Ban pain drug, says leading surgeon

British Medical Association
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The Independent Online
A leading surgeon yesterday called for a ban on paracetamol, one of the most widely used painkillers in the world.

Professor Sir David Carter, director of the Liver Transplant Centre at Edinburgh Royal Infirmary, said paracetamol overdose was the commonest cause of acute liver failure and accounted for about one in 10 of the transplants that he carried out.

The cheap, over-the-counter drug is highly toxic in large doses and as few as 20 tablets can result in life-threatening liver disease. Many of those who take it are young and are making a "cry for help rather than a serious suicide attempt", he said.

Each year, 150 deaths and 30,000 hospital admissions are caused by paracetamol overdose. Following an overdose there is often a period in which the victim feels and appears quite well, believes the suicide attempt has been survived, does not tell anyone what has occurred and sees no need for obtaining medical help. When liver failure then develops it is often too late either to save the organ or carry out a transplant.

Speaking at the British Medical Association's annual clinical meeting in Istanbul, Sir David said: "I would like to see if off the shelves . . . I don't understand the reasons why it is available."

A paracetamol formulation containing the chemical acetylcysteine, which acts as an antidote to the drug's toxic effects on the liver, is available but is much more expensive than paracetamol tablets.

There is little support either from the Government or the drug industry for safer formulations at a more accessible price.

Sir David has promised to highlight the dangers of the drug in his role as the newly appointed Scottish Chief Medical Officer. Another issue he said he would emphasise is the idea of living people becoming kidney donors, and promised to use his position to draw attention to the possibilities.

Less than 10 per cent of kidneys transplanted in the UK come from living donors - usually a close relative or partner willing to give up one of their healthy kidneys for someone in end-stage renal failure who needs dialysis to survive.

In Norway, where living donors have formally been incorporated into the national transplant programme, the figure is 40 per cent, and in the US 20 per cent.

The success rate of living donor transplants over that of kidneys removed from a dead donor was "startling", he said. After three years, 85 per cent of kidneys donated by a spouse were still working satisfactorily, and 82 per cent in the case of a parent-to-child transplantation. However, the figure falls to 70 per cent if organs from a cadaver are used.

The use of a "fresh" kidney from a healthy living person was key to the success and appeared to over-ride tissue match consideration, Sir David said. "I am very struck by these figures. The results are so good. Why shouldn't we be doing more."

He said the risk to the living donor was small: "The Norwegian experience now extends to some 1,200 cases. None of the donors have died as a result of their donation - although two are [in kidney failure] after an interval of 12 to 15 years."

An estimated 5,000 people in the UK need a new kidney and about half will get one. Demand for organs is increasing at about 5 per cent a year.

Liver tissue donations are more problematic because of the significant risk to the donor, Sir David said. Technical advances mean that liver transplants can be carried out using grafts (lobes of the liver) taken from a living person, and a small number have been performed around the world, usually parent to child. "If you have a mother wanting to donate to a child - with the possible risk to her life - then the problems are obvious," he said.

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