Four teams of Japanese doctors began a tricky series of liver transplant operations Friday that will be the first in the world to simultaneously involve four patients.
The 20 doctors on the four teams at Kyoto University Hospital expect to complete the last operation Saturday morning, a hospital official said, requesting anonymity.
The procedure is called a domino transplant because it involves a string of operations conducted one after the other, like a line of falling dominoes.
The transplants are common in Europe, where they are used to help critically ill patients who might not survive the long waits for a healthy liver. But previous domino transplants involved only three patients.
In domino procedures, the first two operations are just like a regular liver transplant. Doctors removed half the liver from a healthy donor and then give it to a recipient who suffers from an ailment. In this case, the recipient is the donor's younger brother.
Doctors had completed that part by Friday night, Kyodo News agency reported.
The domino effect comes as the ailing liver taken from the first transplant recipient is then given to a third patient with more serious problems.
The operations in Kyoto are unique because the second donated liver was cut in two and given to two women who both have life-threatening liver diseases. By Friday evening, doctors had severed the second liver and were starting one of the transplant operations.
Doctors can transplant half a liver because the organ can regenerate and become a healthy organ.
"If it can help people who are suffering ..., then please use my liver," the donor of the second liver was quoted as saying before the operation by Kyodo.
Receiving a less-than-healthy liver may require the two recipients to undergo surgery again in the future. The second donated liver has a disorder known as familial amyloid polyneuropathy, or FAP, which causes it to produce proteins that collect in the body and cause other malfunctions.
Doctors, however, say it will take decades before the recipients show any symptoms from this disease. Without the new livers, at least one of the women would probably not live more than about six months and would not have survived the wait for a healthy liver, said hospital officials.
This was the first domino transplant operation in Japan. Earlier this year, Japanese doctors performed their country's first heart transplant in three decades after a change in the law made the procedure possible.
The first domino liver transplant in the world was conducted four years ago in Portugal.
Written By Martin Fackler