Live Donor Organ Transplant: A Physician’s Perspective

NANCY ASCHER, MD, PhD, has devoted her career to organ transplantation and transplant surgery. The first woman to have performed a liver transplant, she has inspired many women in the medical field, especially in transplantation. She has served on the Presidential Task Force on Organ Transplantation, Surgeon General’s Task Force on Increasing Donor Organs and Secretary of Health and Human Services Advisory Committee on Organ Transplantation. Dr. Ascher has been the chair of the University of California San Francisco Department of Surgery for 17 years, greatly increasing gender diversity among faculty and residents. And, in a unique collaboration, she partners with her husband, John Roberts, MD, on a number of transplant surgeries; she removes the donated organ, and her husband transplants it into the recipient. 

BSTQ: Why did you choose this area of medical specialty?

Dr. Ascher: I was interested in a field that would keep me stimulated and engaged for many years. I also wanted a career that would provide me with an opportunity to perform research relevant to the clinical work I was doing. I was fortunate to pick transplantation because it fulfills the conditions I have described. In addition, bringing health to sick patients is incredibly gratifying. We also care for patients over many years so we get a glimpse into our patients’ lives in the long run.

BSTQ: You and your husband have a unique surgical relationship. Tell our readers about that.

Dr. Ascher: One of the programs at our institution is live donor liver transplant, where we take a portion of a liver from a healthy person and transplant it into someone with liver disease. The liver grows back in the donor and grows in the recipient as well. In this surgery, I do the donor hepatectomy (partial liver removal), and my husband transplants the liver into the ill recipient.

BSTQ: What are some common misperceptions about live-donor transplants, and how do you address them?

Dr. Ascher: People don’t realize that the liver can regenerate. So, while the donor surgery is dangerous at the front end, the liver grows back to almost normal size. Nonetheless, the donor needs to be screened extensively; it is a complex and taxing operation. In the case of live kidney donation, we are born with two kidneys and can live normally with one, so most of us can donate a kidney if we have normal kidney function. Unfortunately, many patients who need kidney or liver transplants will never get them when they are on the waiting lists. There are simply not enough cadaveric donors to meet the needs. We need live donors to make up the difference.

BSTQ: To your point, in the U.S., there is a disproportionately low number of organ donors compared to those in need of transplant. How can we increase these numbers? 

Dr. Ascher: For those who have signed their donor card, I think it’s fantastic. I think it would be even better if donors decided he or she wanted to donate a kidney while alive so that, during their lifetime, they can enjoy knowing the gift that they’ve provided for someone else may have saved a life. I’m advocating for both deceased donation and live donation as an option for people who might want to give a portion of their liver or one of their two kidneys.

BSTQ: What future innovations in the field of organ transplantation excite you?

Dr. Ascher: The use of stem cells to help regenerate the liver could be a reality within the five-year time frame. There are also exciting things related to how the body adapts to the liver and how our patients can get by with less and less immunosuppression over time. Of course, the fact that we are already using live donors is a major advance in the field of liver transplantation because it means someone doesn’t have to die for a patient to recover from liver disease. Another exciting advance in liver surgery is that we can cut the liver into two segments for two different recipients. In the near future, we will have machines that will allow us to keep the (deceased donation) liver out of the body for a period of time after donation to have it recover if it’s somewhat diseased, until it can be successfully transplanted. The direction we’re headed is really exciting!