The liver cannot be propped up indefinitely during end stage liver disease (decompensated cirrhosis). Unlike the kidneys or the heart, the liver cannot be kept going artificially. Eventually it will fail completely. Unless a transplant is performed the patient will die.
Despite the complexity and risks involved in the operation, Liver transplants have a good success rate. Over 80% of liver transplants are considered successful. Success is defined as the patient being able to enjoy a normal or near normal life within a year of the transplant.
With major advances in surgical techniques survival rates have improved considerably. These rates have also been helped by improvements in post-transplant medical management and the availability of better immunosuppressive drugs to counter the body’s attempts to reject a new liver.
There are between 600 - 700 liver transplants a year in the UK. Between 1 April 2009 and 31 March 2010, a total of 706 patients received a liver transplant (including 20 living donor transplants). The number of people waiting for a liver transplant has risen from 199 in 1997/8 to 371 on 31st March 2010. Transplants are only carried out at specialist units. There are seven transplant units in the UK, with six across England and one in Scotland. As of the 31st March 2010 there were about 8,000 recipients with a functioning liver transplant being followed-up.
In Britain HCV is the second most common cause of liver transplants. Alcohol-related liver disease is the most common cause. Between 2001 and 2005 there were 3,365 liver transplants. 459 of these were carried out on people with HCV induced cirrhosis.
Survival rates for liver transplants for people with HCV between 2001- 2005 were 90.1% at three months, 83.98% at one year, and 73.6% at three years.
The current waiting time for low-risk patients in the UK is approximately 18 months. This is due to the number of transplants being limited by the availability of donor organs. Around 200 people are waiting for a liver transplant at any one time.
The limited supply of donor livers and the increase in the number of people waiting for transplantation led to the creation of a national organ scheme to ensure equality of access to treatment across the country. Organs are now seen as a national resource. Whilst research and the development of new transplant techniques have increased the uses of donated organs, the shortfall in donors means that some people die waiting for a liver to be become available. There is also the possibility that their health will deteriorate to the extent that they will be unable to undergo the operation.
Between 2001 and 2005, 351 people died while waiting for a liver transplant. Out of this 351, 41 of these – over 10% - were hepatitis C patients.
In the UK, we currently have the system of contracting or opting in for organ donation. This relies on individuals making a conscious decision to donate their organs after death. There are currently just over 17 million people (25% of the population) registered on the NHS Organ Donor Register.
Some European countries (Belgium, Spain and Austria) have introduced a system of opting out. This is when consent is presumed unless there is evidence that it is against the patient’s wishes or if relatives of the dead person object.
To find out more about signing up to the organ donor register click here