Panel Weighs Donor Safety Concerns
To offer suggestions on liver transplants
By Ridgely Ochs
August 21, 2002
In what one member said is a model for national debate, a state health
department advisory panel on liver transplants discussed ways to
ensure donor safety, ranging from informed consent to staffing ratios
to follow-up studies.
"The donor is different than any other patient in the hospital because
we have nothing to offer him except physical risk," said panel member
Nancy Dubler, head of bioethics at Albert Einstein College of
Medicine, echoing a theme that ran throughout the meeting in Manhattan
State Health Commissioner Antonia Novello appointed the panel, called
the Committee on Quality Improvements in Living Liver Donation, in
March after issuing a report on the death of liver donor Michael
Hurewitz, 57, Jan. 13 at Mount Sinai Hospital. Hurewitz died three
days after donating part of his liver to his brother Adam, 54, chief
of pulmonary and critical care medicine at Winthrop-University
Hospital in Mineola. Novello noted not only problems specific to
Hurewitz's care, but also lack of oversight among the five centers in
the state that do live-donor liver transplants.
Wayne Osten, director of the Health Department's office of health
systems management, said he expectsthat by the next meeting the panel
will have draft recommendations that will be discussed, approved and
ultimately presented to Novello. The panel, made up of transplant
experts from New York and around the country, is scheduled to meet
Oct. 24 in Albany.
A panel member, Dr. Francis Delmonico, head of the renal transplant
program at Massachusetts General Hospital, said the state panel's
actions "will have impact, no question" on a federal Health and Human
Services advisory panel on transplantation grappling with the same
issues. That panel is to meet in November. The state panel is charged
with looking at ways to ensure the donor understands what the risks of
a transplant are; ways to ensure the best care; and follow-up studies
on what long-term health problems a donor might face.
The panel seemed to back a recommendation for an independent donor
advocate team, including a doctor, social worker and transplant
coordinator. The team's job would be to represent the donor's
interests - even if that meant going against a potential donor's wish
to give part of his liver.
Much of the debate on a donor's care in the hospital centered on which
and how many doctors, nurses and other health care professionals need
to be on site and responsible for a donor's care during and after
surgery. Initially, Dr. Lewis Teperman, director of the liver
transplant program at New York University Hospitals Center, presented
his subcommittee's proposal for a 6-1 patients-to-nurse ratio, but
that quickly was changed to a 4-1 ratio. Consensus on the ratio of
surgeons and doctors-in-training to patients was less clear. There
also was disagreement about what kind of unit donors should be taken
to after the operation.
But all seemed to agree with the proposal that those who deal with
donors should be credentialed to do so. There also was consensus that
a donor with a complaint should be seen by someone within 30 minutes
and a senior doctor notified. "Ultimately, the doctor is responsible;
you have to have a different level of concern with a donor," Teperman
Another panel member, Dr. Jean Emond, chief of transplantation
services at New York-Presbyterian Hospital, said that he hoped by the
next meeting to have preliminary results of data gathered from
previous liver donors about the impact of the surgery - the beginning
of what he proposed would be long-term follow-up of donors.
Copyright © 2002,
New Rules on Liver Transplants
State emphasizes donor's protection
By Ridgely Ochs
November 14, 2002
A New York advisory panel on liver transplants from living donors
yesterday unanimously approved guidelines designed to protect the
health of the donor - a move hailed by the state health
commissioner as "likely to serve as a national model."
"No other state has looked at this issue in such depth," Health
Commissioner Antonia Novello told the panel of transplant experts.
"...These recommendations speak clearly that the health and safety
of the donor must be the highest priority."
Next week, a federal Health and Human Services transplant advisory
panel is scheduled to convene in Washington, and executive
director Jack Kress said he expects the proposed national
guidelines to mirror New York's on several points. The two groups
have worked together "synergistically," said Kress, who has
attended meetings of the state panel.
Dr. David Conti of Albany Medical Center, head of the state panel,
said he believes the report "will restore confidence."
Novello appointed the group in March after issuing a scathing
report on the events preceding the death of liver donor Michael
Hurewitz, 57, who died Jan. 13 at The Mount Sinai Hospital in
Manhattan. Hurewitz had donated a section of liver to his brother.
The report detailed a lack of doctor and nursing care and raised
questions about how well-informed such donors are about the
potential impact of such a major, and fairly unstudied, operation.
Two other donor deaths have been reported in the United States.
Novello said the guidelines will be forwarded to the new State
Transplant Council, with members from the state's medical
transplant centers, and then to the health department. Some parts
are expected to become guidelines and others, enforceable
regulations. Wayne Osten, director of the department's Office of
Health Systems Management, said regulations would likely involve
areas that could cost hospitals money - staffing requirements, for
Specifically, the state panel called for:
An independent advocate team for the donor, consisting of a
doctor, transplant coordinator, social worker and psychiatrist
and/or ethicist. If the team decides the person is not a good
candidate, the donation would not be permitted.
The donor and significant family members to be thoroughly informed
of potential risks. The donor could change his or her mind at any
Two liver transplant surgeons to attend the donor, with a third in
the recipient operating room.
Post-surgical staffing and routines that are spelled out,
including one nurse per two patients in intensive care, and a
1-to-4 ratio thereafter on the transplant ward.
A data collection system has been instituted to track donors'
Hurewitz's widow, Vickie, who has called for a moratorium on such
operations, said she hoped to "ratchet up the discussion at the
national level." Conti responded that a moratorium would "cost
lives, not save lives."
Copyright © 2002,