Organ transplants reclaim lives

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Amy Luxnor, age 33, has been living with a transplanted heart for 7 1/2 years, and "I plan to live to old age," she said in an interview. She needed the replacement because hers became infected with inherited tumors.

Pearl Lambert, 56 years, in 2002 received a chunk of her daughter's liver, and says she is doing very well. Daughter Vicki, now 39, said, she has had no ill effects: "I am very healthy."

Organ transplantation is a medical marvel that warrants more attention. Last year a record of 27,033 transplant operations topped 2004's number by 10.8 percent. A new record is expected in 2006, judging from the organ donations through May, said Cindy Speas, director of community affairs, Washington Regional Transplant Consortium. Survival rates have risen as well as operations.

A major problem exists, however, in that significant organ shortages prevail. More about that in a moment.

Since 1954, when kidney transplants gave life to dying patients, doctors have learned to transplant other organs, and "surgical techniques have pushed the envelope to provide living donor transplants," to quote Amy Lu, M.D., director of kidney and pancreas transplantation, Georgetown University Hospital. Preservation solutions enable organs to be stored and moved across state lines, she added, while improved medicines "keep the patient and graft alive for much longer. Rates of rejection are less than 10 percent compared to 50 percent" years ago. Credit improved antibiotics, too, with raising survival by controlling infections.

Physicians today have an expanding arsenal of meds from which to choose the best for a particular organ and particular patient, says Randall Morris, M.D., director, Laboratory Transplantation Immunology, Novartis Pharma AG, Basel, Switzerland.

To illustrate, cyclosporine, which debuted in 1983 as Sandimune, is now available in several versions having different bioavailability. One called Neoral, may increase the risk of infection but has been connected to fewer incidents of diabetes in kidney transplant patients compared to Prograf (also called tacrolimus).

Diabetes is a leading heart disease risk in transplant patients. CellCept (micophenolate mofetil or MMF) fights rejection in a different way than cyclosporine, and the two may be used together when there is a high risk of organ rejection. In kidney patients, however, CellCept can cause gastrointestinal side effects, and myfortic (mycophenolic acid or MPA), approved in 2004, might be chosen instead, since a study reported July 2006 linked it to a reduction in GI symptoms and severity, notably in African-Americans. Ongoing research promises to yield drugs that will be more effective in lower doses, will be needed for shorter periods and will have fewer side effects.

Now we come to that obstacle of too few organ donations. Patients often wait months, even years, for a chance at recovery -- and sometimes can't hold on. Amy Luxnor was on the top of the waiting list, yet spent eight months in the hospital on a so-called Left Ventricular Assist Device until a heart became available from a 13-year-old boy who died in a car accident. An estimated 92,000 people are waiting for an organ transplant and 18 will die while waiting, reports the U.S. Department of Health and Human Services.

Only two-thirds (62 percent) of U.S. adults wish to donate at least one of their organs or tissue, according to a survey by Donate Life America (formerly the Coalition on Donation), an alliance of organizations seeking to inspire more individuals to promise to donate body parts after death. The coalition sponsors educational campaigns that strive to allay fears and answer questions -- explaining, for instance, that an open casket funeral is possible for an organ donor.

Apparently everyone -- regardless of age -- has at least one body part that can be salvaged. Consider Jessica Ward, who died at age 19 of a seizure disorder she had from birth. She could not give major organs "as her heart had stopped," explained her mother Jeanne Ward. "She donated arteries leading to the heart for patients with congestive heart failure; the pericardia [the sac the heart sits in], which is used for patients with brain surgery to cover the opening for that; bones in both arms from the wrist to the elbow, and her leg bones. She also donated her Achilles tendon and skin for burn victims."

The agency through which the donations were made and distributed reported, "Jessica helped 23 lives in various states," said Mrs. Ward. "That helps us because Jessica was a loving and giving person. My husband and my daughters were so glad to know someone else's life was saved or enhanced by her donations."

Several Web sites provide good information about how and why to donate organs: ustransplant.org, unos.org, donate-life.net, hrsa.gov.

Goody L. Solomon is executive editor, FNH News Service.