As the echoes of New Year’s fireworks faded across the nation Saturday morning, the tens of thousands of Americans in need of an organ transplant hoped 2011 would bring them a true renewal.
Many of the more than 110,000 people on organ waiting lists – more than one in ten of whom live in the tri-state area – have spent years hoping for the new lease on life a transplant could bring.
Most of them – four out of five – require a new kidney, but the supply of donor kidneys falls woefully short of the need. In 2009, 16,829 kidney transplants were performed nationwide. And for patients with end-stage renal disease, the only alternative to a transplant is endless dialysis – a disruptive process that consumes countless hours and can lead to dangerous and sometimes life-threatening complications.
“That gap is getting bigger and bigger because the number of donors is not increasing as fast as the need,” said Dr. Cataldo Doria, MD, PhD, director of the Division of Transplantation at Thomas Jefferson University Hospitals.
As a result, some patients will die on the waiting list, lending real urgency to efforts to increase the supply of organs available for transplant.
One morning in early December, four full surgical teams in separate operating rooms at Thomas Jefferson University Hospitals began a carefully choreographed process to transplant kidneys from two living donors into two patients with end-stage renal disease.
The donors – a young man whose mother needed a new kidney and a young wife whose husband also needed a transplant – were wheeled into separate high-tech operating rooms on the Hospital’s seventh floor. They had never met each other, but each was donating to the other’s loved one.
This process – known as a matched-pair transplant – is one way to increase the number of kidneys available for transplantation.
Two floors below on the Hospital’s fifth floor, the young woman’s husband and the young man’s mother were being prepped for transplant surgery in adjacent ORs. Separated by only a dozen feet for the surgery, the transplant recipients would recover on separate floors, waiting family members would be in different areas to protect their privacy and the anonymity of the donors and recipients alike.
The four patients were a matched-pair swap in which the donors who do not match – and thus cannot give their organ – their loved-one in need of a transplant would give to another patient whose relative would return that “gift of life.”
“We have tried several remedies to decrease the organ gap,” Dr. Doria said. “One approach has been to increase the number of live donors with paired exchanges and chain donations. And with the implementation of a nationwide system for paired donations, there is the potential to really decrease the gap significantly.”
In addition, better education on the safety of living donation to encourage more eligible donors to give is important, Doria said.
Still, the surgeon noted, the only way to really close the gap would be to decrease the demand, which means better treatment for high blood pressure and diabetes – the leading causes of end-stage renal disease in this country.
Growth of Living Donors
Match-pair swaps are one way to increase the number of donations and meet the demand for donor kidneys. Jefferson, like other major transplant centers across the nation, has focused intensely on improving and enhancing living donor programs to boost the overall number of available organs.
While the number of kidneys from deceased donors has remained relatively static over the last 20 years, living donations have more than tripled. And with the growth in popularity in such paired-match transplants and transplant chains – that extend the swaps to multiple pairs of donors and recipients – transplant experts hope to boost the numbers of living donations even further.
The transplant team at Jefferson has embraced these initiatives to increase the number of transplants, and they have achieved some successes. In 2009, patients in need of a new kidney at Jefferson spent a significantly shorter time on the wait list on average as the other major kidney transplant programs in the greater Philadelphia region.
Data from the Scientific Registry of Transplant Recipients showed that for programs that had three-year survival rates of 90 percent or more, Jefferson’s weight time was the shortest. Half of the 430 patients on the Jefferson wait list for a kidney from January 2008 through 2009 had a transplant in 37 months.
While three years on a waiting list for a transplant is significant, the strides being made at lowering that period were significant for the patients.
“Compare that number to the wait times at other area hospitals, and there is a dramatic difference,” said Adam Frank, MD, a transplant surgeon at Jefferson and an assistant professor of surgery in the Division of Transplantation at Jefferson Medical College. “Patients at other area hospitals may be waiting as long as six years for a new kidney.”
In addition to a thriving living-donor program for kidneys and the recent matched-pair swap, Jefferson will participate in a chain across several states and multiple hospitals that can provide new kidneys to 18 patients in need.
And in 2010, Jefferson’s Transplantation Center of Excellence launched a living-donor program for liver transplants. Jefferson, the site of the region’s first successful liver transplant more than 25 years ago, started that program to address the need for more livers. Learn how to become a live liver donor.
Such efforts are built on the excellence of existing solid organ transplant programs that include kidney, kidney-pancreas, pancreas and liver.
For more information on the transplant programs at Jefferson, visit hospitals.jefferson.edu.