Living donor liver transplants make history at UPMC
Erica Bednarowicz faced a major surgery, but worried more about her dad than herself.
Bednarowicz, 27, of Cranberry had more than half of her liver removed in October and placed in her father, Francis Drew, 58, of Zelienople.
“I knew I was healthy,” she said. “My main concern was my dad.”
About seven months after their surgeries at UPMC, Drew said he feels great. “No kidding,” he said Thursday at UPMC Montefiore.
“What they do here and how they kept me alive is incredible,” he said. “They saved my life. She saved my life.”
Drew's surgery was one of 60 adult living donor liver transplants performed in 2017 at UPMC. It was the first year that surgeons at the health system performed more liver transplants from living donors than from dead ones, of which there were 52 last year, said Dr. Abhi Humar, chief of transplantation at UPMC.
There also were 11 living donor liver transplants done at Children's Hospital of Pittsburgh of UPMC in Lawrenceville.
UPMC is the only health system performing living donor liver transplants in Western Pennsylvania.
Surgeons at Allegheny Health Network perform liver transplants using organs from dead donors, but not living donors, a spokeswoman said.
With the need for livers far outpacing the supply, and people dying on a waiting list or becoming very ill by the time they get a transplant, living donations should be seen as the first option instead of a last resort, Humar said.
Nearly 14,000 people are waiting for a liver nationwide, according to the United Network for Organ Sharing. In Pittsburgh, 106 are waiting at UPMC.
“Living donor liver transplant is possible for virtually every person on the waiting list and may be the only hope for patients with diagnoses that prevent them from even being placed on the list for scarce organs from deceased donors,” Humar said.
“No one should have to be on a waiting list,” he said. “We can eliminate that.”
A transplant is the only treatment for end-stage liver disease. Dr. Thomas Starzl performed Pittsburgh's first liver transplant at UPMC in 1981. The first adult living donor transplant was done in 1999.
Humar said liver transplants from living donors are possible because of the extra capacity built into the liver and its ability to regenerate. A person needs only a quarter of their liver, and livers will grow back to full size in eight weeks, he said.
People who get livers from living donors live longer than those getting them from deceased donors, Humar said.
“Living donation offers an option for people to get transplanted more quickly,” said Anne Paschke, a spokeswoman at the United Network for Organ Sharing. “It's obviously helpful to their patients.”
Despite the benefits, very few living donor liver transplants are performed in the United States. There were only 367 in the entire nation last year, Humar said. That compares to 7,715 from deceased donors.
A single South Korean hospital, Asan Medical Center, did 400 living donor transplants last year, Humar said. Korea, Taiwan and Hong Kong far outpace the United States in living donor liver transplants per million people; Hong Kong, Japan and Belgium do as well.
Humar attributed that to lack of awareness and knowledge of living donor transplantation.
“People don't know about it,” he said. “Patients don't know about it. Health care professionals don't know about it.”
Living donor transplants have been hurt by complications and deaths that have been highly publicized. That's why, Humar said, donor safety and recovery is important.
He said a living liver donor has never died at UPMC, and complications occur in less than 30 percent of cases, most of which have been minor.
While most living liver donations are directed from one person to another, such as with family, friends and neighbors, there are those who offer their livers to strangers, Humar said. It happens once or twice a month.
Rejection is not a big problem, and a blood match isn't necessary, he said. The recipient's insurance covers the donor's cost.
“The most important criteria is they (donors) are healthy,” Humar said.
Drew was suffering from biliary cirrhosis, an autoimmune disease that causes progressive destruction of the liver's bile ducts. He was diagnosed in 2005, after seeing his doctor for a back ache. He was told he'd need a transplant in 10 years, and that's when his health gave out.
“I thought I could outrun it,” he said. “I couldn't outrun it. It caught up with me.”
Drew said it's very hard to ask someone to donate a liver.
“I didn't know how to ask somebody to do that,” he said. “I realized I had to do it because, if not, I wasn't going to be here.”
Bednarowicz, one of his three children and the middle child, was the best match.
“I owe her my life,” he said.
A registered nurse, Bednarowicz was back to light duty at work in six weeks, and back on full after 12.
“I show people my scar,” she said. “It's my badge of honor.”
Bednarowicz said her mother, Debbie Drew, at first opposed her donating to her father, not wanting to risk both of them.
“What changed her mind was the program at UPMC,” she said. “They started a living donor workshop last summer that educated her more on it. She just didn't know much about it.”
Drew was on the waiting list, but Bednarowicz said they didn't know how long his wait would have been had she not given.
“Don't be afraid to donate,” Drew said. “You will save somebody's life.”