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Wanted: Organ Donors

An estimated 70 percent of people on waiting lists need a kidney

FRIDAY, April 22, 2005 (HealthDay News) -- A little more than 50 years ago, doctors at a Boston hospital performed the first successful human organ transplant, transferring a donor kidney to a dying man from his identical twin.

It's more than a little ironic, then, to consider that more than 60,800 people today desperately need a kidney transplant but are unable to get one.

It's not a matter of risk. In the intervening years since that first surgery, revolutionary breakthroughs in medicine have increased the survival chances of transplant patients to better than 90 percent.

Instead, it's a matter of supply.

"There's a huge backlog for organ requests, and it grows every year," said Dr. Jim Burdick, director of the Division of Transplantation at the U.S. Department of Health and Human Services. "And the limiting factor, overwhelmingly, is the availability of organs."

That's why the federal government has declared April to be National Donate Life Month, and why doctors and medical experts are pursuing ways to improve the organ supply in America.

About 87,500 people currently are waiting for an organ donation, according to the Organ Procurement and Transplantation Network, a private nonprofit group that links all professionals involved in the donation and transplantation system.

Nearly 70 percent of people on waiting lists are waiting for a kidney. Another 20 percent are waiting for a liver, and the rest are waiting for another major organ -- a pancreas, heart, lung or intestines.

Just one healthy donor can help people throughout the waiting list, Burdick said.

"Donors can help up to seven different people, just with the organs," Burdick said. Even more people can be helped through other donations, such as retinas or skin tissue.

But there is a general reluctance among family members to agree to organ donation when they have learned that their loved one is brain dead. And it's an understandable reluctance, said Dr. Dale Distant, an assistant professor of surgery at the State University of New York Health Science Center at University Hospital of Brooklyn who chairs the Organ Availability Committee at the United Network for Organ Sharing.

"Depending on the locality, just over 50 percent of the families will say no," Distant said. "It's a difficult time. They are upset, they are angry. Organ donation is not high on their list. The amazing thing is that 50 percent say yes, that Americans want to help others at one of the most devastating moments of their life."

A coordinated effort in improving outreach, called the Organ Donation Breakthrough Collaborative, has made major strides in improving organ donations, Burdick said.

The collaborative consists of teams of physicians, nurses, hospital executives and leaders from key organizations involved in organ donation and transplantation. The group has demonstrated that certain practices can help improve the supply of healthy organs available to people in need.

"We have seen an important increase in numbers of donors, particularly in the last year," Burdick said. Donations were up 4 percent in 2003, the year the collaborative began, and up 11 percent in 2004.

Practices that can help a family agree to organ donation may seem minor on the surface but cut deep to the heart of their emotional turmoil.

For example, experts have found that separating the discussion of brain death from the discussion of organ donation can help defuse some of that emotion, Distant said. A doctor would deliver the medical news of brain death, and organ bank representatives would follow up separately with a plea for donation.

"When you separate those two, the discussion of brain death and the request for organs, the success rate is higher," Distant said.

Other potentially helpful tactics can include speaking to a family in a quiet area of the hospital rather than a noisy common room, and assigning representatives who are culturally similar to the potential donor family.

"Those little things make a large difference," Distant said.

Another way to increase the organ supply has been to improve the means by which a person can become a living donor -- for example, by giving one of their kidneys to a relative.

About a quarter of the transplants performed in 2004 came from living donors, according to the United Network for Organ Sharing. That's about the same percentage as in recent years.

Doctors also hope improvements in surgery will make organ donation a less-invasive process and thus less dreadful to the potential live donor.

For example, kidney donation used to involve nearly cutting a person in two, and meant a lengthy hospital stay. Now a kidney can be removed surgically through a small incision about 6 centimeters in length, Distant said.

"Usually those patients can eat the same day and be discharged from the hospital in one or two days following the surgery," Distant said.

More information

To find out more about organ donation, go to the U.S. government's Donate Life Web site.

SOURCES: Jim Burdick, M.D., director, Division of Transplantation, U.S. Department of Health and Human Services, Rockville, Md.; Dale Distant, M.D., assistant professor of surgery, State University of New York Health Science Center at Brooklyn, and chair, Organ Availability Committee, United Network for Organ Sharing, Richmond, Va.
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