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Medical Forum / General / General / February 2008

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Why is there no liver dialysis?

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jjsargent@go.com - 04 Feb 2008 22:20 GMT
My mother died a few days ago due to
multiple organ failure, but the first organ
that failed and took down everything else
was the liver.  It was not detoxifying her
blood as it should have been.  A kidney
specialist informed me that kidney
dialysis would not remove the toxins
that her liver should have been removing,
that it would therefore not return her to
consciousness, in effect that it was
therefore not worth the trouble.  In fact
multiple doctors of various specialties all
described her prognosis as "poor", "dismal",
or "grim".  Her Living Will stated that if she
were determined to be terminal, with no
expectation of regaining meaningful
existence, she wanted artificial life support
discontinued.  So I had no choice but to
have the medical staff pull the plug,
and she died within half an hour.

But I would not have had to make this
decision if there had been a mechanical
means to do what the liver was not doing,
if an equivalent of kidney dialysis existed
for the liver.  Why has such a machine
not been invented long since?  And would
someone please be kind enough to devise
one so that other next-of-kin do not have
to go through this?

(Note:  If anyone responds, please do not
wax very technical.  I have no medical
training, but I would like to understand the
response; so please phrase it in lay terms
as much as possible.)

-- Jeffrey J. Sargent
Mark & Steven Bornfeld - 04 Feb 2008 23:40 GMT
> My mother died a few days ago due to
> multiple organ failure, but the first organ
[quoted text clipped - 34 lines]
>
> -- Jeffrey J. Sargent

    I can't give you a technical answer.  Your question is a good one.  The
filtration system of the kidneys, as complex as it is, basically is a
simple mechanism.  The liver produces enzymes to metabolize many
substances circulating in the bloodstream.  On a chemical level, these
processes are much, much more complex than the filtration system by
which waste products are eliminated through the kidneys.
    The ideal situation is a good match for a liver transplant; there have
been devices utilizing animal tissue to tide a patient over until a
transplant is available.  Unfortunately the patient must be healthy
enough to survive the procedure, and a suitable liver must be found.
This is a tall order--if you remember the to do that was generated by
Mickey Mantle's liver transplant and whether he "jumped the line"
waiting for a transplant even though his chances of surviving long term
were pretty poor, you'll know what I'm talking about.
    I don't know if the stem cell guys are working on liver cell
generation, but they should.
    I'm sorry for your loss.  I know first hand what it's like to see a
parent suffer and die.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

jjsargent@go.com - 05 Feb 2008 21:55 GMT
On Feb 4, 4:40 pm, Mark & Steven Bornfeld
<bornfeldm...@dentaltwins.com> wrote:
>         The ideal situation is a good match for a liver transplant; there have
> been devices utilizing animal tissue to tide a patient over until a
> transplant is available.  Unfortunately the patient must be healthy
> enough to survive the procedure, and a suitable liver must be found.

Thanks for the response and the condolences.

My mother's Living Will stated specifically
that she did not desire an organ transplant,
and that at her age she was disinclined to
have any major surgery.  She was no spring
chicken, after all -- 78 when she wrote the
Living Will, 79 when she died.  (A good
moral there:  Only about 4 months elapsed
between the time she wrote the Living Will
and her other end-of-life documents and
the time they were needed, so it's a good
thing she got them done when she did.)
So she might not have been considered
a good candidate to receive a transplant
even if she'd wanted one.

I understand that the liver's actions are
more complex than the kidneys', but
one would think that at least the most
vital subset of the liver's functions could
be faked by machinery and chemistry.
Don't think you have to come out with
a machine that does everything the
liver does as your 1.0 release; just
give us something that does the most
important things to start with -- it will
be much better than nothing.

-- Jeffrey J. Sargent
bae@cs.toronto.no-uce.edu - 07 Feb 2008 17:35 GMT
>On Feb 4, 4:40 pm, Mark & Steven Bornfeld
><bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 17 lines]
>a good candidate to receive a transplant
>even if she'd wanted one.

I was courageous of you to follow through with your mother's wishes
despite the pain it no doubt caused you to do so.  It was courageous
of her to face her fate and leave instructions for you so you wouldn't
have to decide for yourself what she would have wanted.  

>I understand that the liver's actions are
>more complex than the kidneys', but
[quoted text clipped - 7 lines]
>important things to start with -- it will
>be much better than nothing.

Unfortunately, doing just some of those functions wouldn't be enough,
except perhaps as a supplement to a liver that still has some function.
Just about all those functions are too complex to fake.

In your mother's case, you said she had multiple organ failure. Would
prolonging her life for a short time until some other organ failed
have been what she would have wanted?  Perhaps she preferred not to
spend her last days or weeks hooked up to machines, feeling terrible,
not entirely conscious, waiting for the inevitable, and that's why
she left you the living will.  You did for her what she wanted you to,
what she couldn't do for herself, when she desperately needed it.  As
hard as it seems, you couldn't have done anything better for her.

Grieving is a long and painful process, but it will get less painful
with time.  My best wishes to you.
Jason - 05 Feb 2008 22:00 GMT
> > My mother died a few days ago due to
> > multiple organ failure, but the first organ
[quoted text clipped - 36 lines]
>
>         I can't give you a technical answer.  Your question is a good
one.  The
> filtration system of the kidneys, as complex as it is, basically is a
> simple mechanism.  The liver produces enzymes to metabolize many
> substances circulating in the bloodstream.  On a chemical level, these
> processes are much, much more complex than the filtration system by
> which waste products are eliminated through the kidneys.
>         The ideal situation is a good match for a liver transplant;
there have
> been devices utilizing animal tissue to tide a patient over until a
> transplant is available.  Unfortunately the patient must be healthy
[quoted text clipped - 9 lines]
>
> Steve

Steve,
Excellent post. Keep up the great work.
Jason
J - 06 Feb 2008 11:21 GMT
> My mother died a few days ago due to
> multiple organ failure, but the first organ
[quoted text clipped - 26 lines]
> one so that other next-of-kin do not have
> to go through this?

There is a machine.
Currently, there is no artificial organ or device capable of emulating all
the functions of the liver. Some functions can be emulated by liver
dialysis, an experimental treatment for liver failure. Whilst the
technique is in its infancy, the prognosis of patients with liver failure
remains guarded. Liver dialysis, currently, is only considered to be a
bridge to transplantation or liver regeneration (in the case of acute
liver failure) and, unlike kidney dialysis (for renal failure), cannot
support a patient for an extended period of time (months to years).

http://en.wikipedia.org/wiki/Liver_dialysis

I'm sorry for your loss.
The way I see it, is our bodies are like machines or a vehicle, if you
will, composed of various parts.
Our bodies (machines) run 24 hours a day for many years without parts
replacement, so even the healthiest of people have some damage and/or
aging to their organs.  We can live without some organs, but not the
liver. We can replace some organs, but as Steve mentioned it has to be a
good match, and I imagine the rest of the organs should be in good shape.
Your mother's other organs were 79 years old.

Some causes of liver failure are listed on these websites
http://en.wikipedia.org/wiki/Acute_liver_failure
http://en.wikipedia.org/wiki/Liver_failure

Again, I am very sorry for your loss.
J
 
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