New technology can keep a damaged donor liver alive for days - is this a game-changer for organ transplants?

In 2020, there were an estimated 130,000 organ transplants worldwide. The kidney was the most transplanted organ, followed by the liver and the heart. The Americas, Europe and Western Pacific had the largest number of liver transplants. Top of the list was the United States which undertook more than 12,000 life-saving liver transplants that year. However, only two took place in the whole of Africa.

In the United States alone, there are more than 100,000 people waiting for a suitable organ to be transplanted. Every day in the US, 17 people die waiting for an organ to become available. It’s estimated that 20% of all patients die waiting for a liver transplant, and around a third of donor livers are unable to be used for transplantation, according to the BBC. Usually donated livers are kept cold prior to transplant surgery but this only gives them a “shelf life” outside the human body of around 12 hours, with some remaining unusable if they aren’t in good enough condition.

However, a team of Swiss surgeons has successfully transplanted a donor liver which was stored outside the body for three days using new technology.

The normothermic perfusion machine mimics the human body by giving the organ a continuous blood supply. The machine can also deliver drugs or other nutrients to make sure the liver is kept in optimal condition before being transplanted. The team says the method gives better results than keeping donor livers cold, or in existing perfusion machines. It will also reduce the number of donor organs that have to be discarded, the doctors say.

The unnamed male recipient of the donor liver is said to be doing well after the revolutionary transplant technique was used in May 2021. He was suffering from several serious liver conditions including liver cancer.

“I am very grateful for the life-saving organ,” said the man, who had been on the Swiss transplant list, in a press release from the University Hospital Zurich. “Due to my rapidly progressing tumour I had little chance of getting a liver from the waiting list within a reasonable period of time.”

The patient’s transplant operation was carried out three days after the donor organ was removed from its original owner. The patient took immunosuppressants to ward off the risk of infection post-surgery and was discharged from hospital several days after the operation. An assessment one year after surgery found no sign of liver damage, injury, or rejection.

The Liver4Life team, based at the University of Zurich, says the donor liver had been rejected by other transplant centres because it had a lesion. Examining it to determine whether it was benign would have taken 24 hours. The doctors say the new storage technique gave them time to perform a biopsy and a successful treatment of the lesion. This technology could allow doctors to transplant other damaged livers, potentially saving more lives. Extending how long a donor liver can be kept would also allow more flexibility in the timing of transplant operations.

“Our therapy shows that by treating livers in the perfusion machine, it is possible to alleviate the lack of functioning human organs and save lives,” said Professor Pierre-Alain Clavien, who led the Liver4Life team at University Hospital Zurich.

The doctors say more research - with more patients and longer observation periods - is still needed, but the results so far look very promising.