Living donors shorten waits

[Karol]

Living donors shorten waits

National registry's pairing system can lead to a cascade of as many as 10 transplants at once
 
BY RICHARD WATTS, TIMES COLONIST MARCH 6, 2011
 
While patients in need of organ transplants can wait years for a transplant from a deceased donor, the wait is much shorter if the organ comes from a living donor.

In B.C., the median wait with a living donor in B.C. is 567 days, or 1.5 years, just shy of the national median of 534 days.

Since its formation in 2009, the Living Donor Paired Exchange, a national donation registry, has led to 65 kidney transplants in Canada.

The registry allows people to sign up in pairs -one person who needs a kidney and another, usually a spouse or other family member, who is willing to donate one. The two differ in tissue type so the willing donor can't assist the other, but by signing up as a pair, the two agree to an exchange.

So when the time comes, the willing donor gives to someone else, whose willing donor then reciprocates. Sometimes, the exchange can work in a cascading effect. One willing donor gives to someone, whose partner then gives to someone else whose partner then gives to someone else until a whole group gets a transplant.

Brennan said in one case in Canada as many as 10 transplants took place at once because of the cascade effect.

The program, while successful, does have its limits: It can be difficult to co-ordinate multiple simultaneous transplant operations across the country; and unlike in deceased donor transplants, the donor is alive in this case and can potentially back out.

While the registry currently focuses on kidneys, live transplants can be done for livers and bone marrow as well.

But for Claudia Millett of Metchosin, the donation of a kidney from a live donor has been life-changing.

The 42-year-old, who has had diabetes since she was eight years old, received a donor kidney in October after spending a little more than one year on dialysis. Complications from diabetes sent her into renal failure in September 2009.

Millett's kidney was donated through a paired-exchange -her husband, Stew, whose tissue type made him ineligible as a donor for Claudia, agreed to donate his kidney when a suitable match could be found for his wife.

Health officials never confirmed the identity of the people on the other side of the exchange -but the Milletts did happen to notice another married couple, from Kelowna, in the hospital for kidney transplant and donation at the same time.

Millett says now even her nine-year-old daughter, Alexandra, is delighted with the increase in energy. "She's so happy. I'm more alive. I'm so much better. I don't take naps anymore."

Dr. Jean Shapiro, medical manager for solid organ transplants at Vancouver General Hospital, believes the paired organ exchange program is a key way -along with better management of organ resources and national co-ordination of donors -to increase the number of organs that are being transplanted in B.C.

"[Paired and living donors] has dramatically increased our abilities to transplant people who would otherwise not have been transplantable," said Shapiro. "We know it works, and we've been talking about it for years, but it's just been a matter of getting going enough to push it through."

Q&A WHY WE CAN'T LIVE WITHOUT OUR KIDNEYS

What do kidneys do?

The kidneys are responsible for filtering out wastes and excess fluids from the blood, which are then excreted in urine. They can fail for a large number of nonspecific reasons, such as diabetes, high blood pressure, enlarged prostate, kidney stones, cancer and infections.

What happens when they stop working?

Patients whose kidneys no longer function properly, which is called renal failure, must have their blood artificially filtered, usually through one of two methods: hemodialysis or peritoneal dialysis.

What's the difference between the two treatments?

Hemodialysis involves attaching a patient to a machine through which the blood is circulated and cleansed through filtration and diffusion. In peritoneal dialysis a patient's body cavity is filled with a sterile solution containing glucose.

The fluid is left for a time and it absorbs waste products that diffuse in from surrounding tissue.

With peritoneal dialysis the fluid must be exchanged several times per day. While not as efficient as hemodialysis, it can be done at home by the patient and is often considered more convenient than a trip to a facility with a hemodialysis machine.

What is involved in a kidney transplant?

Doctors began transplanting kidneys in the 1950s and 1960s, and transplants became increasingly common as medications were developed to suppress the immune system response to reject the foreign organ.

The surgery usually takes about three hours and requires a hospital stay of up to a week after the operation.

Patients must take immunosuppresant drugs for the rest of their lives.

Why are kidneys the most commonly transplanted organ?

Doctors say it's not because they are any easier to transplant than other organs, but instead because dialysis has improved sufficiently to keep people alive for years. Artificial devices have yet to be developed that similarly replicate the function of organs like the heart or liver.

Are more transplants being done now than before?

Yes. A total of 295 organs, a record number, were transplanted in 2010 in B.C. B.C.

Transplant also cited records for specific organs in 2010, including: 189 kidney transplants (surpassing the previous record of 172 in 2007), 53 liver transplants (surpassing the record of 47 from 2008), and 10 double lung transplants (surpassing the record of six from 2008).

B.C. has the longest wait times for kidney transplants, but what about other organs?

It's not clear how B.C. stacks up against other provinces in wait times for those other commonly transplanted organs and body parts -such as the heart, lung, liver, pancreas, bowel, cornea, skin and bone -because the Canadian Organ Replacement Register didn't provide that comparison in its report.

Read more: http://www.timescolonist.com/health/Living+donors+shorten+waits/4391782/story.html#ixzz1HCMWqutW