Dramatic rise in obesity, fatty liver disease increases need for transplants

The dramatic rise in obesity is leading to more fatty liver disease in the United States, increasing the need for more transplants at a time when there already is a severe shortage of donated organs.

"We normally see a two to 3 percent increase each year in the number of people needing a transplant. In 10 years, we are looking at about a 30 percent increase," said Dr. A. Osama Gaber, director of the Methodist J.C. Walter Transplant Center in Houston. "If you double that number to 60 percent in 20 years, we might have to make tough decisions about who receives organs."

Alcohol, drugs, obesity, lipid disorders and diabetes can all be causes of fatty liver disease, which is a buildup of fat inside the liver cells. More than 30 million Americans live with this disease and between five and 20 percent of people with fatty liver will develop serious liver disease.

"Many of the people with this condition suffer from Metabolic Syndrome, a constellation of factors which include a large waist circumference (men greater than 40 inches, women greater than 35 inches), high blood pressure, high triglyceride levels and insulin resistance that heighten the risk of heart attack, stroke and type 2 diabetes," said Dr. Archana Sadhu, an endocrinologist with The Methodist Hospital.

"Unfortunately, fatty liver disease will cause more cirrhosis which in turn will cause more people to need a liver transplant and we are not sure if the organs will be there," said Dr. Howard Monsour, chief of Hepatology at The Methodist Hospital in Houston. "The good news is that fatty liver can be brought under control with a change in diet and vigorous, consistent exercise."

In fact, fatty liver can be significantly reduced by just losing 12 percent of your current body weight and other disease related to obesity such as type 2 diabetes can be improved by weight loss.

"There has been enough talk about prevention, it's time for patients and physicians take these problems seriously," Gaber said. "We need to treat people early. Get them into exercise programs, change their diets and better educate them about the consequences of not changing their lifestyles."

If these problems are not addressed soon, or a new source for organs found, it will be inevitable that some sort of rationing based on weight and other medical conditions might have to be introduced into the system, he said.

"Just like the environment, if you intervene and stop the trend now you will hopefully prevent it from getting worse," Gaber said. "I really don't want to have to tell someone in 10 years that new rules prevent them from even being listed and that we do not have an organ for them because there are not enough to go around."