Digestive Diseases News
Spring/Summer 2008

Research News

NIH Lecture Series Spotlights Liver Cancer, Transplantation, and Organ Allocation

The increasing rate of liver cancer in the United States has focused attention on the shortage of donor livers for people who need them—and how decisions are made about who gets them. These issues were the subject of a recent session in the Demystifying Medicine lecture series at the National Institutes of Health (NIH).

Liver transplantation and tumor removal are the only currently effective options for treating liver cancer, which has been increasing in the United States due to growth of the hepatitis C virus and the Asian population in this country, according to Irwin Arias, M.D., moderator for the lecture series designed for doctoral students, fellows, and staff.

A study of nearly 700 individuals with liver cancer found that half had hepatitis C, 15 percent had hepatitis B, and 5 percent had both. Another study associated diabetes with a two-fold increase in the risk of liver cancer, according to Arias. Other risk factors for liver cancer include obesity, alcohol, hemochromatosis, and aflatoxin.

The 1-year patient survival rate among people who have received liver transplants is 85 to 90 percent, according to Marc Ghany, M.D., a gastroenterologist with the National Institute of Diabetes and Digestive and Kidney Diseases“ Liver Diseases Branch who participated in the lecture. The 3-year survival rate is 75 to 80 percent, and the 8-year survival rate is 60 to 70 percent, Ghany said. Currently, about 17,000 people are on a waiting list for a donated liver. About 1,800 people on the list die before receiving one.

Allocating Limited Resources

According to criteria from the United Network for Organ Sharing (UNOS), an individual“s position on a waiting list for a liver depends on blood type, waiting list time, mortality risk score—or the probability of death without a transplant—and whether the individual is a child, according to Alan Wertheimer, Ph.D., a research scholar in the department of bioethics at the NIH Clinical Center. In his lecture, Wertheimer explored whether the UNOS policy is ethical and how scarce medical resources should be allocated in the United States.

To view the lecture entitled “Liver Cancer: A Global Problem. Who Gets the Liver Transplant?” go to http://videocast.nih.gov/summary.asp?file=14460. The NIH launched the Demystifying Medicine lecture series to help bridge the gap between advances in biology and their application to major human diseases.

The 2-hour lectures are held on the NIH campus from January through May and are presented live through online streaming video. Recorded videos are available online following each live event. For more information about Demystifying Medicine lectures, visit www1.od.nih.gov/oir/DemystifyingMed.

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NIH Publication No. 08–4552
July 2008