transplant. There are several issues here worth discussing.
Firstly, people are wondering about what condition he is in. Clearly, if he’s admitted, he’s at a stage where his liver is failing rapidly. And unlike for the kidneys, where we can replace their functions with a dialysis machine, we don’t have a machine that effectively replaces the liver’s functions.
The liver performs a number of important tasks in the body: it produces proteins; it clears the bilirubin that our body produces (which is why people appear yellow when bilirubin accumulates due to liver disease — which we call jaundice) and it has a host of other metabolic functions.
Patients who don’t have functioning livers will be fatigued, develop fluid retention and swelling, including fluid in the abdomen called ascites, and can have major bleeding from the stomach and esophagus from dilated veins called varices.
People are also wondering how the live donor process works. Basically, there’s really only one cure for end-stage liver disease, and that’s liver transplantation.
According to the Canadian Institute for Health Information, about 400 liver transplants take place in Canada every year, but about 400 people are waiting for a liver at any one time. About 45 people die each year while waiting. This organ shortage is what gave rise to the idea of live donation.
The first live donation was performed in a child in 1988, but since then, this has been shown to be safe and effective in adults too. About 20-25 per cent of liver transplants done in Canada are now from live donors. Basically, the right lobe of the liver is removed from the donor and given to the recipient (that’s the larger lobe, which usually accounts for about 60 per cent of the liver), and remarkably, the liver grows back fully in both the donor and the recipient within a few months.
Donors are matched based on their blood type, the size of their liver, and their general health. Data from the United Network for Organ Sharing in the US suggests that survival is similar after usual deceased-donor liver transplant and living-donor liver transplant. Recipient survival is estimated at about 82 per cent one year after transplant, and 65 per cent five years after transplant.
Finally, we’ve heard some criticism about the fact that Eugene Melnyk is a wealthy and powerful man, and may be using this to “jump the queue.” In my view, Eugene Melnyk has a platform, and he’s using that platform to try to save his life. The way that transplant priority is assigned is very black and white — there is a point system (called the Model for End-Stage Liver Disease – MELD system), whereby the worse your liver disease, and the higher your chance of dying, the more points you get, and the higher you are on the list — for a deceased donor.
The challenge is that even with a relatively high score, people can end up waiting a long time. If we look at U.S. data, the median wait time for someone Melnyk’s age was over a year, and he may not have that long to wait. So he’s reaching out to his community.
One cannot pay for an organ in this country, so he’s asking someone to perform an act of altruism. In fact, many patients reach out to their ethnic and religious communities for a transplant, and there have been successful social media campaigns for individual organ donations as well. To my mind, this is no different except possibly on a larger scale. And as to whether he’s jumping the line, I would say that rather than taking a liver from the next person down the list from him, he’s adding a liver to the system by finding a donor who would not otherwise have donated. Accordingly, in a way, he’s helping the next person down the list by not putting his name on that deceased donor waiting list.
Top 5 diseases that affect the liver
- Viral hepatitis
Hepatitis B and C are among the most common worldwide causes of liver scarring, or cirrhosis, and this is a particular issue in Canada because many people contracted Hep C through tainted blood in the ’80s. - Alcoholic liver disease
Alcohol is a major toxin for the liver, heavy drinking over a short period can cause acute inflammation of the liver, and over a long period can lead to cirrhosis. - Nonalcoholic fatty liver disease
This is a type of liver disease that results from accumulation of fat in the liver, and is linked to obesity and diabetes. As these diseases become more common, we are seeing more and more of this type of liver disease. - Hepatocellular carcinoma (HCC)
This is liver cancer, and any patient with cirrhosis is at a higher risk of this. If it’s caught early enough, the cancer can be cured through liver transplant. - Acute liver failure
Although chronic liver failure is more common, several toxins can make the liver fail acutely (suddenly), including overdoses of Tylenol and other medications, certain herbal supplements, and even certain rare mushrooms.
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