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  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 ¡§anhepatic phase¡¨, 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.
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