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A Critical Need

Not Nearly Enough Organs to Go Around

December 18, 2006

The Greatest Gift • MOD Squad Helps Families Make the Greatest Gift • Strangers to the Rescue: Living Organ Donations • "Angels From God:" Stories of Organ Donation • Organ Donation: How It Works • A Critical Need • Organ and Tissue Facts • Transplant Timeline --- • Study Eyes Payments for Living Organ Donors • Wealthy Saudi Received Liver Transplant Ahead of Other Patients • AMA Hopes to Increase Organ Donations • New Safeguards for Living Organ Donors

As of December, 2006 the Organ Procurement and Transplant Network reports the following patients waiting for organs:

• 69,317 waiting for a kidney transplant.
• 17,038 waiting for a liver transplant
• 1,770 waiting for a pancreas transplant
• 2,413 waiting for a kidney-pancreas transplant
• 240 waiting for an intestine transplant
• 2826 waiting for a heart transplant
• 138 waiting for a heart-lung transplant
• 2856 waiting for a lung transplant

Total: 94,436

Scantlebury, the first African-American woman surgeon in transplantation, is a leader in the field of kidney transplants for minorities. There are, she noted, two kinds of transplant -- whole organ and cell. Of the 83,000 then awaiting a whole organ transplant, the kidney is the most frequently-sought organ, followed by the liver, heart, lung, kidney-pancreas, pancreas, heart-lung and small intestine.

Of these, the liver, heart, heart-lung and lung are life savers.

"There's no survival without a new organ in these cases," Scantlebury said. For those awaiting a kidney, kidney-pancreas, pancreas or intestine, both quality of life and longevity are at stake.

Kidney

Though not immediate life savers, kidney transplants are clearly the most urgent in terms of sheer numbers. Those on the waiting list are usually on dialysis, which destroys quality of life and opens the door to infection and other complications. More than half of those awaiting a kidney transplant are diabetic and about 40 percent also have high blood pressure, she said.

For many, chronic renal failure (CRF) and end-stage renal disease (ESRD) go hand in hand, according to Scantlebury. Over 8 million Americans have CRF, adding to a vast number with ESRD. (CRF is defined as having less than 60% of normal kidney function). Many of those with CRF also have diabetes and/or hypertension. They may survive for years, only to suddenly learn they are at ESRD (less than 20% of normal kidney function).

While many can survive for some time with diet adjustments, there are basically only two options -- dialysis or transplant, either living or cadaver.

"Some teaching is needed with patients," Scantlebury said. "Many show up in the emergency room with no known history, no previous diagnosis. They gain weight, they're tired, they're swollen, now they need emergency dialysis. If patients knew their kidneys were failing they could move more quickly to transplant and avoid the need for dialysis."

"Many patients now remain on dialysis for years without knowing of the option for transplant. Many are on dialysis for 8 to 10 years. Dialysis is 3 to 4 times a week being hooked up to a machine. It limits the ability to travel and there are many potential complications," Scantlebury said.

Complications of longterm dialysis include:

• heart disease;
• bone disorders;
• growth retardation;
• phosphorus/calcium abnormalities;
• anemia; and
• infections.

The overall impact of dialysis on someone who has heart disease and high blood pressure is great, she said. "It puts tremendous burden on them. Many gain 20 pounds or more between dialysis sessions, because any fluid you take in, you keep until your next session."

While dialysis can keep patients with end stage renal disease alive, it is only a kidney transplant that can enable them to return to a normal lifestyle, Scantlebury said.

Children afflicted by congenital kidney conditions must reach a certain size before they can receive a transplant. Once they do, they begin to grow normally for the first time and often reach normal size by adulthood.

"When we see someone years after they had a kidney transplant as a child, it's just so gratifying to see how they have developed," Scantlebury said.

Liver

To be a candidate for a liver transplant, the patient must have irreversible acute or chronic liver disease, Scantlebury said. Advanced chronic disease is often congenital. Other causes include vascular disease, autoimmune disorders, alcoholism, drug abuse, malignancies or metabolic irregularities.

"Once a patient gets to 10% of normal liver function, a transplant is needed," Scantlebury said. "Once you develop cirrhosis, there is no going backwards." She noted that cirrhosis is not itself a disease but is the end result of liver failure, regardless of cause.

Although most liver donors are cadavers, there has been a steady increase in the number of living donors. Scantlebury noted that a single liver from a cadaver can serve two recipients. A living donor can give one lobe of his or her liver and retain sufficient function to live normally.

Lung

Lung transplants are needed for victims of pulmonary birosis, chronic obstructive disease, chronic bronchial infections as well as for young people suffering from cystic fibrosis, a hereditary disease that is invariably fatal without a transplant.

"Often a family will have two or three children, all suffering from cystic fibrosis. One gets a transplant and lives, while the others die. It's devastating," Scantlebury said.

Lungs, she noted, are "very hard to come by" since they are often damaged at the time of death.

Transplant options include a single or double lung or a heart-lung combination.

In the "living-related double labor lung transplant," different family members donate different lungs to get a total of two -- one from each parent, for example. Such procedures are becoming increasingly common.

Heart

The most frequent indication for a heart transplant is cardiomyopathy -- sudden heart failure from a viral infection, although it can sometimes be caused by artery disease. If the patient has less than 20% heart function, he or she is a candidate for transplant.

"This is truly life and death for most patients. Patients on the list for a heart are usually hospital-bound. Priority goes to those with arrythmia, pain and failure of the heart's right side," Scantlebury said. In recent years, heart-assist devices have advanced to the point that patients are sometimes able to leave the hospital for short while. But generally speaking, a transplant remains the only option for most, she said.

Kidney-pancreas

A combination kidney-pancreas transplant is sometimes the answer for those with advanced Type 1 diabetes, the genetic disorder in which the pancreas fails to produce insulin (formerly known as "juvenile" diabetes). A pancreas and kidney from the same donor can help the patient avoid dialysis and live a normal life.

Unfortunately, patients with Type 1 diabetes often suffer extensive organ damage and are not good candidates for surgery.

Intestines

An intestine transplant is indicated for patients who have lost their intestines due to congenital disease or trauma. Without functioning intestines, the patient must have IV therapy for nutrition, which can cause long-term complications including liver failure, not to mention poor quality of life.

Cells

Islet cells can be used for insulin-dependant (Type 1) diabetes and can avoid the need for a pancreas transplant. Requires multiple donors.

Bone marrow/stem cells are used to treat leukemia, anemia and immune disorders. Anyone from 18 to 60 can be a donor.

Next: Organ and Tissue Facts

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