Transplant patient did not need liver

Apparently unnecessary transplantation - patient did not need a new liver

30/10/2013

In the autumn of 2010, the former head of transplantation surgery at Göttingen University Hospital had used a donor liver for a 57-year-old man from Osterode, although there were no complaints from the person affected. Now there are more serious charges against the physician. An opinion from the head of the Department of Transplantation Medicine in Ghent (Belgium), Professor Xavier Rogiers, as well as the head of the Department of General and Vascular Surgery of the University of Frankfurt, Professor Wolf Bechstein, concludes that there was no indication for liver transplantation , The person involved had serious complications after the transplant, as a result of which a further surgical procedure had to take place. One year after the first transplant, the patient died

Patient was at the bottom of the waiting list
The 57-year-old was at the time of completely unnecessary transplantation with only eight points very low on the waiting list for a donor organ. The so-called MELD score indicates the severity of liver disease. The scale ranges from six to 40 points. A high value increases the likelihood that a patient will die within the next few months and there is an acute need for action. With the man from Osteroder the value was so low that an operation would have had to take place later. This was also the result of the evaluation of the transplant ambulance notes. During the regular checks, the words "Complaint free“ entered. The Belgian transplant surgeon Xavier Rogiers had vainly searched the case for a rationale for the procedure, although a low MELD score was registered and the patient himself was in stable health. He did not find anything

No reason for a transplant
"According to the file, there was no reason for a transplant.“ It is striking, however, that the medical records had been very poorly documented. If a Belgian clinic had written down the findings in this way, it would have failed in the audits, replied the expert. Without a transplant, the patient suffering from alcoholic cirrhosis would clearly have had better chances of survival. For a long time, the 57-year-old had already drunk no alcohol and with abstinence, liver cirrhosis can even improve so much that a transplantation would not have been necessary. The place on the waiting list could then have taken another

Many strange events
For the Frankfurt professor of medicine Wolf Otto Bechstein, who himself has performed more than 300 liver transplants, there was neither a reason to include the patient on the waiting list nor an indication for a corresponding transplantation. "In liver cirrhosis with no life-threatening complications, liver transplantation is not indicated." Bechstein referred to studies from the USA. With such a low MELD score, the risk of dying as a result of transplantation is 3.6 times higher than if the patient remained on the waiting list.

Bechstein also pointed to some oddities. Moreover, the files do not show why the patient ended up on the waiting list. According to the referral note, the physicians at Göttingen University Hospital should only check whether a stent treatment could be useful. Instead, the 57-year-old was evaluated as a candidate for liver transplantation. It is remarkable that in the necessary examinations it was noted that the patient had epigastric discomfort. In the notes which had been made at his admission to the hospital, however, there was "no complaints". What has ultimately led to this faulty OP must be clarified in the further process. (Fr)

Picture: Martin Büdenbender