Transplant Question/Issue

[Guest guest]

Just a topic for discussion but a pretty serious one that affects not

just those of us with lung diseases but many others.

Most European transplant centers age-match organs for transplants. They

will use healthy organs from older donors in older patients, still not

giving organs older than the patients.

Most U.S. transplant centers use very few organs from older donors.

This is true not just of lungs or hearts but all deceased organ donors.

Now, this practice greatly restricts the number of transplants. Since

the two leading sources of organs are stroke victims and motor vehicle

accidents you can see how this limits even more. Motor Vehicle accident

victims are spread fairly evenly across age groups although more

heavily weighted toward younger groups. However, victims of strokes are

far more likely to be older. Every center has different practices, but

on the whole, the country doesn't use organs from older donors nearly

as much as might be possible.

Now, I personally, if I need a lung or two in say four years and I'm 62

I would absolutely grab up healthy 50 or 55 year old lungs. They are

better than the ones I've got. I'd prefer perhaps 30 year old lungs but

with a common blood type I'm not likely to be top on the list for them.

Now the 50 year old lungs aren't going to be used for the 35 year old

recipient so why not me? Why not at least give me that choice? Also,

are we being too restrictive on both recipients and donors.

Let me site two vary distinct hospital practices. Hospital A is one of

the most successful centers in the country. They have a 91% one year

survival rate on lung transplants, but their transplant rate of those

on their waiting list is only 30%.

Hospital B has an 81% survival rate, but they provide transplants to

95% of those on their wait list within 6 months and their annual

transplants are 3.7 times the size of their wait list.

How should we balance levels of risk versus providing as many of those

in need transplants as possible? Should we take slightly greater

chances when we have a person who we know isn't going to survive

without a transplant?

Hospital A had a 91% success rate vs. B's 81% on one basis. However, on

another basis Hospital A only really had a 27% success rate (91%

success times 30% transplanted) and Hospital B had a 77% success rate.

Note: this is not a lung only issue. This has become a rather debated

issue within the medical community but we tend to only look at the

success rates of those given organs. For instance, what if we provided

more kidneys and got more off of dialysis even if that meant that some

of those patients had to have second transplants later? Would you take

a slight extra risk to get off dialysis? Of course with lungs its not

new kidney versus dialysis, its more a matter of life and death.

Obviously we don't want our hospitals taking unreasonable risks. But

are they being too cautious? To those of you who have been rejected

because of weight or another disease, would you take some risk if

they'd give you one of the organs being thrown away instead of used?

I'm not writing this for us to resolve it here on the board, but more

just to make us all aware that there are issues on the matter. We talk

about the serious lack of organ donors regularly, but we don't really

talk about the policies as to use or rejection of organs from the

existing donors.

[Guest guest]

Interesting issue. I'm inclined to suggest that litigation plays a large part in hospital choices when it deals with transplants.

A hospital in England was investigated last year as it's survival rate post transplant had dropped significantly and it turned out that it was due to using older donors. Unfortunately here we have about 3000 patients a year needing a lung transplant (I don't know the figures for other organs) and about 1000 suitable donors a year. I think that hospital had good intentions of cutting down the waiting list. It's a difficult line to balance. Right now, at 38, I wouldn't turn down a healthy 50y/o set of lungs as they're still going to be better than mine.

Love Ze xx >> Just a topic for discussion but a pretty serious one that affects not > just those of us with lung diseases but many others.> > Most European transplant centers age-match organs for transplants. They > will use healthy organs from older donors in older patients, still not > giving organs older than the patients. > > Most U.S. transplant centers use very few organs from older donors. > This is true not just of lungs or hearts but all deceased organ donors. > > Now, this practice greatly restricts the number of transplants. Since > the two leading sources of organs are stroke victims and motor vehicle > accidents you can see how this limits even more. Motor Vehicle accident > victims are spread fairly evenly across age groups although more > heavily weighted toward younger groups. However, victims of strokes are > far more likely to be older. Every center has different practices, but > on the whole, the country doesn't use organs from older donors nearly > as much as might be possible. > > Now, I personally, if I need a lung or two in say four years and I'm 62 > I would absolutely grab up healthy 50 or 55 year old lungs. They are > better than the ones I've got. I'd prefer perhaps 30 year old lungs but > with a common blood type I'm not likely to be top on the list for them. > Now the 50 year old lungs aren't going to be used for the 35 year old > recipient so why not me? Why not at least give me that choice? Also, > are we being too restrictive on both recipients and donors. > > Let me site two vary distinct hospital practices. Hospital A is one of > the most successful centers in the country. They have a 91% one year > survival rate on lung transplants, but their transplant rate of those > on their waiting list is only 30%.> > Hospital B has an 81% survival rate, but they provide transplants to > 95% of those on their wait list within 6 months and their annual > transplants are 3.7 times the size of their wait list.> > How should we balance levels of risk versus providing as many of those > in need transplants as possible? Should we take slightly greater > chances when we have a person who we know isn't going to survive > without a transplant? > > Hospital A had a 91% success rate vs. B's 81% on one basis. However, on > another basis Hospital A only really had a 27% success rate (91% > success times 30% transplanted) and Hospital B had a 77% success rate. > > Note: this is not a lung only issue. This has become a rather debated > issue within the medical community but we tend to only look at the > success rates of those given organs. For instance, what if we provided > more kidneys and got more off of dialysis even if that meant that some > of those patients had to have second transplants later? Would you take > a slight extra risk to get off dialysis? Of course with lungs its not > new kidney versus dialysis, its more a matter of life and death.> > Obviously we don't want our hospitals taking unreasonable risks. But > are they being too cautious? To those of you who have been rejected > because of weight or another disease, would you take some risk if > they'd give you one of the organs being thrown away instead of used? > > I'm not writing this for us to resolve it here on the board, but more > just to make us all aware that there are issues on the matter. We talk > about the serious lack of organ donors regularly, but we don't really > talk about the policies as to use or rejection of organs from the > existing donors.>