Massachusetts General Hospital and Brigham and Women’s Hospital have a rich history in performing and pioneering organ transplant procedures. In 1954, Brigham transplant surgeons performed the world’s first successful organ transplant (a kidney). Mass General surgeons have performed more than 1,000 liver transplants since 1988, making it the most experienced liver program in New England. Together, these renowned institutions have built a legacy of first-of-their-kind transplants.
Now, Mass General and the Brigham have come together to create the Mass General Brigham Liver Transplant Program. This gives patients access to one of the most active and experienced living kidney and liver donor programs in the country.
“It means that we can care for patients both inpatient and outpatient, pre- and post-transplant at both institutions,” explains Anna E. Rutherford, MD, MPH. Dr. Rutherford is a Mass General Brigham transplant hepatologist. She is also the clinical director of hepatology and the Mass General Brigham Liver Transplant Program at Brigham and Women’s Hospital.
The Mass General Brigham Living Donor Liver Transplant Program helps patients find a faster path to transplantation. Irun Bhan, MD, a Mass General Brigham transplant hepatologist, is the program’s medical director. Adel Bozorgzadeh, MD, a Mass General Brigham transplant surgeon, is the surgical director.
Drs. Rutherford, Bhan, and Bozorgzadeh each bring a unique perspective to their work in liver transplant. Here, they explain living liver donation and discuss the ways Mass General Brigham is making clinical care more equitable through improvements in living liver donation. They also explore the lifesaving work they do every day.
Liver donation comes in two forms: deceased donation and living liver donation.
Deceased donors are the most common organ donors. But the liver transplant waitlist is very long, and there aren’t enough livers available for patients who need them. Too often, patients waiting for a liver in the United States become too sick for the transplant.
“Many people with liver disease on the liver transplant waiting list are sick enough to benefit from liver transplant, but not sick enough to be at the top of the deceased donor waiting list,” explains Dr. Bhan. “Living donor liver transplant may be a great option for many of these patients.”
In living liver donation, or living donor liver transplant, surgeons remove a patient’s diseased liver. They then replace it with a piece of healthy liver from a living donor.
There are many benefits to receiving a living liver transplant. It’s faster than waiting for a deceased liver. That means patients can get healthier sooner. Living donor livers can last longer than deceased donors’ livers. Living donor livers are often healthier. And, importantly, living donors’ livers can function right away.
“That’s an advantage to living donors,” says Dr. Rutherford. “We get these patients at a better time for them where they’re able to handle a smaller piece of a liver and come off the larger waiting list.”
Your liver is unique in that it can grow back. In fact, it only takes a few months for a healthy liver to return to its full size and function.
The same is true for patients receiving a piece of liver. Within months, they’ll have a full-sized, functional liver.
Living liver donors can go on to lead long, healthy lives. And recipients can usually rely on these new livers for decades.
“The organ shortage for liver transplantation has been getting worse in recent years,” explains Dr. Bhan. “The number of people in need of liver transplantation has been increasing, but the availability of organs through deceased donation has not kept up with the demand. With the growing organ shortage, the time is now to make living donor liver transplant more accessible to our patients.”
“The Mass General Brigham Living Donor Liver Transplant Program is a sprawling, multidisciplinary program,” says Dr. Bozorgzadeh. “It has psychiatrists, nutritionists, social workers, independent living donor advocates, a medical director, a surgical director, nurses, nurse practitioners, and coordinators. All of us participate. We take pride in our patient-centered approach, and we have a massive amount of respect for our living donors.”
The Living Donor Liver Transplant Program aims to increase access to lifesaving organs. It supports both living liver donors and patients in need of livers in tandem.
Meanwhile, patients have access to living liver donors. This means less time spent waiting for new livers. And the faster patients can get their new livers, the better their health outcomes can be.
“There are a number of barriers patients who need liver transplants face,” says Dr. Bhan. “A major one is that medically underserved individuals who have chronic liver disease may not be referred for liver transplant evaluation when indicated. This issue is pertinent to living donor liver transplant. It can be a great option for people who are sick enough to benefit from liver transplant, but not sick enough to be high on the deceased donor waiting list.”
The Living Liver Donor Program works strategically to address inequities in liver donation care. Their approaches include:
Education. As Dr. Bhan explains, one of the program’s goals is “to educate providers who care for people underserved by the medical system about when to refer for transplant evaluation, and to partner with these providers to educate people about liver disease.”
Accessibility. “Another strategy is to make transplant evaluation clinics more geographically accessible by setting them up closer to people who need to be evaluated,” says Dr. Bhan.
Flexibility. Potential donors with demanding schedules are often faced with a difficult question: Is it possible to donate without losing out on work? “We really are a team that goes out of its way to accommodate our donors,” says Dr. Bozorgzadeh. “If a donor says, ‘I just changed my job and I’m really busy right now. I need to do this on the weekend, or on a specific day,’ we accommodate them. We come in for the weekend.”
The Living Donor Liver Transplant program also offers resources to help donors understand and use the tools available to them. “Social workers will help patients tap into, for example, family medical leave, or leave of absence programs,” adds Dr. Bozorgzadeh. “Our team will even help people who want to reach out and do a fundraising campaign or social campaign. There is a lot of help and support for anyone who wants to donate.”