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Device Keeps Liver Alive Outside Body For 24 Hours
kkleiner writes "A new device will keep a liver alive outside of the human body for up to 24 hours. Developed at Oxford, the OrganOx circulates oxygenated red bloods cells and nutrients through the liver while maintaining the proper temperature. Doctors estimate that this new technique could double the number of livers available, saving the lives of thousands who die every year awaiting transplant."
If the subject is a liver then in what sense is it remarkable that they're kept alive?
At the Toronto General Hospital they have a full lung living outside the body. They talked about it in this short TED segment. Ex Vivo Lung: http://www.youtube.com/watch?v=T2EmuyHoMAI
Head in a jar, here we come!
No onions?
I need a device to keep my liver alive inside my body.
So will this help me get more drunk? Less hungover? Will I dance better? I mean, what else do you really use your liver for?
Because you know, all those people with defective, cancerous, or physically-damaged livers don't really need the second chance, either.
Yes, you've been told through all thirteen years of your life that drinking and abusing drugs can damage your liver. That doesn't mean it's the only way a liver can be damaged.
You do not have a moral or legal right to do absolutely anything you want.
Protip: you don't get a liver transplant if you are a drinker.
A successful API design takes a mixture of software design and pedagogy.
The liver is one of the more resiliant organs (the only one that can regenerate). It's probably the easiest organ to start with.
XML is like violence. If it doesn't solve the problem, use more.
Don't ever eat out and contract hepatitis.
This is quite specific to liver transplants in the United States. Here most patients who die while awaiting a liver transplant have had an offer of a donor liver. 55% of patients who die have had the offer of a high-quality donor liver.
Increasing supply will always be a good thing, but there are huge issues to be addressed in making sure those on the US wait list for a liver transplant actually get a transplant from the available organ supply. It seems patients and doctors are turning down way too many good organs.
"Our data show that the current liver allocation system has provided one or more transplant opportunities to nearly all candidates before death/delisting. Therefore, simply increasing the availability of de-ceased donor livers or the number of offers may not substantially reduce wait-list mortality." http://www.ncbi.nlm.nih.gov/pubmed/22841780
If you stop drinking entirely for some months you qualify for a new one.
That's true, even though there's no medical justification for that. People who get a transplant tend to quit drinking if they haven't already quit. And requiring a period of abstinence just makes the surgery more likely to be a waste than if they just did the operation up front.
Of course, how available do they have to get before you do? Given the study someone else posted showing that there is already a fair supply of livers, and increasing availability may not decrease mortaility.... perhaps a surplus of livers means that the availability of transplant can be opened to more people.
"I opened my eyes, and everything went dark again"
https://www.youtube.com/watch?v=aclS1pGHp8o I mean, that's how I get all MY livers...
Cancers would generally disqualify you, as any cancer outside the liver would throw a massive house-wrecking party when you start the patient on immunosupressants after the transplant.
Also, avoid accidentally poisoning your liver with meds or mushrooms, and stay off them bad genes. No sex, and no blood transfusions either.
While at it, we could simply stop all transport accidents by telling people to not crash their vehicles.
It isn't about second chances.
Now you can just out your liver before going on a 24-hour binge and spare it the exposure to the damaging effects of alcohol in the first place. Don't forget to put it back when you're done or leave it in a taxi while you're drunk.
Just take liver out, go out drinking and put it back in when finished. What could wrong with that?
On y va, qui mal y pense!
How can there be no justification? I have nothing against prolonging an alcoholic's agony, but this should be handled by putting them on a bottom of the list. People who don't intend to destroy their livers should be given precedence IMHO. Given that the shortage of organs of all kinds is going to stay with us for the foreseeable future, this pretty much means that in fact drinkers are not going to get transplants. Yes, I do realize that there are many things that must match in a liver and it may just happen that in spite of otherwise good recipients, there's simply no match to anyone on the list but a drinker. That's fair game, of course.
A successful API design takes a mixture of software design and pedagogy.
This is good - my liver sure doesn't stand much of a chance as long as it's still inside me.
Also, avoid accidentally poisoning your liver with meds or mushrooms, and stay off them bad genes. No sex, and no blood transfusions either.
While at it, we could simply stop all transport accidents by telling people to not crash their vehicles.
Or just tell them not to drive
What's a fair supply in terms of the probability that a recipient finds a matching donor? Just having plenty of donor organs may simply mean that you'll have plenty of livers that none of your recipients are good matches for. It may well be that, for example, people with less likely combinations of some matching factors (as I shall call them) are more likely to get liver disease. So it's more likely for an unlikely liver to get sick -- then good luck finding a matching donor organ. It's a made up scenario, but I'd like to see some numbers that show it isn't so. I'm overly skeptical when it comes to transplants -- we're still long way away before a transplant could really be considered an everyday thing, in spite of them being done daily all over the world. Having to take drugs with serious side effects for the rest of your life doesn't strike me as something that should be mentioned merely in passing. Transplantology is really a very young discipline. Despite it seeming mainstream, it's anything but. Yeah, sure, it's often better to stay alive and take drugs than face sure death, but the anti-rejection cocktails are no fun. Well, a bit more fun than chemo, but still.
A successful API design takes a mixture of software design and pedagogy.
The liver is used to living at the tail end of the circulatory supply, after all the other organs have gotten their share. Plus, one of its main jobs is detoxifying the blood, so it can put up with higher levels of contaminants in the blood. In other words, if you are testing out an organ-sustaining machine, and you can't guarantee that you can keep the blood pristine, the liver is a pretty good choice for trying things out.
I had a liver transplant almoust 5 years ago.
This is a big for the liver transplant world because right now a liver can only survive for 12 to 16 hours outside the body. Given the amount of time to call a patient in and prep them for surgery as well as harvest and transport an organ. Furthermore a lot of work has to be done crossmatching the organ on several levels (not just blood type). All of this results in surgeries that are often under huge time pressures. Having more time to do all of the above will result in much better outcomes and survival rates
just breathtaking
I see what you did there.
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That seems like a huge generalization, as there are thousands of types of cancers. Also seems like you're thinking very narrowly in an attempt to criticize the researchers. Perhaps there is a chemotheraputic that is really effective at killing a type of cancer, but is also super effective at destroying your liver. Perhaps you could beat cancer by taking your liver out and keeping it going while taking the drug, then putting it back in. Or perhaps this technology advancing a little could allow you to take a liver biopsy, grow a new liver in culture, and then replacing it. No need for immunosupressants.
This is a big advance, even if there are still specific problems.
It's inspiring, is what it is.
The lead researcher on the project was a Dr H. Lecter, who is also researching methods of Fava Bean propagation, and assisting Italian wine growers in enhancing the quality of Chianti.
When asked for a comment, Dr Lecter said: I do wish we could chat longer, but... I'm having an old friend for dinner. Bye
Donte Alistair Anderson Roberts - hi son!
Karma: Chameleon
Jim Baxter, the famous Rangers player and well-known alcoholic received two liver transplants before he died of pancreatic cancer several years later.
I don't know how to keep a liver alive outside a body for 24 hours, but I know how to destroy a liver inside a body in under 24 hours.
Check out TransMedics.com - their device keeps hearts and lungs alive outside of the body.
Active alcoholism is a contraindication to transplant, however, damage due to alcohol related diseases is not:
Except from UpToDate (requires subscription)UpToDate.com
INTRODUCTION — After initial reluctance to transplant patients with alcoholic liver disease, it is now clear that transplantation offers an excellent survival advantage in appropriately selected patients, equal to that for other disease indications. The original reluctance stemmed from the perception that the disease was self-inflicted and from the possible presence of alcohol-mediated damage to sites outside the liver [1,2]. There was also concern that compliance with postoperative recommendations would be suboptimal and that recidivism would lead to graft failure. Opposing opinions and accumulated data have addressed these reservations [3]. Liver transplantation appears to be cost-effective for alcoholic liver disease, albeit possibly less so than for transplantation for some other indications such as primary biliary cirrhosis and primary sclerosing cholangitis [2,4-6].
snip
Alcohol abstinence and psychosocial factors — Sobriety and adequate social support are essential. No absolute interval of sobriety is required because some patients who are otherwise suitable candidates will not survive a six-month period. However, a period of six months of sobriety is used widely for predicting recidivism and also allows for hepatic recovery from ongoing alcohol-related injury [31], but accurately determining which patients are abstinent can be difficult. One study that included 40 patients with alcoholic liver disease who were admitted for an assessment for liver transplant found that 38 percent of patients had urine tests that were positive for alcohol (20 percent) and/or illicit drugs (30 percent) [32]. However, only 3 percent of the patients admitted to using alcohol.
Cancers would generally disqualify you
Not entirely. You can have HCC (hepatocellular concinoma) and get a transplant:
Also from UpToDate
INTRODUCTION — Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)
The only potentially curative treatment options are resection and liver transplantation Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation. Unfortunately, the majority of patients are not eligible for either resection or transplantation because of tumor extent, underlying liver dysfunction, and lack of donor organs.
(extra link mine)
The liver makes a good candidate because it is a "nice" organ to transplant. It is very tolerant of ABO incompatibility. It also has a decent survival outside of the body, IIRC, it is exceeded only by the kidney for durability outside of the body.
My concern is that this "liver-in-a-box" makes bile. Bear with here.....
RBCs (red blood cells) are primarily broken down in the spleen, not the liver. The hemoglobin is then broken down in macrophages (which do exist in the liver, but typically aren't involved in this part) into bilirubin which is transported to the liver by binding with albumin. Once in the liver, it is conjugated (chemically linked) to a sugar to increase its solubility, it is then excreted into the bile (which gives the bile the golden brown coloring). If there is no spleen in this circuit, what's breaking down the RBCs(now granted the liver can assume some of this function in asplenic patients, but I'm not sure it can take over this quickly)? This sounds like a fundamental problem with their system....guess if they can solve that they can keep a liver on the shelf for a week or more.
Could just imaging the Monty Python skit coming out of that!
What requirement for liver survival is not being met? I recall quite some time ago when it was considered to be some sort of breakthrough when they realized "you know that pump we use when we do heart surgery? The body needs pulsing circulation to survive, so let's do that instead of just streaming fluid." I have to wonder if they are trying something similar here.
Why not plumb this liver up to someones blood supply system, and use it to clean the blood etc of unhealthy people. if its temporary, then immuno response shouldn't be that big a deal. if they can get it to live even longer, so much the better. if they can use cows liver instead, even better still. Those things are huge, and could be even better that teh real thing...... just plug your self in over night after a session, and wake up all cleansed...
There seems to be an adequate supply of Chinese felons waiting to donate their organs.
... didn't like, no, didn't like it one bit...
Whoops....looks like your tin foil hat fell off, better get it back on quick!
I have had a liver/kidney transplant. The MELD scoring process determines who get the next liver available. Blood type is considered, transplants match blood type, even though this is not strictly technically necessary, because otherwise, type O (universal donor, anyone can use type O) patients would be on longer lists then other blood types - it's a fairness problem. MELD score considers various blood test score indicators for how sick you are. The sicker you are, the higher score you get, and thus higher on the "list". Other factors will be considered, to adjust for "sick" that doesn't show up in the blood tests. Early stage liver cancer will usually move someone up on the transplant list.
Caveats:
1) you have to be well enough to survive the operation, and well enough to have good prospects for reasonable survival beyond the surgery. You'll inactive until you recover sufficiently.
2) you have to have NOT demonstrated mental instability (not attributable to liver disease) that would cause you to be unable to maintain the post-transplant drug regimen - this will get you off the list until such issues are resolved. Attitude, doctor shopping, and any behavior that makes the transplant team unhappy can qualify. Follow your doctors instructions! Note that liver disease does commonly cause mental issues in it's end-stages, so the assumption is that your ok, till you demonstrate otherwise.
3) Cancer: you can have a limited amount of cancer of the liver (since they will replace the liver anyhow). There are specific criteria about how many lesions and how big they can be. Too little gives you a smaller MELD score (and you have to wait till they get bigger). Too much, and your off the list. Other cancers will generally put you off the list entirely, as the immuno-suppressant regimen will cause the cancers to take off like wildfire, resulting in a shorter overall lifespan. In support groups for transplant-list patients, announcing you have been diagnosed with liver cancer can lead to minor celebrations, which is a bit weird, but makes sense given how the system works.
4) Infections must be eliminated, again, because the immuno-suppressant regimen will cause them to take off. Off the list till eliminated.
5) Recreational drugs and alcohol. None. Top 2 causes of liver failure are cirrhosis and hepatitis - primarily brought on from drinking and intravenous drugs. They do blood tests for metabolites monthly, or more often, to ensure that you're behaving. No point in a new organ if you haven't eliminated the habit that destroyed the old organ. Plus, people generally look at that as unfair (see Mickey Mantle, one of the drivers for the MELD reform).