Transplants
If PSC has advanced to the stage of potential liver failure, or cholangitis attacks are occurring with high frequency, liver transplantation may be recommended as the next step in treatment. It is estimated that more than 50% of patients with PSC will need a liver transplant sometime within 20 years of diagnosis. Of these who receive a new liver approximately 80% do not have recurrent PSC. The severity of PSC in terms of liver failure is determined by objective criteria such as the Childs Pugh Score and/or the MELD score. While living donors are used with relative frequency in the US this is not the case in Australia and very few living donor liver transplants have been conducted.
Cumulative data from the Australian and New Zealand Liver Transplant Registry 1985 to 31 December 2012, showed that of 3980 people receiving liver transplants, PSC patients accounted for 8.8% of all recipients: of these, 10.6% were adults and 1% were children. The patient survival rate for liver transplantation is 90% in the first year and 85% at five years.
Further information may be found in the liver protocol as set out by the Transplantation Society of Australia and New Zealand. This includes information on living donor liver transplantation.
Inclusion Criteria for Liver Recipient Suitability
From: Consensus Statement on Eligibility 2015 Protocols:
"chronic liver disease with life-threatening complications:
Recognised Liver Transplant Units
Qld: Princess Alexandra Hospital
Paediatric Service - Royal Childrens Hospital
NSW: Royal Prince Alfred Hospital
Paediatric Service - New Children's Hospital, Westmead
VIC: Austin Hospital
Paediatric Service - Royal Children's Hospital
SA: Flinders Medical Centre
WA: Sir Charles Gairdner Hospital
NZ: Auckland City Hospital
Transplantation in the Australian Context
Organ transplantation is a highly effective treatment for advanced organ failure and Australia's transplantation success rate of one-year survival for most organs is above 80%, one of the highest in the world.
A transplant may be considered if
Unfortunately, the number of people requiring transplants each year in Australia is greater than the number of organs donated. Due to this shortage, organ transplantation is usually offered to those with end-stage organ disease and who have exhausted all other treatment options. At any given time in Australia, 1500 people are officially on the waiting list for all organ transplants. The scarcity of donor organs means that there is strict eligibility criteria to be met for allocation of organs.
The allocation of organs for transplant is designed to be fair and equitable and follows the guidelines and protocols set down by the Transplantation Society of Australia and New Zealand and the Australasian Transplant Co-Ordinators Association. Each state or territory, in conjunction with groups responsible for each organ, manages the waiting lists for potential transplant recipients. When an organ becomes available, it is first offered to the transplant units in that state or territory, and if there is no suitable recipient then the organ is offered to other transplant units in a predetermined order.
Decisions regarding eligibility and allocation will take into account the following ethically relevant factors: urgency of need; medical factors which affect likelihood of success; immediate medical condition; length of time on the waiting list; and the likelihood the recipient will be able to comply with the necessary ongoing treatment after transplantation.
Potential recipients are referred to transplant units by their specialist to be assessed for eligibility and are then evaluated by a multidisciplinary transplant team. There are organ-specific criteria to be met, however there are also some general inclusion and exclusion criteria: advanced age with multiple comorbidities; commodities that include conditions have have an unacceptably high mortality or morbidity risk form transplantation, lifestyle that is contraindicated to transplantation and an inability to comply with complex medical therapy are exclusion criteria.
References
Donate Life: About Transplantation, Australian Government Organ and Tissue Authority
Australian and New Zealand Liver Transplant Registry 25th Report
Organ Transplantation From Deceased Donors: Consensus Statement on Eligibility Criteria and Allocation Protocols, Version 1.3, January 8, 2014, The Transplantation Society of Australia and New Zealand, Australian Government Organ and Tissue Authority
NHMRC (2007) Organ and Tissue Donation After Death for Transplantation: Guidelines for Ethical Practice for Health Professionals.
Transplantation Society of Australia and New Zealand
Australasian Transplant Co-Ordinators Association
Australia's ranking in international organ donation and transplantations.
The top ranked countries in organ donation and transplantation have "presumed consent" laws for organ donation, where one is considered a donor unless they specifically opt out. Alternatively, countries like Australia, the US and Finland work on the principle of "opt in" whereby citizens have to provide express and informed agreement to donate their organs. Even then, the family may not wish to uphold the deceased patient's request to be an organ donor and their objections are not necessarily overruled.
International Registry of Organ Donation (IRODaT)
This is a database established in 1996 for use by the international community. The content is permanently updated online. The full data on Australian organ and tissue donations for 2013 can be found here. In 2013 there were 252 deceased liver transplants and 1 living donor liver transplant performed in Australia.
Cumulative data from the Australian and New Zealand Liver Transplant Registry 1985 to 31 December 2012, showed that of 3980 people receiving liver transplants, PSC patients accounted for 8.8% of all recipients: of these, 10.6% were adults and 1% were children. The patient survival rate for liver transplantation is 90% in the first year and 85% at five years.
Further information may be found in the liver protocol as set out by the Transplantation Society of Australia and New Zealand. This includes information on living donor liver transplantation.
Inclusion Criteria for Liver Recipient Suitability
From: Consensus Statement on Eligibility 2015 Protocols:
"chronic liver disease with life-threatening complications:
- the principle indication in patients with end-stage liver disease is a Model for End-Stage Liver Disease (MELD) score of >15 in an adult or a Paediatric End-Stage Liver Disease (PELD) score of >17
- patients may also be suitable candidates if they have small hepatocellular carcinomata (HCCs) that fulfil the University of California San Francisco (UCSF) criteria
- liver disease that would result in a 2-year mortality rate of >50% without liver transplantation;
- diuretic-resistant ascites;
- recurrent hepatic encephalopathy;
- recurrent spontaneous bacterial peritonitis;
- recurrent or persistent gastrointestinal haemorrhage;
- intractable cholangitis (in primary or secondary sclerosing cholangitis patients);
- hepatopulmonary syndrome;
- portopulmonary hypertension;
- metabolic syndromes (with severe or life-threatening symptoms) that are curable with liver transplantation (eg familial amyloidosis, urea cycle disorders, oxalosis etc);
- polycystic liver disease with severe or life-threatening symptoms; and
- acute liver disease unlikely to result in spontaneous recovery as determined by the King’s College"
Recognised Liver Transplant Units
Qld: Princess Alexandra Hospital
Paediatric Service - Royal Childrens Hospital
NSW: Royal Prince Alfred Hospital
Paediatric Service - New Children's Hospital, Westmead
VIC: Austin Hospital
Paediatric Service - Royal Children's Hospital
SA: Flinders Medical Centre
WA: Sir Charles Gairdner Hospital
NZ: Auckland City Hospital
Transplantation in the Australian Context
Organ transplantation is a highly effective treatment for advanced organ failure and Australia's transplantation success rate of one-year survival for most organs is above 80%, one of the highest in the world.
A transplant may be considered if
- it is a condition for which transplantation is considered an effective treatment
- it is a severe and progressive disease that no longer responds to medical treatment and may be fatal within a short time
- the patient is willing to accept the risks of surgery and subsequent medical treatment
- the patient is physically and emotionally capable of undergoing surgery and subsequent medical treatment. (Donate life)
Unfortunately, the number of people requiring transplants each year in Australia is greater than the number of organs donated. Due to this shortage, organ transplantation is usually offered to those with end-stage organ disease and who have exhausted all other treatment options. At any given time in Australia, 1500 people are officially on the waiting list for all organ transplants. The scarcity of donor organs means that there is strict eligibility criteria to be met for allocation of organs.
The allocation of organs for transplant is designed to be fair and equitable and follows the guidelines and protocols set down by the Transplantation Society of Australia and New Zealand and the Australasian Transplant Co-Ordinators Association. Each state or territory, in conjunction with groups responsible for each organ, manages the waiting lists for potential transplant recipients. When an organ becomes available, it is first offered to the transplant units in that state or territory, and if there is no suitable recipient then the organ is offered to other transplant units in a predetermined order.
Decisions regarding eligibility and allocation will take into account the following ethically relevant factors: urgency of need; medical factors which affect likelihood of success; immediate medical condition; length of time on the waiting list; and the likelihood the recipient will be able to comply with the necessary ongoing treatment after transplantation.
Potential recipients are referred to transplant units by their specialist to be assessed for eligibility and are then evaluated by a multidisciplinary transplant team. There are organ-specific criteria to be met, however there are also some general inclusion and exclusion criteria: advanced age with multiple comorbidities; commodities that include conditions have have an unacceptably high mortality or morbidity risk form transplantation, lifestyle that is contraindicated to transplantation and an inability to comply with complex medical therapy are exclusion criteria.
References
Donate Life: About Transplantation, Australian Government Organ and Tissue Authority
Australian and New Zealand Liver Transplant Registry 25th Report
Organ Transplantation From Deceased Donors: Consensus Statement on Eligibility Criteria and Allocation Protocols, Version 1.3, January 8, 2014, The Transplantation Society of Australia and New Zealand, Australian Government Organ and Tissue Authority
NHMRC (2007) Organ and Tissue Donation After Death for Transplantation: Guidelines for Ethical Practice for Health Professionals.
Transplantation Society of Australia and New Zealand
Australasian Transplant Co-Ordinators Association
Australia's ranking in international organ donation and transplantations.
The top ranked countries in organ donation and transplantation have "presumed consent" laws for organ donation, where one is considered a donor unless they specifically opt out. Alternatively, countries like Australia, the US and Finland work on the principle of "opt in" whereby citizens have to provide express and informed agreement to donate their organs. Even then, the family may not wish to uphold the deceased patient's request to be an organ donor and their objections are not necessarily overruled.
International Registry of Organ Donation (IRODaT)
This is a database established in 1996 for use by the international community. The content is permanently updated online. The full data on Australian organ and tissue donations for 2013 can be found here. In 2013 there were 252 deceased liver transplants and 1 living donor liver transplant performed in Australia.
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Worldwide liver transplant from deceased donors (PMP) 2012 (Australia is ranked 16th)
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Worldwide liver transplant from living donors (PMP) 2012 (Australia is ranked 32nd)
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Source: (IRODaT) PMP = per million population
Page Created: 01.04.2014
Page Updated: 13.09.2015