Weaker Organs Used to Boost Supply
The Washington Post's Health section today examines the growing use of "old or even defective" organs in transplants, especially among elderly patients, as a "better bet than waiting for an ideal organ that may never become available." Because the demand for transplants exceeds supply by more than a three-to-one margin, surgeons across the country are "implanting donor organs" -- known as extended criteria "organs" -- that "only a decade ago [would have been] deemed too old or damaged or otherwise unusable." Livers with "excess fat from an obese donor," a kidney with vessels that have "deteriorated over time" and hearts that "first need a bypass" are "marginal organs" that doctors once discounted but now consider. The eased transplant criteria stem from recent advances in immunosuppressants, which allow doctors to "target specific parts of the immune system" to increase the chances of a patient's body accepting a donated organ. In addition, improved infection management, more experienced surgeons and "careful selection of organ donors and recipients" have also helped relax the criteria. Although broad research on the relative success of extended criteria donation has yet to be conducted, "most studies paint a promising picture," the Post reports. For instance, Robert Corry, director of pancreatic transplantation at the University of Pittsburgh Medical Center, "reported no significant difference in the survival of 137 patients about two years after they had received either a marginal or 'non-marginal' pancreas at his center."
Many doctors, patients and advocacy groups "cautiously applau[d]" the use of marginal organs as a means to "boost supply." Stewart Van Scoyoc, a lobbyist for the Patient Access to Transplantation Coalition, said, "Anything that will expand the donor pool is bound to benefit patients, and therefore is something we would support." Manikkam Suthanthiran, editor of the journal Transplantation, estimates that the use of marginal organs could reduce demand by about 10% to 15%. The practice, however, has "raise[d] a few ethical flags," the Post reports. In some cases, patients have not been informed that they are receiving marginal organs, according to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. He said, "There are a few programs where you know that older organs and older recipients are being used. But in other cases, if an organ comes from someone who's not quite as healthy or if the organ has been damaged a little bit when taken (from a donor), people just don't discuss it, to put it bluntly." Caplan also is concerned about the "lack of objective national standards to guide the selection and use of all marginal organs," as well as the lack of a system to track the outcomes of patients who receive such organs. "(That) should be mandatory when you're pushing the frontier," he said (Engstrom, Washington Post, 6/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.