If one considers those parts of the body which are essential for life, most people would suggest the heart as a pivotal organ.  In fact, the heart can be replaced with a mechanical pump for extended periods of time and the person functions relatively normally.  Certainly the brain is essential and today our legal system recognizes the concept of brain death in which the person's heart may continue to beat but there is no brain function as sometimes occurs after a stroke, a bad accident, or an intoxication.  People have tragically "remained alive" for extended periods of time even though they had no brain function.  Thus, in the strictest sense of the word, neither the heart nor the brain are essential for a person to be deemed alive.

     There is however, one essential organ for a person to remain alive and that is the liver.  To this time, modern medical technology has not even come close to developing methods of sustaining a person's life when their liver has failed completely. Thus the liver is "the most essential organ" in order to maintain life.

    The complexity of the liver's job can be broken down into two broad categories of function.  First, the liver makes all manner of proteins that the body uses to maintain itself.  Multiple factors involved in blood clotting, healing, and fighting infection are all made in the liver.  Secondly, the liver gets rid of things that the body can't use that are potentially toxic.  When a person's liver is no longer able to get rid of waste products, a condition called hepatic coma develops and the person is not able to think in a coherent manner.  Thus the liver is a major clearinghouse for making things the body needs and getting rid of things that the body doesn't need.

    A third major function that the liver serves involves regulating the body's blood sugar, processing all of the food, and most of the drugs that a person takes in.  The liver has an amazing array of tools for processing and getting rid of drugs and many toxic substances that are in our diets.  The liver changes protein into sugars and vice versa.  If we eat more than we need, the liver changes the sugars that are eaten into fats that can be stored in the body.

    Surprisingly, end stage liver disease accounts for only 40,000 deaths per year in the United States.  One would think that such an essential organ would be a greater cause for mortality in the United States.  Heart disease accounts for 600,000 deaths per year and strokes account for another 100,000 deaths per year.  Liver disease only accounts for 40,000 deaths per year and this is fortunate because we have no meaningful treatment or replacement for people whose livers fail.

    Liver failure is most commonly caused by alcoholism.  It is estimated that anyone who consumes 600 quarts of alcoholic beverage in their lifetime, will have some liver damage.  Note the average alcohol consumption in the United States is around 10 quarts per year per person.  The degree of damage that can happen to a person from alcohol excess is closely related to how well their diet is maintained.  Those alcoholics who eat very little tend to become malnourished and the alcoholism is much more damaging in that situation.

    The second major cause of liver failure is viral hepatitis.  It is now known that there are at least 3 different major hepatitis viruses.  Hepatitis A happens in children mostly and rarely leads to liver failure.  Hepatitis B and Hepatitis C are both blood borne viruses obtained either through transfusions or illicit intravenous drug use.  These latter two diseases have a very high incidence of liver failure from cirrhosis of liver and development of cancer of the liver. Surprisingly, as opposed  to the  detrimental  effects  of  alcohol  or  viruses, liver failure from adverse drug reactions is remarkably rare.  Several years ago, the "Statin" group of cholesterol medications first came on the market in 1988.  It was known that a few individuals developed abnormal blood tests suggesting liver function abnormalities when taking the statin group of drugs.  There was substantial initial concern when these drugs were released on the market.  Since that time, the concern has been turned down so that we carefully monitor people who are using the statin drugs.  But there have been vanishingly few problems with them.  Some may recall a drug called Rezulin (troglitazone) that was a diabetic drug taken off the market in March of 2000.  Apparently, a very few individuals who took this medication metabolized it in a manner that resulted in severe damage and some deaths from liver failure.  The drug was removed from the market for that reason.

    Perhaps one of the most tragic problems that develops from liver disease is cirrhosis of the liver in which the liver becomes badly damaged and scared but the person still has enough liver function to "get by".  Patients with this problem frequently have a prolonged course being weak and sick for several years before the disease finally claims them.  Fortunately, there are steps that can be taken to help the person with liver failure, and make their life more comfortable. Testing for liver function is a relatively common blood test and can be done through your local clinics.  The test is frequently done for those taking different medications or as a screening test or routine physical exams.  The healthcare providers at our local clinics are well aware of how to interpret liver function tests and deal with problems that may arise in regard to that.