Article title: ORGAN DONATION AND TRANSPLANTATION: NWHIC
Conditions: transplants, kidney failure (type of Kidney disease), liver failure, bone marrow transplant
Source: NWHIC
What is organ
donation and transplantation?
What is the current
status of organ donation and transplantation in the United
States?
Who can be an organ
donor?
What organs and
tissues may I donate?
How do I become a
donor candidate?
Does the donor's
family have to pay for the cost of organ donation?
If hospital staff
knows I am willing to be a donor, will that affect the quality of my
medical care?
Does organ donation
disfigure your body?
How are women and
people of color affected by organ transplants?
Who manages the
distribution of organs?
What is the process
for receiving an organ for transplantation?
How can someone
find a transplant hospital?
What is the
survival rate for organ transplantation?
What are the
barriers to successful organ transplantation?
Organ donation is the gift of life. Medical advances have made it possible to transplant numerous organs and tissues from one human being (the donor) into another (the recipient) to treat life-threatening diseases. In many cases, transplantation is the only viable treatment available. Each year, hundreds of thousands of people are affected by diseases that result in the need for transplantation, yet only tens of thousands of people receive transplants.
In recent years, the science of organ transplantation has made great strides. Unfortunately, however, the process of securing and allocating organs has not matched this progress. Although there are many organizations that work on various areas of organ donation and transplantation, there still is a critical shortage of organs. Here are some statistics:
The number of people waiting to receive a lifesaving organ transplant in the United States has reached an unprecedented amount. There are now more than 76,000 men, women and children on the national organ transplantation waiting list.
More than 100,000 people are waiting life-saving bone marrow transplant.
An average of 15 people die every day waiting for organs that never become available.
Over 85% of the American people approve of organ donation, yet only 35% actually donate.
More than 200,000 people in the U.S. suffer from kidney failure. As of April 2001, there are 48,639 people in the U.S. waiting for a kidney transplant.
More than 60,000 Americans die each year from liver failure. As of April 2001, there are 17,413 people in the U.S. waiting for a liver transplant.
When bone marrow transplantation is successful, it can cure the following diseases: leukemia; immunodeficiency; sickle cell anemia; and certain metabolic disorders.
If families discuss and share their decision to donate, many more lives could be saved.
Experts suggest that each of us could save the lives of six and help as many as 50 people, by being an organ donor.
If you are 18 years or older, you can show you want to be an organ donor by signing a donor card or telling your family members. If you are under 18, you must have a parent’s or guardian’s consent. Relatives can also donate the organs or tissues of someone who has died, even if he or she was under age 18.
The list of organs includes the kidneys, heart, liver, lungs, pancreas, and intestines. Some of the tissues that can be donated include: corneas, skin, bone marrow, heart valves, and connective tissues. It is also possible to donate organs and partial organs while living. Kidneys are the most common organ donated by living donors. Other organs that can be donated while living include partial liver, lung, and pancreas. Living donor organ transplants are increasing in frequency, especially for livers. Living liver donations more than doubled between 1998 and 1999, from 85 to 218.
Indicate your intent to be an organ donor on your driver’s license. You also can fill out a donor card and carry it in your wallet. Even if you sign a donor card or indicate your wishes on your driver’s license, it is important that your family and loved ones know that you want to become an organ and tissue donor when you die. Your family may be asked to sign a consent form in order for your donation to occur. It's also helpful to tell your family physician, lawyer, and your religious leader that you would like to be a donor.
No. The donor's family neither pays for, nor receives payment for, organ and tissue donation. The recipient, usually through insurance, Medicare or Medicaid, pays all costs.
No. A transplant team does not become involved until other physicians involved in the patient's care have determined that all possible efforts to save the patient's life have failed.
No. Donation does not disfigure the body and does not interfere with having a funeral, including open casket services.
People are biologically different and those differences can have significant effects on the risk for certain diseases and the need for, access to, and outcome of transplantation. Autoimmune diseases, such as systemic lupus erythematosus, which can lead to end-stage organ failure, are six times more common in women than in men.
Other diseases of the kidney, heart, lung, pancreas and liver are found more frequently in racial and ethnic minority populations than in the general population. For example, end-stage renal disease is four times greater in African-Americans than in whites, mainly because of higher rates of high blood pressure and autoimmune disease. Asian Pacific Islanders and Hispanics are three times more likely to suffer from end-stage renal disease. End-stage renal disease is increasing rapidly among Native Americans because of a significant growth in the new cases of diabetes. Native Americans also are four times more likely to suffer from diabetes than are whites. Some of these diseases are best treated through organ transplantation; others can only be treated through transplantation.
Members of these ethnic groups and other underserved populations also receive fewer transplants than expected from their numbers on waiting lists. This is partly due to immunologic incompatibility, or the inability of their immune systems to adapt to the new organs or tissues. A person is more likely to reject an organ that is not genetically similar. People of the same ethnicity or race are more genetically similar than to people of other races. Because there is a shortage of organ donations by minorities, this leads to longer waiting periods for transplants for minorities, as well as more deaths. In kidney transplantation, women, African-Americans and children are among the disadvantaged groups. Successful donor-recipient matching plays a large role in the success of the transplant. However, identifying the factors used to match organs to African-Americans, Native Americans and Hispanics lags behind those identified for whites.
Women, the poor, and minorities also are much less likely to complete the steps of examination to get on the waiting lists for organs.
The United Network for Organ Sharing (UNOS), located in Richmond, Virginia maintains the national Organ Procurement and Transplantation Network (OPTN) under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Through the UNOS Organ Center, organ donors are matched to waiting recipients 24 hours a day, 365 days a year. Through its policies, UNOS ensures that all patients have a fair chance at receiving the organ they need - regardless of age, sex, race, lifestyle, religion, financial or social status. UNOS members include every transplant program, organ procurement organization and tissue typing laboratory in the United States. Policies governing the transplant community are developed by the UNOS membership through a series of regional meetings, deliberations at the national committee level and final approval by a 40 member board of directors, comprised of medical professionals, transplant recipients and donor family members.
UNOS sets professional standards for efficiency and quality patient care. It also maintains the database that contains all clinical transplant data. These data are used to improve the medicine and science of transplantation, develop organ allocation policy, and aid scientific research and support transplant professionals in caring for patients. UNOS also raises public awareness about the importance of organ donation and works to keep patients informed about transplant issues and policy.
UNOS has outlined the following process: If you need an organ transplant, your doctor will help you get on the national waiting list. To get on the waiting list, you need to visit a transplant hospital. There, a doctor will evaluate you (based on your medical history, current condition of health and other factors) and decide if you meet the criteria to be listed. Each hospital has their own criteria for listing patients. However, UNOS has developed listing guidelines for some organ types.
You also can get on the waiting list at more than one transplant hospital. UNOS policies permit "multiple listing." However, each hospital has it’s own criteria for listing patient’s and may have different rules about patients listing at other hospitals. There will not be a set amount of time that you wait, and there is no way to know how long a patient must wait to receive a donor organ. Factors that affect waiting times are patient medical status, the availability of donors in the local area and the level of match between the donor and recipient.
When a transplant hospital adds you to the waiting list, it is placed in a pool of names. When an organ donor becomes available, all the patients in the pool are compared to that donor. Factors such as medical urgency, time spent on the waiting list, organ size, blood type and genetic makeup are considered. The organ is offered first to the candidate that is the best match. The organs are distributed locally first, and if no match is found then they are offered regionally and then nationally until a recipient is found. Every attempt is made to place donor organs.
Every transplant hospital in the U.S. is a member of UNOS and must meet specific Requirements for membership. You can use the UNOS Member Directory (http://www.unos.org/Resources/frame_resources.asp?SubCat=mbrdir) to find contact information for a Transplant Program, Organ Procurement Organization (OPO) or Histocompatability Lab.
UNOS defines survival rates as the percentage of patients or transplanted organs that are still alive/functioning at a certain point post transplant. Survival rates are often given at one-, three-, and five-year increments. Survival rates vary for the different types of organs transplanted and can be as high as 90% or as low as 50% for one year. Changes in organ transplantation policy are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advancements. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates.
After an organ is transplanted, the body’s natural reaction to the transplanted organ or tissues is to reject them, a process called immunologic rejection. Rejection is the major barrier to a successful transplantation, and threatens each patient with the loss of the new organ or even loss of life. Rejection occurs when the transplanted organ’s cells, also called graft, try to destroy or reject recipient tissues. Rejection episodes may be mild or severe, and with time, may lead to graft failure or death. Of those awaiting organ transplantation, more than one-fourth of patients have already had at least one graft failure. The current therapy to prevent and treat rejection is called immunosuppression. This therapy, however, has several side effects, including causing an increased risk of infection and cancer. Scientists are searching for better ways to treat rejection.
You can find out more about organ donation by contacting the following organizations:
Division of Transplantation
Health Resources and Services
Administration
(410) 443-8665
http://organdonor.gov/govinks.htm
American Organ Transplant Association
3335 Cartwright
Road
Missouri City, TX 77459
281-261-AOTA
281-499-2315
http://www.a-o-t-a.org/
Children’s Organ Transplant Association
2501 COTA
Drive
Bloomington, IN 47403
1-800-366-COTA
http://www.cota.org/
Coalition on Donation
(804) 330-8620
http://www.shareyourlife.org/
1-888-355-SHARE
National Marrow Donor Program
Suite 500
3001 Broadway Street
Northeast
Minneapolis, MN 55413-1753
1-800-MARROW2 (1-800-627-7692)
(General Information)
1-888-999-6743 (Office of Patient Advocacy
(OPA))
http://www.marrow.org/
National Minority Organ Tissue Transplant Education Program
(202)
865-4888
http://www.nationalmottep.org/
United Network for Organ Sharing (UNOS)
(804) 330-8500 or (888) TX
INFO-1
(888) 894-6361(for an organ specific information kit)
http://www.unos.org/
Publication date: April 19, 2001
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