Wednesday, March 23, 2011


We all know what the word ‘transplant’ means, but what exactly does it entail? I’ll try to explain the process without putting you to sleep.

Dr. Christiaan Barnard performed a successful transplant on a black woman in South Africa in 1969. She lived twelve years and six months with her new heart. In 1967, Dr. Barnard had first tried several heart transplants but the patients died. For many years the effectiveness of transplants was debated. Then, in 1981, Dr. Starzl (my hero who transplanted me in 1984) championed the anti-rejection drug Cyclosporine. Prior to then, rejection occurred almost 100% of the time. The way to stop rejection was high levels of steroids, which ended up killing the patient. Once Dr. Starzl found the solution to keeping patients alive (Whew! Am I glad…), other transplant centers came into being, and with it a need for regulation (1984).

All transplant candidates have been evaluated and suffer from confirmed end-stage organ failure. At that point they are placed on ‘the list.’

The list, that mysterious word every transplant patient pronounces with pathos, becomes the first step on the long road to an operating room. The list is kept in Richmond, VA at a place called the United Network of Organ Sharing (UNOS), a complex national bank of organ data, which it collects and manages. UNOS operates twenty-four/seven, continually updating and changing the list as information becomes available.

Being on the list is not a linear thing. One doesn’t get a number and wait in line. The list is actually a pool functioning according to patient data. This patient data is regularly modified to ascertain placing on the list. A score called Model for End-stage Liver Disease or MELD score is one of the many criteria used. It’s based on certain levels in a candidate’s blood test: the worse the levels, the higher the score. This information and other such as organ, blood type, tissue, size and match will determine the candidate’s position.

But wait…there’s more. UNOS, the headquarters of the list located in Richmond has tentacles. They’re called OPOs or Organ Procurement Organizations, to be precise eleven of them scattered throughout the United States. These organizations see to it that donated organs from their specific region get used at their transplant centers first. If an organ cannot be used in their region, then it goes to the next closest OPO region. Should it not be needed, the organ will be free for distribution to any other transplant centers in the country. The reality though, is that the majority of organs are used in their OPO region. Because the list is a pool, patients’ waiting time varies. All things being equal, it’s the patient with the greatest need that will be transplanted first.

Are you still with me?

The average waiting time for a heart is from three to eight months, a liver eight to fifteen months, a lung fifteen months to two years, a kidney three to five years. Currently there are between 80,000 and 100,000 people waiting for an organ. On average, eighteen people die every day waiting. 15,000 people are added to the list yearly.

There are plenty of horror stories out there with respect to organ retrieval. I should know. My husband was offered a script about steeling kidneys in India. I’m glad he didn’t make that movie. To be fair, the script was exciting: the topic lends itself to an action flick. But when I read it, the flaws were too obvious, which, for someone like me, is unacceptable.

Transplant myth A: “If you die, your organs will be taken without your consent.” You cannot take an organ from a dead person. If the heart has stopped beating and oxygenation of the body has ceased, so has oxygenation of the organs. Organs can only be retrieved from the certified brain-dead. That person has zero or very little brain activity, and therefore, is a corpse with blood flow and oxygenation of the organs. There is no recovery from brain death. Period.
More recently ‘non heart-beating organ donation,’ is experiencing resurgence. If you’re in the hospital and have a directive to become an organ donor, after your heart stops and you are proven dead (checks and balances) your organs are retrieved before they deteriorate. This practice has helped narrow the gap between donors and recipient.

Transplant myth B: “There’s a black market out there for organs.” The United States does not have an organ black market. There are no hidden, fully equipped, sterile, state-of-the-art operating rooms floating about where people are kidnapped and anesthetized to harvest their insides. Everything regarding transplants of any kind, be it living donor, tissue or organ is regulated and verifiable.

Transplant myth C: “If I say I’m a donor and I’m in the hospital they might let me die.” The person who came up with this conspiracy theory has obviously never been in a hospital. Need I elaborate more than to say that doctors, nurses, orderlies, more nurses and more doctors pass through your room at all times? The likelihood of something getting past them is as unrealistic as a mother committing suicide to give her remaining kidney to her daughter. The script definitely needs a rewrite.

But, forget the myths and the regulations. None of it would mean a damn thing if not for the most important component to organ transplants, which is…(drum roll…) organ donation. And here the scariest statistic of all: practically every American adult (98%) has heard of organ donation, however, only 30% take the trouble of becoming donors. All you healthy people out there, this is your chance for greatness. The gift of an organ is a purely altruistic and trusting act. It comes from a place of generosity and caring for your fellow human. Whether you are a living donor, or a deceased one, the decision to donate organs is by far the kindest and humblest accomplishment in your life. 

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