Right lobe living-related liver transplantation in a Jehovah's Witness.

Received: 13 November 2002 Revised: 17 February 2003 Accepted: 7 March 2003 Published online: 16 August 2003 Springer-Verlag 2003 Dear Editors: Jehovah’s Witnesses (JWs) refuse transfusions of homologous and autologous blood and blood products that have been removed from continuity with the body. They accept crystalloid solutions, synthetic colloid solutions, hemoglobin substitutes such as perfluorocarbons or artificial hemoglobin solutions, and recombinant proteins such as erythropoietin or recombinant factor VIIa. Individual decisions need to be made regarding administration of purified fractions of plasma, such as immunoglobulins and albumin, or solid organ transplants. Liver transplantation (LT) has been performed in some highly selected and prepared JW recipients [1]. In this report the authors describe the successful transplantation of a young adult using a right liver lobe harvested from her father. A 17-year-old JW girl (60 kg, 180 cm) was suffering from endstage liver disease secondary to cirrhotic autoimmune hepatitis. Liver failure was complicated by severe portal hypertension, hypersplenism, thrombocytopenia (15,000 platelets/mm), and refractory ascites. She refused the use of any blood product other than purified albumin. In preparation for LT, she underwent iron, folic acid, and erythropoietin therapy, and spleen embolization (Fig. 1), as described [1], to increase hematocrit and platelet count, respectively. At first, she was listed for cadaveric whole liver transplantation. Her condition deteriorated to Child–Pugh C liver failure, and living-related LT was considered. Her father (90 kg, 190 cm) proposed himself for donation and was compatible. Right lobe procurement was considered to provide sufficient liver mass to allow immediate liver function, and the procedure of living-related LT was performed on 1 March 2002, using the described technique [2]. For right lobe harvesting, hemostasis of the cut surface of the liver was achieved by contact radiofrequency (TissueLink Floating Ball, Tissuelink, Dover, N.H.). The right lobe (segments V–VIII) weighed 1244 g, i.e., 2% of the recipient body weight. In the recipient procedure, 20 lg/kg recombinant activated factor VII (Novoseven, Novo Nordisk, Denmark) was injected at the beginning of dissection and at reperfusion. A temporary surgical end-to-side portocaval shunt was created to decompress the splanchnic circulatory bed during dissection [3]. Continuous-circuit cell salvage, high-dose aprotinin, and argon beam coagulation were also used to limit blood loss during the procedure. Right lobe graft function was immediate. No transfusion of allogeneic red cells, platelets, or fresh frozen plasma was needed either in the donor or the recipient, in accorTranspl Int (2003) 16: 895–896 DOI 10.1007/s00147-003-0630-2 LETTER TO THE EDITORS