Let’s start with the sobering truth: There simply aren’t enough organs to go around. More than 114,000 people currently sit on the national organ recipient wait list, and so far this year, only about 21,000 transplants have been performed.
There’s a sea of Americans waiting for a lifesaving organ right now — and the wait could take anywhere from three to seven years. That makes for a ton of daily stress, physical pain and (at a rate of about 20 people per day) death for the many patients waiting for donor organs.
Suffice it to say, when it comes to organ transplantations in the U.S., the disparity between supply and demand is at a crisis level. That’s why the many experts here at Penn Medicine are dedicated not just to performing successful organ transplantations, but to developing innovative ways to expand the national donor pool.
Through various endeavors, such as our living organ donor program, and cutting-edge procedures involving hepatitis C and ex vivo lung perfusions, our Penn experts are making exciting advancements in our overall effort to address the national organ donor crisis.
Hepatitis C — An Unlikely Boon For Kidney Transplants
Effectively combating the organ donor crisis requires creativity. It requires thinking outside the box. And thinking outside the box was exactly what nephrologist Peter Reese, MD, and hepatologist David S. Goldberg, MD, were doing when they came up with the idea to begin transplanting kidneys infected with hepatitis C.
Roughly 500 otherwise viable kidneys are discarded every year due to hepatitis C infections. That’s half a thousand organs thrown out because of one infection, an infection that isn’t as difficult to treat as it once was. With the help of new antiviral medications, doctors can fight Hepatitis C more easily than ever before. They can even treat it post-transplant.
Realizing the groundbreaking possibilities of this idea, Dr. Reese and Dr. Goldberg — along with the support of Peter Abt, MD, and Emily Blumberg, MD — secured funding for a clinical trial wherein patients received a kidney infected with hepatitis C. After transplantation, the patients received antiviral medications to treat the infection.
“All of the patients have reached the one year transplant mark and all have excellent renal function and are free of hepatitis C,” said Dr. Goldberg in a recent Penn Medicine report. At this point, more than 40 of these transplants have been successfully performed.
In fact, the results have been so promising that Penn specialists are now expanding the program to include hearts and lungs extracted from donors who were infected with hepatitis C. At time of reporting, 10 such heart transplants have been performed.
“This research has opened the eyes and raised the eyebrows of people around the world,” according to Rajender Reddy, MD, Medical Director of the Liver Transplant Program. “It’s a huge advancement.”
Procuring More Donor Lungs Through Ex Vivo Lung Perfusions
The lung is one of the most delicate organs in the human body — especially when it comes to transplantations. The moment death occurs in a donor host, the lungs begin flooding with water, which enters through air sacs known as alveoli. If the lungs aren’t procured quickly enough, they’ll become too damaged for transplantation.
That’s where ex vivo lung perfusion (EVLP) comes in.
A therapy designed to mitigate donor organ loss by repairing damaged lungs, EVLP was first performed by Penn’s Edward Cantu, MD, in 2013, and it continues to be a successful means of preserving, repairing and evaluating donor lungs.
EVLP is performed outside the body, after the lungs have been placed in a sterile plastic dome outfitted with pumps, filters and a ventilator, explained Dr. Cantu.
“We take the lung out of a hostile environment and place it in a non-hostile environment,” Dr. Cantu said. Once inside the dome, excess water is removed from the lung, and the organ is treated with a melange of nutrients, proteins, antibiotics, steroids and heparins — all of which help to address various infections, clots and inflammatory reactions.
Within hours, a damaged lung — one that, in the past, may have been deemed unviable for transplantation — is healed and ready for a recipient.
According to Dr. Cantu said, “There are about 400,000 unexpected deaths in the United States every year. If we transplanted just one percent of them, that’s 4,000 lung transplants.” Ex vivo lung repair “has the potential to make a lot of organs available.”
Increasing the Donor Pool With Living Donor Transplants
Waiting for an organ from a deceased donor can be a lengthy and stressful process. Would-be recipients rarely have an idea of when an organ will become available, so they end up living in a state of tense anticipation. Sometimes they live that way for years.
But there’s hope: A living organ donation can offer expeditious relief from life on the national waiting list.
Since 1999, when the Penn Transplant Institute’s first adult-to-adult liver transplant was performed, Penn surgeons have transplanted more than a 100 livers from living donors. What’s more, our surgeons have performed over 1,400 successful living donor kidney transplants to date — more than any other hospital in Pennsylvania.
There are numerous upsides to receiving a kidney or liver from a living organ donor, not least of which is increased long-term survival. On average, kidneys from living donors last longer (15-20 years) than kidneys from deceased donors (10-15 years). There’s also a reduced risk of organ rejection, which is especially true if the donor is a blood relative of the recipient.
Compared to life on the national waiting list, the living donor transplant process is an all-around more streamlined and more convenient experience for everyone involved. Donors and recipients can schedule their operations weeks or months in advance, allowing both parties to make all necessary pre- and- post-op preparations well ahead of time. There’s relief in having this sort of control over an ordinarily uncertain process.
That being said, an unfortunate reality is that some live donors simply aren’t blood or tissue compatible with the friend or loved one who needs a kidney. That’s why Penn established the Paired Kidney Exchange program. When an organ donor and recipient aren’t a good match for each other, the Paired Kidney Exchange program locates another donor pair in the same situation and connects them, which can lead to two successful kidney transplants.
If you or a loved one would like to learn more about how the multi-faceted Penn Transplant Institute can help you in the procurement and transplantation of an organ, schedule an appointment with one of our nationally renowned medical experts.