| |
The first
liver transplantation in Taiwan was performed on March 23, 1984
at the Linkou Chang Gung Memorial Hospital. This case was the
first successful liver transplant (extended survival) in Asia.
This was also the first case of organ procurement from a brain-dead
cadaver donor at a time when brain death was not yet approved
in Taiwan. This event stimulated extensive discussion and debate
in the medical community until a consensus was finally reached
when the Medical Association of the Republic of China issued
a statement recognizing brain death as death in October of the
same year. Thereafter, the Human Organ Transplant Act was passed
in Congress in 1987 and Taiwan became the first nation in Asia
to legalize brain death.
Chang Gung Memorial Hospital
has caught the attention of neighboring countries on the achievement
of liver transplantation. Dr. Hideo Kawarasaki of the University
of Tokyo and I conceived of the possibility of liver transplantation
from a live donor in 1988 when living donor liver transplantation
had not yet become a clinical reality. We then decided to collaborate
in setting up an animal model and the transplant team of the
University of Tokyo visited our hospital for six times in 1988-89
to work on this project. This cooperation facilitated the clinical
development of living donor liver transplantation in both University
of Tokyo and Chang Gung Memorial Hospital. In 1990, Professor
Masatoshi Makuuchi of National Shinshu University invited me
to supervise their first living donor liver transplant operation.
The patient became the longest surviving liver transplant patient
in Japan.
Sufficient support and collaboration
from related disciplines are necessary to successfully carry
out liver transplantation. Consequently, the development of
a liver transplant program can bring along progress in related
disciplines. During liver transplantation surgery, complete
interruption of return flow to the heart when the entire liver
is removed and the inferior vena cava is crossclamped, in the
so-called Ħ§anhepatic phaseĦ¨, causes drastic changes in hemodynamics
and metabolism, creating unprecedented challenges for anesthesiologists.
These new problems and challenges in anesthetic management in
a complex operation such as liver transplantation have provided
the impetus for enhancing technology in anesthesiology. Another
indispensable service is diagnostic radiology. Liver transplantation,
especially living donor liver transplantation, is a highly sophisticated
operation, which requires precision in liver imaging including
demonstration of vascular and biliary branching patterns and
volume measurements. The development of liver transplantation,
therefore, demands the production of high-quality images that
allow accurate interpretation. Moreover, liver transplantation
also brings about unique pathological changes in the human body
due to rejection, infection, etc., so that new issues and challenges
in differential diagnoses are created for pathologists. All
these phenomena associated with transplantation serve as stimuli
to bring about advancement in research and service in medical
science. For these reasons liver transplantation must be developed
in the setting of a medical center to allow specialists from
related disciplines to fully develop in an environment of healthy
interaction in working together to achieve a common goal.
|
