To help sickest patients get organs, rules evolved

— Since the first successful organ transplants in the 1950s and 1960s astounded the world, there have been numerous changes in the way donated organs are distributed to waiting transplant patients.

Some of those changes met with fears they would reduce access to a limited supply of donated organs for certain patients. But years later, surgeons and transplant officials say the changes have helped make distribution more fair.

“We’re actually pretty happy with the allocation system,” said Dr. Scott Young, medical director of the kidney-transplant program at Baptist Health in Little Rock.

The first successful kidney transplant was in 1954, and the first successful liver and heart transplants were in 1967.

At the time, individual hospitals and doctors sought out organ donors for their patients.

“They identified donors in the local area, and they brought them back and used the organs for their patients,” said Joel Newman, assistant director of communications for the United Network for Organ Sharing.

“A lot of it was very informal.”

Eventually hospitals began to work together, forming the first organ-procurement organizations.

A NATIONAL NETWORK

The Richmond, Va.-based United Network for Organ Sharing started in 1977.

It used computer technology to match organ donors with transplant patients.

In the 1980s, the introduction of the first medication to suppress the immune system changed transplants forever.

Before then, transplants were limited because the risk of a patient’s immune system rejecting a new organ was high.

“The success rates went way up,” Newman said. “A lot of people that would not have ever been considered as transplant candidates were suddenly very good candidates.”

As the number of people eligible for transplants grew, so did the demand for donated organs.

In 1984, Congress passed a federal law to have a national network operated by a nonprofit under contract with the U.S. Department of Health and Human Services.

The United Network for Organ Sharing received the contract in 1986.

EVOLVING RULES

The network has steadily revised how it designates what organs go to which patients, Newman said.

Initially, livers were distributed based on the level of care patients were receiving - such as whether they were in the intensive care unit or a regular hospital room. But each hospital treated patients differently, so judging illness that way wasn’t accurate, Newman said.

When the network proposed revising the rules, many transplant surgeons feared the changes would make it harder for patients to get organs from local donors.

In the 2002, the network began using a formula that uses laboratory tests to determine how sick a patient is.

“In hindsight, that was a great thing,” Young said.

A similar change was made for lung transplants in 2005, when the United Network for Organ Sharing developed a score to prioritize patients based on the severity of their disease.

The next year, the network changed its policies for heart transplants by expanding to a 500-mile radius the area in which hearts could be sent for transplant.

Dr. John Ransom, surgical director of Baptist’s heart transplant program, said if there’s a heart donor in Arkansas, it means that the sickest patients get first priority. If there aren’t any, then the heart is offered to patients throughout the region.

“That allocation is good because it has helped the sicker patients get the hearts first,” Ransom said.

CONSIDERING KIDNEYS

The United Network for Organ Sharing is debating how to revise its rules for distributing kidneys.

Boyd Ward, executive director of the Arkansas Regional Organ Recovery Agency, said unlike organs such as the heart that must be transplanted quickly, the kidneys can last 48 to 72 hours.

“With kidneys, you can cold-store them and ship them to New York,” Ward said.

Newman said the network is trying to determine how best to match kidneys to the sickest patients and those who will live longest after transplant.

“We don’t have a proposal yet - we’re just talking about concepts,” Newman said.

Young, who heads Baptist’s kidney-transplant program, said there are two competing interests.

A younger person may live longer after transplant, but an older patient may benefit more.

For example, a 50-year-old with diabetes and kidney failure isn’t likely to do well on dialysis.

“So if you do a transplant on someone with diabetes, you help them more, but they may not necessarily live longer,” Young said.

Newman said the United Network for Organ Sharing will release a draft proposal this summer.

“The list is trying to determine what is fairest for the whole country,” Young said.

Front Section, Pages 4 on 08/09/2010

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