Phoenix Area Brothers Survive First Arizona Live Liver Transplant

Monday, April 02, 2001

PHOENIX, Ariz. — A 30-year-old Glendale man is alive, walking and planning his future, all because his 24-year-old brother gave him part of his liver in a medical first in Arizona. Contrary to how traditional liver transplants are done, both the donor and the recipient are alive to talk about it.

The state's first live donor liver transplant marked a milestone as well for the Transplant Center that opened at Mayo Clinic Hospital in 1999.

The donor, 24-year-old computer student Ryan Winklepleck of Phoenix, gave up a section of his liver to save the life of his 30-year-old brother, Tim. A Glendale machinist, Tim had suffered from primary schlerosing cholangitis (PSC), a rare liver disease that inflames and scars the bile ducts and eventually causes the liver to stop functioning. Most people with PSC rely on a liver transplant to prevent death from liver failure.

In live liver donation, an uncommon lifesaving medical procedure, a portion of liver is harvested from a healthy, adult donor and then immediately transplanted into a recipient — most often a blood relative who suffers liver failure. In traditional liver transplantation, a patient is placed on a waiting list for a liver from a deceased donor, a wait that can take months or even years.

The life-saving procedure began at Mayo Clinic Hospital early on Tuesday, March 27, and required two operating rooms in close proximity – one for the donor and one for the recipient. Mayo transplant surgeons first removed the right lobe of Ryan's healthy liver, a four-hour operation. That lobe was then transplanted into Tim, an operation that took another six hours.

Mayo Clinic Scottsdale transplant surgeons David Mulligan, M.D., and Adyr Moss, M.D., were joined in the landmark procedure by Michael Ishitani, M.D., transplant surgeon from Mayo Clinic Rochester. All three surgeons have extensive experience with liver resection, an essential skill in live donor liver transplantation.

The surgeons are confident the surgery was a success for both patients. While Tim, the recipient, is expected to remain hospitalized for observation for several days, Ryan, the donor, was doing well enough to be discharged much sooner and has resumed many normal activities.

The donor liver regenerates and regains normal function within a few weeks, as does the liver for the recipient. This further supports the practice of using living donors to ease the shortage of organs, according to David Douglas, M.D., MCS medical director of liver transplantation. "This procedure stands to save hundreds of patients who would not otherwise be able to get a cadaver liver because of the long waiting period," Dr. Douglas added. Currently, more than 17,000 people are on the waiting list for a liver transplant.

Dr. Mulligan, chief transplant surgeon, emphasized that the success of this groundbreaking procedure depends greatly on the combined strengths of the entire team of professionals in the surgery suites – including surgeons, hepatologists, anesthesiologists and the nursing staff. "And, credit must go to the patients, of course," Dr. Mulligan said. "Organ donation is a precious gift that must be nurtured and respected. We become partners for life with our transplant patients."

Live donor liver transplantation has many advantages beyond the reduction in waiting times for an organ. A liver transplant using a living donor can be scheduled, allowing for the procedure to be done in a timely fashion, and the healthy donor liver experiences less trauma.

BACKGROUNDER Living Donor Liver Transplantation

 The exact cause of primary sclerosing cholangitis (PSC) is not known, but among the theories under investigation are the role of bacteria, viruses and immune system problems. PSC affects more men than women and often begins in the person's 30s, 40s and 50s.

 PCS is the disease that struck Chicago Bears' Hall of Fame celebrity Walter Payton. Payton succumbed at age 45 to bile duct cancer, a complication of the disease, in late 1999.

 Until recently, the most common form of liver transplantation was via a liver from a deceased, unrelated donor. Such patients are placed on the liver transplant waiting list until such an organ becomes available.

 Many times patients become so critically ill while waiting for a cadaver liver that they are no longer a candidate for transplantation.

 More than 17,000 Americans are awaiting liver transplants today – nearly four times the number registered in 1988.

 Mayo Clinic Scottsdale surgeons feel live donor transplantation is essential to ease the shortage of available organs. The goals of live donor liver transplantation are to minimize donor risk and achieve recipient outcomes comparable to results of cadaver donor liver transplantation.

 Live liver donation requires extensive physical and psychosocial evaluation to determine eligibility, the altruistic nature of the donor and the suitability of the organ for the recipient. Donors must meet rigorous criteria in terms of their ability to withstand emotional stress as well.

 Potential donors are made fully aware of the advantages and risks and are told they can opt out of the evaluation or donation at any time.

 Live donor liver transplantation is a fairly new procedure. By the end of 2000, 344 live donor liver transplants had been performed in the United States.

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