The Surgeon

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The Surgeon

Dr. Nicolas Jabbour, a liver transplant surgeon, likes to compare the human body to a car. If the transmission or the carburetor is broken, a driver would not throw away the whole car and forget about it, he says.

"You replace the carburetor and you fix the transmission," says Jabbour, associate director of liver transplant surgery at the University of Southern California. "In a way, that is how medicine is moving. If one organ is failing because of a specific disease, the whole body should not fail."

photo Gina Comparini
Dr. Nicolas Jabbour, associate director of liver transplant surgery at the University of Southern California, inquires about one of his patients.

Jabbour entered the field at the advice of a mentor.

His mentor predicted that only two medical disciplines would grow in the future - trauma, because of crime, wars, automobile accidents and violent sports, and transplants, because people would no longer accept that the whole organism should fail if only one piece is not working. Jabbour followed the advice, and over the last 10 years has performed nearly 300 liver transplants.

Just as his mentor promised, the field has grown.

In 1988, 1,693 liver transplants from deceased donors were performed in the United States; in 2002, 4,968 of these procedures were performed, according to the Organ Procurement and Transplantation Network.

Recipients also have benefited from the increasing use of living donors - individuals who donate a segment of their liver, which has the ability to regenerate to its close to normal size. Other vital organs, such as the heart, lungs, kidney and pancreas, cannot regenerate this way.

The first living donor liver transplant was performed in 1989; two of the procedures were performed that year. In 2000, 385 living donor liver transplants were performed and in 2001, the number was up to 518, according to OPTN. Last year, 358 such transplants were performed in the United States, according to OPTN.

Seven years ago, less than 1 percent of liver transplants were performed using living donors; today, that number is at 10 percent, Jabbour says. He predicts that by 2013, at least 20 to 30 percent of liver transplants will be done using live donors.

Transplants from living donors tend to be more successful, according to the United Network for Organ Sharing. Often the living donor is related to the transplant recipient, meaning a better tissue match and thus a decreased risk of organ rejection.

Living donations also help recipients avoid the national organ donor waiting list, which can be years long. Family members, relatives or friends who want to participate in living donation work directly with the transplant center treating the recipient. Potential donors undergo medical and psychological testing before the process of transplantation can begin. If the living donor is deemed a suitable match, the transplant can be scheduled at a mutually agreeable time. With deceased donor transplants, surgery often is scheduled on a moment's notice because an organ suddenly becomes available.

As of April, 2003, OPTN reported that there are 17,063 people waiting for a liver from a deceased donor.

When transplants are successful, patients have a new attitude and tend to enjoy life more, Jabbour says.

"In a way, transplantation is a little bit like magic," Jabbour says. "Any other surgery may make you feel better, but you are weaker, because of the insult to the body."

Jabbour and the other transplant doctors at USC develop close relationships with patients and their families.

"(Transplant surgery) is not a surgery you do and then forget about the patient," Jabbour says. "If they have a problem, they only trust us because we were the ones that took care of them when they were dying."

Overall, about 87 percent of patients who received liver transplants between 1996 and 2001 survived the first year after surgery, OPTN reported in March 2003. About 80 percent survived the first three years.

There are many factors that determine success or failure in a transplant patient, including the quality of the new organ and the body's reaction to it.

Jabbour recalls a recent liver transplant surgery that was performed in three hours with no blood transfusions. The patient was scheduled to go home in less than a week. Then, for some reason, the patient started to reject the organ and had to be re-transplanted with another liver. The second liver was also rejected and the patient died a short time later.

"Even if you assume the brain-dead patient or the live donor has a perfect liver, you don't really know until you implant it," Jabbour says. "And how is the body going to react to the new organ? Is it going to accept it or reject it? We don't know. All these unknowns make the surgery more intriguing in a way and more stressful because even if you do a perfect job, the patient might not do well for other reasons."

Live donors also face potential problems. Possible complications include bleeding, bile duct injury, infection and death. But most donors do very well, according to the Multi Organ Transplant Program London Health Sciences Centre, one of Canada's largest teaching hospitals.

Jabbour says he is very straight with people who are thinking about donating part of their body to save someone else. He doesn't want to scare them, but he believes they have to understand the risks. If a living donor cannot accept the risk of death, then they should not do it, he says. So, are people crazy to risk their lives for someone else?

"In a way, (being a live donor) is less risky than jumping in the water to save someone, because (the surgery) is happening in a controlled situation with people who are qualified," Jabbour says. "It doesn't mean the risks are zero. Risking your life to help others is part of being human."