In November 1989, Alyssa Smith lay sedated in a tiny bed at the University of Chicago children's hospital. Not yet 2 years old, she had undergone a surgery--the first of its kind--that drew an entire country's attention. Alyssa needed a new liver. However, at that time patients who required liver transplants had no other option but to wait for cadaver donors. This created an especially long waiting list for infants because they could only receive organs from other young donors closer to their size; adult livers were too large to fit their bodies.
When Alyssa went on the transplant list in 1988--at less than a year old--the list had grown to 700 infants in the United States alone. Approximately one-third of all children, including half of all infants, placed on liver transplant waiting lists at the time died while waiting to get a donor organ, according to J. Richard Thistlethwaite, MD, former professor of surgery and transplant surgeon at the University of Chicago.
But Christoph Broelsch, MD, then chief of the liver surgery service, was working on an idea that might take some pressure off those waiting lists. A few years before Alyssa's surgery, he became the first surgeon in the United States to transplant a section of a deceased donor's liver into a child. His next project: to split a cadaver liver in two and transplant the halves into separate children. Again, the operation proved successful.
Broelsch was working toward something that, to many people, may have seemed ludicrous. Because the liver can regenerate, he reasoned, why not take part of a healthy, living adult's liver and transplant it into a child who would otherwise have to wait for a cadaver liver?
"Our goal was not only to do the procedure, but to develop a concept on when a living donor liver transplant ought to be done, why it should be done, and what the ethical implications are," he wrote in a University of Chicago report in 1990. In papers, Broelsch described the procedure; he attempted it in animals with positive results. But when surgeons in Brazil and Australia jumped to operate on emergency patients without Broelsch's oversight, the recipients died.
"Broelsch was one of only a few people who were working on this idea at the time. However, he was the. only one to thoroughIy and systematically evaluate the procedure including proof-of-principle experimentation in animals, ethics consultation, and public announcement of the planned procedure with request for comments," Thistlethwaite said.
The university's transplant team took serious precautions. They spent a year developing the program and set out to approve a small group of patients for the initial trials. "If successful," the Associated Press reported in newspapers across the country, "the operation at the University of Chicago would provide a solution to a severe shortage of organs for children who need transplants."