Transplantation of vital human organs, one of the most complex medical endeavors, is now a common lifesaving therapy for victims suffering from end stage kidney, liver, heart, lung and pancreas failure. The transplantation of skin, bone, corneas and other tissues can restore thousands of people to normal, active and productive lives. The need for cadaver organs and tissues for transplantation continues to exceed donations in all areas of the country. Thousands of chronically ill people are awaiting transplantation. It is imperative that physicians and nurses in the community recognize that their professional contributions are essential if we are to offer transplantation to all those patients in need.
To better understand the problems that confront transplant physicians today, each of the organs clinically transplanted must be explored individually. Although each organ transplanted confronts physicians with a different host of technical considerations, all organ transplants have two things in common:
- A transplanted organ is a foreign tissue and is subject to rejection. Here, biochemistry and immunology find their challenge. Although rejection can be clinically challenging, enormous strides have been made in the medical management of transplant recipients.
- A transplanted organ must be a living organ. Unlike bone, skin and corneas, which can be recovered several hours after cardiac death, vital organs must be recovered from a heart beating, brain dead donor.
Kidney Transplantation:
For patients with end stage renal disease (ESRD), there are two available therapies: dialysis and transplantation. Although some patients respond well to dialysis, many do not. Children maintained with chronic dialysis do not grow at normal rates. Adults frequently must give up their jobs and lose their roles as providers and heads of their families. Physical and financial dependency often lead to emotional dependency and depression. The majority of individuals with ESRD also suffer from a myriad of medical complications, including chronic anemia, muscle wasting, extensive bone deterioration and peripheral nerve damage. The incidence of suicide among dialysis patients is considerably greater than it is for the general population. For those patients who adapt poorly to dialysis, the only hope for a normal life is a new kidney-a real kidney.
More than 80,000 renal transplants have been performed since 1963. Renal transplantation has been an accepted therapy for many years, and renal graft survival of beyond 20 years is well recognized. Over 7,000 kidneys are transplanted annually throughout the United States .
Ninety percent of the patients receiving kidney transplants from post mortem donors have normal renal function at the end of the first postoperative year. Right now in our area, there are more than 150 patients waiting for a phone call that tells them a suitable kidney has been found for them. Nationally, there are over 15,000 ESRD patients on renal transplant waiting lists, and the list continues to grow.
Cardiac Transplantation:
Heart transplants are now performed at approximately 80 specialized transplant centers in the U.S. More than 2000 heart transplants are performed annually, with hundreds of patients waiting for cardiac transplantation at any given time.
There is no effective long-term mechanical support available for patients suffering from end-stage cardiac disease. Many of these patients, however, are suitable candidates for the only therapy which can provide not only continued life, but a high quality of life-cardiac transplantation. Almost 80% of heart transplant recipients are alive and well at the end of the first postoperative year. Cardiac transplantation still relies on the donation of organs. The medical science is not lacking, the number of donated hearts is.
Liver Transplantation:
Liver transplantation has been performed since 1963 in the U.S. , only one liver transplant program was active through 1982. Today there are over 50 active liver transplantation programs in the U.S. alone. Liver transplant patients have a one- year survival rate of 75%, although long-term survival of 10 to 15 years is well documented. Children suffering from congenital biliary malformations are a major group of patients for whom liver transplantation has been a most effective therapy. Post-transplant survival among this group is close to 80% at one year. The alternative to liver transplantation for all patients now waiting is certain death within a few months.
Pancreas Transplantation:
More and more patients each year are being evaluated for pancreas transplantation. One year success rates have been improving dramatically from only 25% to now over 50%. New developments in surgical technique and immunosuppression have been very successful in the short run, although more clinical trials are in progress. Today over 700 people nationwide await pancreas transplants. Thousands of patients suffering from diabetes will be potential recipients for pancreas transplantation in the years to come.
Heart/Lung Transplantation:
Heart and lungs are transplanted en block in recipients suffering from primary pulmonary disease with secondary cardiac pathology. Patient survival is approximately 50% at one year. Over 50 heart/lung transplants are performed annually. Although some patients currently awaiting heart/lung transplantation may be suitable candidates for single lung transplantation, many will not. The major problem of donor availability continues to be an overriding constraint in heart/lung transplantation.
Single/Double Lung Transplantation:
Single/ double lung transplants are performed on patients suffering from idiopathic pulmonary fibrosis, pulmonary hypertension, emphysema and related end-stage pulmonary disease. The first successful single lung transplant procedure was performed in 1983. While nearly 200 single lung transplants are performed each year, many new patients are identified daily who may benefit from this therapy. The clinical results with lung transplantation now seem comparable to the results of other major organ systems.
The Problem & The Solution
One single factor prevents the transplantation of all patients who need and want a new kidney, heart, liver, pancreas or heart and lungs. It is not the lack of money, surgical or technical skill and it is not the shortage of potential donors. The problem is solely the lack of suitable donor referral.
Gallup polls have found that more than 80% of Americans are willing to donate their organs and tissues for transplantation after death. In our experience, grieving families welcome an opportunity to consider organ and tissue donation. The knowledge that others' lives have been enhanced through the gift of a loved one's organs and tissues is generally a strong solace for a family struggling to accept what they feel is a meaningless death. But most of these families will not think of organ donation unless someone cares enough to reach out and let them know of this opportunity ARORA provides extensive bereavement follow-up care to all families of potential donors.
