Doctors make tough decisions on heart and liver transplants

More than 120,000 people need life-saving organ transplants and each day, 18 of them die waiting for one.

With the need outstripping the supply, doctors have to make tough decisions about who gets a new heart or a new liver and who does not.

Mark Johnson had been married for 29 years, has four kids, and years of ventricular tachycardia. It is a rapid heartbeat that led to sudden deaths, but he would always come back.

His wife, Lori, knew he needed a new heart and fast.

Lori says, "I just knew that he wasn't going to last much longer if he didn't receive a new heart."

Mark's doctor labeled him "sickest of the sick."

Doctor Robert Higgins, Director at the Comprehensive Transplant Center, says, "We kept him in the hospital until we could find the right heart based upon the blood type, the height, and the weight.”

A good organ match is only one of the criteria doctors use to decide on a transplant.

More factors include whether the donor is near the patient, and whether the patient is good at following a medical regiment. The doctor determines whether the patient is urgent and emergent or sickest of the sick.

Mark says, "It was a matter of waiting until you're sick enough to be on the list, but not so sick that, that's uh, you know, that the transplant's not going to help you."

After four months, Dr. Higgins gave Mark a new heart and a second chance.

Dr. Higgins says, "In doing so we save lives, hopefully for 5, or 10, or maybe even 20 years."

However, thousands of people on the list die waiting.

Dr. Higgins says, "Only about 10,000 organ donors are available in the United States. The challenge is there are 120,000 people waiting for life-saving, life-enhancing organ transplants."

With those odds, Mark Johnson feels blessed.

He says, "Just being able to, you know, have a, a heart at this point is, is just beyond words."

Dr. Higgins says it is critically important for good donor candidates to give their organs but adds that tissue donation is needed even more.

Donated corneas, skin, and bone tissue enhance even more lives.

RATIONING ORGANS, RATIONING LIVES
REPORT #2081

BACKGROUND: Organ transplants have been done in the United States since the 1950s. Organs most often transplanted include: the kidney, liver, heart, pancreas, lung, and small intestine. Not everyone is a good candidate for an organ transplant. You are probably not a good candidate if you have an infection, heart disease that isn't under control, a drug or alcohol problem, or another serious health problem. Many of the elements considered in matching organs from a donor to a patient on the waiting list are the same for all organs. These usually include: blood type, body size, severity of the patients medical condition, distance between the donor's hospital and the patient's hospital, the patient's waiting time, and the availability of the potential recipient. However, for certain organs, other factors have to be considered. (Source: www.webmd.com)
HOW ARE HEARTS MATCHED?: Thoracic organs like the heart and lungs can survive outside the body for only four to six hours. So, they are given first to people who live near the hospital where the organs are recovered from the donor. People waiting for a heart transplant are assigned a status code, which shows how urgently they need a heart. If no one near the donor is a match for the heart, experts start searching farther away to spot a recipient. (Source: http://organdonor.gov/about/organmatching.html)
HOW ARE LUNGS MATCHED?: The lung allocation system uses clinical information that include lab values, test results, and disease diagnosis to arrive at a number, which represents an estimate of the urgency of a candidate's need for transplantation and the likelihood of prolonged survival. As for hearts, body size and distance between hospitals are especially important because lungs must fit within the rib cage. (Source: http://organdonor.gov/about/organmatching.html)
HOW ARE LIVERS MATCHED?: People who need a liver are assigned a MELD or PELD score (Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease) which indicates how urgently they need the organ. A donor liver is offered first to the candidate who matches the common elements and has the highest MELD or PELD score first. If the first candidate's surgeon does not accept the organ, then the liver is offer to the one with the next highest MELD or PELD score. Geographic factors are also taken into consideration. However, livers can remain outside the body for 12 to 15 hours so they can travel farther than hearts and lungs. (Source: http://organdonor.gov/about/organmatching.html)
HOW ARE KIDNEYS MATCHED?: Identifying a potential recipient for a donor kidney involves all the common elements. Other factors include a negative lymphocytotoxic crossmatch and the number of HLA antigens in common between the donor and the recipient based on tissue typing. Kidneys can stay healthy outside the body for 36 to 48 hours, so many more candidates from a larger geographic area can be considered. (Source: http://organdonor.gov/about/organmatching.html)
? For More Information, Contact:

Robert S.D. Higgins, MD, MSHA
Chairman, Department of Surgery
John H and Mildred C. Lumley Medical Research Chair
Director, Comprehensive Transplant Center
The Ohio State University Wexner Medical Center
(614) 293-4558
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