The first successful human organ transplant occurred more than 60 years ago. Since that time, transplant has evolved significantly and become an integral part of standard medical care. If you’ve been told you can’t get one, it might be time for an organ transplant second opinion.
The reason: Today, more patients are eligible for organ transplant than ever before. That’s because of recent advances in technology, improved clinical treatments and new medications and approaches to care. These have helped chip away at the barriers that have kept some patients from receiving the organs they desperately need to improve and extend their lives.
We sat down with José Oberholzer, transplant surgeon and director of the Charles O. Strickler Transplant Center, to learn more about the patients who are now eligible for transplant surgery.
Frequently Asked Questions: Organ Transplant
Which organs can surgeons transplant?
Some of the most common organs include the:
- Heart
- Kidney
- Liver
- Lungs
- Pancreas
- Intestines
Who is eligible for organ transplant surgery?
Not every patient is an appropriate candidate for this complex procedure. Physicians and multidisciplinary care teams carefully weigh many factors, including a patient’s age and health status, to determine who should be placed on the waiting list to receive a donated organ.
Patients who are elderly and frail or medically unstable may be ineligible. Cancer or infection may also prevent a patient from being considered a viable candidate for organ transplantation. But we’ve made a lot of progress in recent decades to make organ transplants available to more patients.
Which previously ineligible patients are now candidates for transplant?
Morbidly Obese Patients
In the past, surgeons considered patients who were morbidly obese to be too high risk to undergo kidney transplant surgery. Their doctor required them to lose the weight prior to surgery to decrease the risk for infection and other complications.
The problem, of course, is that weight loss could take years, especially for those patients on dialysis for kidney failure. The delay in treatment increased the risk of death not just for a few, but many; approximately 20 to 30 percent of patients needing a kidney transplant are obese.
Because of the evolution of minimally invasive surgery, kidney and pancreas transplants can now be done with smaller incisions and robotic tools. These improve surgical precision and make the procedure safer for the patient. Once the patient is healthier, they can work to lose the weight.
HIV and Hepatitis Patients
Until the late 2000s, the organ wait list also excluded patients with HIV [human immunodeficiency virus] and hepatitis. However, when new drugs made these conditions more manageable or even curable, physicians advocated for a change in organ allocation and acceptance criteria.
Now, patients with HIV can, if they wish, receive an organ from an HIV-positive donor. Patients with hepatitis B or hepatitis C can donate and receive an organ as well; they may donate to another hepatitis-infected patient or, in cases involving hepatitis C, could even donate to someone without hepatitis. This is possible because hepatitis C is now curable with medication.
Could you benefit from an organ transplant second opinion?
You might be eligible for an organ transplant, even if you were told otherwise. Contact the Charles O. Strickler Transplant Center today.
Cancer Patients
Cancer would also typically disqualify a patient. However, there are two types of liver cancer that surgeons can now treat successfully with liver transplant. If the cancer is confined to the liver, removing the organ and replacing it may cure the patient.
Patients with liver cancer may get a whole liver from a deceased donor or, because the liver regenerates, they can also receive a partial organ from a living donor. Living liver donation is more common today, so these patients have a better chance of receiving an organ.
Is it true that some patients might not be able to get a transplant due to social or financial limitations?
This is one element of organ transplant that we often overlook. Having organ failure and going through a transplant procedure is very overwhelming, especially for patients who lack support or who have limited financial means.
In the past, these patients may have been considered poor candidates for transplant, but now we have programs in place to remove these barriers for patients. At UVA, we have a strong team of social workers and others who work to support patients. No financial or social reason should impede a patient’s ability to get a transplant.
What other advances in the field of transplant medicine do you feel are significant?
There are many exciting things happening. UVA physicians are now transplanting islet cells from the pancreas to help restore a diabetic patients’ ability to regulate blood sugar levels, essentially curing the disease. If the success of this procedure is any indication, in the future, we may not transplant entire organs at all, but only the cells necessary to repair a defective organ.
We’re also making significant progress in lung transplantation. Lungs are easily damaged, so often, donated lungs must be discarded, or there are complications after surgeons transplant the lungs into the patient.
UVA is one of the leaders in the use of new technology called ex-vivo lung perfusion (EVLP). Basically, this device allows us to improve the quality of the lungs by pumping blood or other liquid through them outside of the body prior to transplant.
In the future, we may use this same technology to resuscitate organs while they’re still inside a deceased donor. A lot of patient education will have to occur – and we’ll have to get beyond the ‘creepy’ factor – but this would allow families to fulfill an organ donor’s last wishes and give another patient an opportunity to receive a healthy organ.
If a patient is told he is ineligible for organ transplant, should he seek a second opinion?
Yes. At UVA we feel it is our duty to the community to ensure access to transplantation for all Virginians. If a patient has been told they are ineligible for transplant at an outside center, we encourage them to contact the Charles O. Stickler Transplant Center for a second opinion.
April is Donate Life Month. Learn how to become an organ donor today.