Transplanting organs article

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Organ Donation: An Advancing Science Hindered by Supply Shortages

7,200 Americans die each year waiting for a replacement organ that never

arrives

Posted June 29, 2008

By Dennis

HealthDay Reporter

SUNDAY, June 29 (HealthDay News) -- More than 98,000 Americans are clinging

to life this very second, and their only chance for survival is a dead

person's generosity.

The science of organ transplantation has improved by leaps and bounds. But

despite the advances, almost 7,200 Americans died in 2005, waiting for a

replacement organ that never arrived, according to the U.S. Health Resources and

Services Administration.

" The success of the clinical side is phenomenal, " said Fleming,

executive director of Donate Life America, a nonprofit alliance of national and

local organizations dedicated to promoting organ donation. " Unfortunately, it's

not a medical problem we're looking to solve. It's truly a matter of just not

having the supply that we need. "

The waiting list for donated kidneys is longest. Almost 75,000 patients are

waiting for a kidney, or about three of every four people waiting for an

organ.

That's generally because a person without a kidney can be kept alive longer,

Fleming said. Dialysis can sustain them, while patients in need of such vital

organs as hearts or lungs often die quickly.

However, the nation's diabetes epidemic is expected to make kidney failure

much more prevalent in the future, leading to even greater demand for donated

kidneys, Fleming added.

The waiting list for livers is next longest, with more than 16,000 patients

awaiting help. More than 2,600 people are waiting for a heart, while an

estimated 2,100 people need a lung, and around 1,600 patients are waiting for a

pancreas.

The main problem with supply is that donors must die in a very specific way

for their organs to be useful to others.

" In order to donate a solid organ, you have to die a brain death, " Fleming

said. " It's a very small percentage of the population that die in a way that

leaves them brain dead, " he said, about 1 percent of deaths annually, between

20,000 to 30,000 people.

Of those who die under optimal conditions, only about 60 percent have

consented to donate their organs, he said.

" Realistically, if 100 percent of the people consented to donate their

organs, we still wouldn't be able to save everybody, " Fleming said. " The need

continues to outstrip the supply. But if we can get everyone to consent to

transplant, that's nearly twice the number of people who can be saved. "

But supply isn't the only obstacle facing transplant recipients. To keep

their bodies from rejecting donated organs, patients must take a variety of

medications that suppress the immune system. Unfortunately, those drugs often

come with a range of severe side effects. By suppressing the immune system, they

also leave patients open to infection.

In the latest wave of innovation, researchers have discovered therapies that

allow transplant recipients to stop taking the powerful drugs that keep their

bodies from rejecting the new organ.

" We hope this will improve the quality of life for someone who receives a

transplant from another human being, " said Dr. Sachs, director of the

Transplantation Biology Research Center at Massachusetts General Hospital in

Boston, who published his findings in a recent edition of the New England

Journal of Medicine. " We think this tolerance also will help reduce the amount

of

chronic rejection of organs.

" That's the main disadvantage of immunosuppression, that it increases the

risk of a wide range of infections, and even cancer, " he added.

And that's why the new research -- in which patients can be taken off the

anti-rejection drugs -- is important, said Sachs, who heads one of the research

teams that have had success.

The method being investigated involves a procedure that partially destroys a

transplant recipient's bone marrow. This is done to reduce the level of

T-cells, the part of the immune system most responsible for organ rejection.

When the bone marrow regenerates, the new T-cells it produces tend to accept

the new organ as part of the body.

" We start the immune system over, so to speak, so the new T-cells that form

are eliminated if they react too strongly to either the self or the new

organ, " Sachs said.

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