The most important fact to know about organ donation is that many people who need a new kidney or liver or heart never get one.
Each day, about 18 people in the U.S. die while awaiting a replacement for a diseased organ that no longer works.
But that fact doesn’t tell the whole story. Organ donation is complicated. It sparks strong emotions and ethical debates. And, while the need for more organs can seem desperate, generous donors and new developments in transplantation give reason for hope.
Here, transplant surgeon Edward Hollinger, Jr., MD, PhD, talks about the acts of generosity on which his work depends. Ranging from the must-know to the quirky, the facts he shared paint a fuller picture of organ donation in America:
No matter how old you are or what diseases you've had, you can register to donate your organs. Only after your death will doctors assess whether your organs might help people who need new ones.
"Years ago doctors would automatically say no to organs from people who were over a certain age or more likely to have health problems," Hollinger says. "Today we look at the relative risk: It's often better to take an older organ that might not last as long rather than wait for a younger organ that might never come."
Most transplanted organs come from deceased donors. But the living can — and do — donate. Because humans have two kidneys and can live with one, giving a kidney is the least complicated and most common kind of living organ donation.
However, you can also donate part of your liver (and, in rare cases, part of your lung).
Transplant surgeons at Rush are experienced in performing split liver transplants, in which one deceased donor's liver is used for two recipients. It is possible to live with only part of a functioning liver. This procedure helps more people receive the life-saving treatment they need, despite a shortage of livers available for transplantation.
Most living donors give their organs to close friends or family members. But some of them give to people they don't know.
This usually happens when someone wants to donate to a friend or relative but is not a good match. "Swaps" or exchanges match two (or more) of these would-be donors with each other’s intended recipient. Exchanges can involve two sets of donors and recipients or a group of several donor and recipient pairs, sometimes at multiple hospitals across the country.
Sometimes, the whole chain starts with an altruistic donor, someone who wants to donate while living without having any connection to a recipient.
Altruistic donors provide a way for a recipient who does not have any medically-appropriate donors to participate in a paired exchange.
This may be the only way that a patient is likely to get a transplant. "You'd be surprised how often people simply feel called to donate an organ," Hollinger says.
What remains makes up for what's gone, so your body keeps working normally. This is one of the reasons that donating a kidney is safe for the donor.
"Donors undergo an extensive medical workup to make sure that their organ function is adequate for donation — not just at the time of surgery, but for the rest of their life," Hollinger explains.
Giving a kidney is the least complicated and most common kind of living organ donation. However, you can also donate part of your liver (and, in rare cases, part of your lung).
Kidneys from deceased donors last for a median of nine years, and kidneys from living donors last for a median of 15 years (although some last much longer). For that reason, some people with kidney disease need more than one transplant in the course of their lives.
These people can end up with three or four kidneys in their bodies because doctors usually don't take the old organs out. (While these organs don't work, they generally don't cause any harm or discomfort, either.)
Some people need more than one new organ at the same time — a heart and lungs, for example, or a kidney and a pancreas. Others need different organs at different times in their lives.
For these groups, surgeons can sometimes transplant different organs at once or over time.
For one thing, new surgical techniques make it possible to remove living donor kidneys laparoscopically (that is, through a few small incisions rather than a single large one). This results in faster recovery.
Another area of change involves the drugs people take after transplant. These medicines aim to stop the immune system from attacking the new organ.
The availability of new drugs allows better individualization of care and decreases the risk of side effects as well as helping the transplanted organ to function better and longer. "But the immune system is very smart," Hollinger explains. "It has lots of ways to attack the organ."
For that reason, researchers have focused on creating drugs that block these different pathways. "Today," Hollinger says, "if the standard drugs don’t work as well for someone, we have many more options."
There is a myth that, if you indicate your wishes to be an organ donor, doctors won’t try as hard to save your life if you are sick or injured. This, says Hollinger, is not true.
"Everyone is treated equally," he explains. "Most treating physicians don't even know about your wishes to be an organ donor when they meet you."
Patients who receive organ transplants are statistically likely to live longer than those who need a transplant but opt for other types of care.
For example, patients who are eligible and receive a kidney transplant are likely to live longer than those who remain on dialysis — and have a higher quality of life because they have fewer restrictions on their daily activities.
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