University at Buffalo - The State University of New York

Published: January 18, 2007

By JOHN DELLACONTRADA
Contributing Editor

A UB researcher has been awarded a $741,360 grant from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, to develop an educational intervention program to increase living liver donations in New York State.

Thomas H. Feeley, associate professor of communication and a research assistant professor of family medicine, will work with the New York Center for Liver Transplantation on the three-year program, which will focus on educating patients awaiting liver transplants about the option of living donation.

"People awaiting a liver have limited knowledge about living liver donation," explains Feeley, who will serve as the grant's principal researcher and evaluation director. "We want to provide them with the information they need to be better equipped to talk to family and friends about the possibility of being living liver donors.

"In doing so, we hope to significantly increase the number of people who come forward to be screened as potential liver donors and ultimately increase the number of living liver donors in New York State," Feeley added.

Because the liver can regenerate itself, it is possible that a living donor can give a part of his or her liver to a recipient. Both the segment that was donated and the remaining section of the donor liver will grow to normal size within a short period of time, according to the New York Center for Liver Transplantation. Parents, siblings and other relatives may be able to donate organs to family members. Unrelated donors also may donate a portion of their liver if they prove to be a match for the recipient.

Carla R. Williams, executive director of the New York Center for Liver Transplantation, will serve as the grant's principal investigator. The center, which shares the grant with UB, collaborates on projects and services with five transplant programs in New York State: at Columbia University, New York University, Mount Sinai Medical Center, Westchester Medical Center and Strong Memorial Hospital at the University of Rochester.

The grant intends to improve patients' knowledge about living liver transplants through one-on-one counseling, brochures, video materials and a Web site. The goal of the educational program is to increase by 25 percent the number of people who present themselves for living liver donation evaluation at New York State transplant centers and increase by 25 percent the number of people who become living donors.

The typical patient awaiting a new liver has only two people come forward to be screened as a potential donor, Feeley noted. Of these donor candidates, 90 percent are rejected for physical or psychological reasons.

Through the grant program, potential donors who come forward but are deemed unsuitable as living donors will be told how they can declare their intentions for deceased donations, Feeley said.

According to Feeley, the number of patients needing a liver transplant has increased dramatically over the past decade to more than 17,000 in 2006, an increase of 3,500 more individuals than in 2004. Meanwhile, the waiting period for liver transplantation and the rate of death among patients have increased 10-fold. The problem is especially acute in New York State, Feeley said, where high incidence of chronic hepatitis C, especially among minority populations, has increased demand for liver transplants.

A survey of living liver donors in New York State will provide content for the educational program to be developed under the grant, Feeley said. The survey assessed donors' quality of life six months after they donated a liver. It addressed donors' employment before and after donation, personal finances, health and life insurance status, activities and daily living, physical and emotional health, donor experience, personal relationships and opinions of the donor experience.

"Along with questions about health impact, financial concerns are a major factor for people considering donation—they want to know 'how much does insurance pay' and 'how long will I be out of work?,'" Feeley said. "The answers to these questions can be used to educate people who are awaiting a liver transplant so that they are knowledgeable, confident and comfortable when talking to peers about donating a liver."

Living liver donation is a relatively recent medical advance in transplantation, Feeley noted. The limited data available shows that survival rates are greater for patients who receive a liver from living donors than from deceased donors (94 percent vs. 93 percent after 3 months; 88 percent vs. 87 percent after one year; 80 percent vs. 79 percent after three years; and 77 percent vs. 73 percent after five years).

Though the number of deceased liver donors has increased steadily since 1995 to nearly 7,000, the number of living liver donors has remained at little more than 300 over the past three years, Feeley said.

"Increasing living donation is a promising solution to the critical shortage of available livers," said Feeley, who last year studied college student attitudes about organ donation.

Since 1988, the New York Center for Liver Transplantation, a non-profit organization composed of the five liver transplant programs in New York State, has brought together liver transplant professionals dedicated to collaboration, data sharing and peer review to enhance the quality of liver transplant services. Through public and professional outreach, the center strives to provide accurate and current information about liver transplantation to transplant professionals, recipients, donors and families.