Unhealthy numbers: A study on UPMC liver transplants reveals risks

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City Councilman Jim Motznik is a lucky man.

Last year, while Mr. Motznik was considering whether to donate part of his liver to his ailing mother, he had a chance encounter with transplant pioneer Dr. Thomas Starzl, who, the councilman said, advised against the living-donor procedure. Instead, Rose Marie Motznik waited and currently is recovering from a liver transplanted from a dead donor.

Not all UPMC patients have the opportunity for consultations with the 83-year-old legend, the first surgeon to successfully transplant a human liver and the man most responsible for turning Pittsburgh into the world's transplantation capital in the 1980s. Dr. Starzl's concerns now are detailed in a long-awaited study being published in a medical journal.

The study raises serious ethical questions about the decision-making process used to determine who would undergo living-donor liver transplantation at UPMC's Montefiore Hospital and the broader question of whether such surgery is too risky.

It questions the value of exposing healthy donors to the risks associated with such major surgery and the assessment methods for recipients that differ from the long-established procedure of "sickest first" that is the basis for the national allocation system developed by the United Network for Organ Sharing.

Dr. Amadeo Marcos, head of UPMC's liver transplant program from 2002 until his forced resignation last year, reported a 34 percent rate of serious complications in living donor recipients, but subsequent studies by Dr. Starzl and others found nearly twice as many -- 66 percent of the patients who received livers from live donors between 2003 and 2006 suffered potential or actual life-threatening complications.

Although the one-year survival rate of 91 percent met national standards, the rate of complications was more than twice the national average for such surgeries, a comparison that UPMC discounts. It says it applied standards more rigorously in evaluating patient outcomes.

Further studies may well show that complications at other medical centers also are at least as prevalent, but that wouldn't erase the concerns. Another troubling finding was that the incidence of complications actually got worse as time passed, something the report says "could be viewed as a warning against relaxed vigilance once the operation becomes 'routine.' "

Dr. Marcos' approach included transplanting into far healthier patients than would have received livers if the protocol used to prioritize allocation of organs from cadavers had been followed, something that was the subject of disagreement between him and his former supervisor. Dr. John Fung, who now is chairman of general surgery at Cleveland Clinic, has said his inability to exercise authority over Dr. Marcos contributed to his decision to leave UPMC.

Dr. Marcos' departure from UPMC, though, was unrelated to his medical practice; he was accused of violating the medical system's code of conduct because of sexual misconduct.

Even though Dr. Marcos is gone, serious questions remain. How did one doctor get so much authority that his actions seemed beyond the reach of his own supervisor? Why did it take so long for the concerns of Dr. Starzl, a world-renowned pioneer, to get the scrutiny they warranted from UPMC officials?

UPMC says it gives all patients the most up-to-date, relevant information so they can make sound choices for their own care. Mr. Motznik had the added benefit of taking advice directly from Dr. Starzl. UPMC should have done the same.



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