Liver kept alive outside body and fit for transplantation too

A human liver can now be kept "warm, alive and functioning" outside the human body for it to be transplanted into a new patient. 

In a world's first, scientists from Oxford University and doctors from King's College Hospital have successfully "kept alive" a donated human liver outside a human being and then successfully transplanted it into a patient in need of a new liver. 

Currently, transplantation depends on preserving donor organs by putting them 'on ice' — cooling them to slow their metabolism. But this often leads to organs becoming damaged. 

So far the procedure, which will be a major boon for countries like India that already face an acute shortage of donor livers for transplantation, has been performed on two patients; both are making excellent recoveries. 

The innovation is a machine developed over 15 years at Oxford University that can preserve a functioning liver outside the body for 24 hours. 

A donated human liver connected to the device is raised to body temperature and oxygenated red blood cells are circulated through its capillaries. Once on the machine, a liver functions normally just as it would inside a human body, regaining its colour and producing bile. 

Based on pre-clinical data, the team says the new device will lead to better preservation of livers that would otherwise be discarded as unfit for transplantation — potentially as much as doubling the number of organs available for transplant and prolonging the maximum period of organ preservation to 24 hours. 

"If we can introduce technology like this into everyday practice, it could be a real, bona fide game changer for transplantation as we know it," says professor Nigel Heaton, director of transplant surgery at King's College Hospital. "Buying the surgeon extra time extends the options open to our patients, many of whom would otherwise die waiting for an organ to become available." 

Dr Wayel Jassem, liver transplant surgeon at King's College Hospital, who performed both transplant operations, says: "There is always huge pressure to get a donated liver to the right person within a very short space of time. For the first time, we now have a device that is designed specifically to give us extra time to test the liver, to help maximise the chances of the recipient having a successful outcome. This technology has the potential to be hugely significant, and could make more livers available for transplant, and in turn save lives." 

In Europe and the US, about 13,000 liver transplants are undertaken each year. But there is a combined waiting list of about 30,000 patients, and up to 25% of these die while awaiting transplantation. 

Meanwhile, over 2,000 livers are discarded annually because they are either damaged by oxygen deprivation or do not survive cold preservation due to elevated intracellular fat.