Organ Donation: New Developments, Common Misconceptions, And Ever-Present Need
The organ donation system is complex, and often misunderstood - with a waiting list that is long, and constantly shifting. But living donations, high-risk donors, and new scientific developments in tissue growth are making new strides in addressing the need.
This show originally aired on April 17, 2017.
- Alexandra Glazier - President and CEO of New England Donor Services, a nonprofit organization designed by the federal government to coordinate organ donation for transplant.
- Dr. Fred Gordon - Vice Chair of the Department of Transplantation at Lahey Hospital and Medical Center.
- Logan Shannon - Donated a portion of her liver to her husband. He later required another transplant from a non-living donor. Shannon is also a producer at NHPR.
How does the organ transplant waiting list work?
Once a candidate is listed, there are very special algorithms to ensure that the right organs are matched to the right candidates. Of course, there is also a matter of priority, because unfortunately, we don't have all the organs available for all those who are waiting. . .We have over twenty people who die waiting every day, so this is a scarce resource that we need to allocate carefully.
When an organ donor is identified, then it's our organization's responsibility to work with the national system to see who the candidate is in order of priority that should receive that organ. Some of that is biological matching, blood type, for example, or maybe size. And some of that is priority based on that algorithm. . .We work in critically short time periods.
Dr. Fred Gordon:
The list [for liver donation] is set up by something called the MELD (model of end-stage liver disease) score. This is a mathematical calculation that uses four blood results. . .and what the score actually tells you is a three-month prediction [of survival] without a liver transplant. So a low score, which is six points, is the best score anyone can have, and would predict there is a one percent chance of dying in the next three months. . .a MELD score of 40, which is the highest score, means there is about a 95% chance of dying in the next three months. So the list sets up that the higher the score, the higher you are on the list.
Logan Shannon's husband Derek, was diagnosed with a rare liver disorder, and was initially given a very low MELD score. However, after a few years of monitoring, he suddenly became very ill, and was put on the transplant list, at which point Shannon donated a portion of her liver to him. When that ultimately did not work, Derek was put at the top of the transplant list, because his MELD score was high, and he received a non-living donation 28 days later. You can hear their full story here.
There are similar, but different, types of medical criteria that are used for each of the organ systems that a patient might be waiting for, so it does look a little different for those waiting for hearts, for those waiting for kidneys.
Medical priority is obviously incredibly important because we want to maximize the number of lives saved. . .In our system here in our country, age is not one of the criteria. [We use] medical criteria, so that we can move away from any kind of judgment of societal worth, or any other area that would really be a slippery slope for us.
What makes a non-living donor viable for donating organs?
Two to three percent of deaths are clinically eligible for organ donation. And there's a number of reasons for that, both in terms of the medical conditions that individuals have at the time of their death that might rule them out, for example, malignancies or cancers of some type. And also, maybe the manner in which they died. So for an organ donation to be successful, we're really talking about individuals who have traumatic brain injury, either from an organic cause like stroke, or an accident, and are in the hospital on ventilator support so that their organs remain viable for transplant. That's a fairly small number.
Is age or health a factor in whether or not a person can donate organs?
Don't rule yourself out. That's what we like to tell people, that in fact, we are able to successfully save lives through transplant with our transplant partners for donors that are well into their seventies or eighties. And it's so important that individuals that believe in organ donation and what that legacy for themselves, to save lives after they die, to not rule themselves out.
One thing [Derek and I] do every year is we go to the Vans Warped Tour and talk to kids at the concert about the power of organ donation. But the thing about that is that we talk to a lot of parents [too]. . . And I've had so many people come up to me and say, 'Oh, I can't be a donor, I'm on these medications, I'm on a heart medication,' and the point that we always make is: signing up to be an organ donor doesn't mean you're going to be an organ donor. It means that you want to be a hero. . . Doctors will figure out whether or not that's okay, or whether or not [a donation] is going to work out.
Do conditions like Hepatitis rule someone out as a donor?
Listener David from the Lakes Region asked:
I am in my sixties, and I have a very good, healthy lifestyle. And I wanted to fill out the paperwork that was involved in organ donation, but the one problem I do have is that I am Hepatitis C positive. So I question whether or not that is viable, and whether it is still possible to donate.
There's evolving standards of medical suitability. . . While Hepatitis might have been ruled out years ago, it most certainly is not today. And in fact, I can tell you here in New England, we routinely recover donated organs from individuals who are Hepatitis positive. However, there are protocols underway now to expand that to candidates waiting who are Hepatitis negative. The reason why is because there has been so much advancement in treatment and cures in some instances of Hepatitis that the transmission of that disease as a risk for a candidate waiting for a transplant really pales in comparison of their potential risk of dying.
What is a "kidney chain?"
[In an instance where] a willing living donor may be incompatible with the individual they would like to donate their kidney to, the concept is relatively simple. . . Let's take a group that is in that same circumstance, and try and match up through a chain, so to speak, so that everyone get's a compatible kidney. And this has been a great innovation in the field, it actually started here in New England more than a decade ago, and it's picked up speed. But it's important that people know that this is an option. So if you need a kidney transplant and you have a willing donor that's not compatible, it's a great opportunity to expand that gift.
Additional Links and Information
Sign up to be an organ donor at OrganDonor.Gov.
Find information to become a living donor here.
Register to be a donor on your Apple iPhone.