After a million organ transplants in the United States, changes are needed

After a million organ transplants in the United States, changes are needed

After a million organ transplants in the United States, change is coming

Surgeons work on a kidney during a kidney transplant at Georgetown University's MedStar Hospital in Washington (file photo).   After a million organ transplants in the US, change is coming

The US has had its one millionth organ transplant, but more will be needed in the future

The one millionth organ transplant was performed in the US on Friday, a milestone for Americans who are still desperately waiting for their chance at life extension.

Decades have passed since the first success – a kidney transplant in 1954 – to a million organ transplants.

It was not officially possible to record whether this “anniversary transplant” was a kidney or some other organ transplant. And now, organ transplant advocates have already begun a new campaign to accelerate the “next” million transplants by encouraging more people to register as donors.

At the same time, the national transplant system is at a crossroads. On the one hand, more people than ever are getting new organs: 41,356 last year alone, a historic record. On the other hand, the system is criticized for its policies and outright mistakes, resulting in wasted organs and loss of life.

Discontent surfaced last month at a Senate committee hearing where lawmakers accused the United Network for Organ Sharing (UNOS), a non-profit organization that received a government contract to manage the entire

“While you're sitting around, people are dying,” Senator Elizabeth Warren, Massachusetts, told the organization's executive director when she and other congressmen proposed replacing UNOS.

“UNOS is constantly taking steps to improve organ delivery and equitable distribution. We don't feel we've accomplished our mission until everyone who needs an organ transplant gets theirs,” CEO Brian Shepherd replied.

Other experts say all the hype is a distraction from work already started.

“Everyone would like the system to be better,” said Renée Landers, a medical law expert at Suffolk University who, earlier this year, as part of an independent US government scientific advisory panel, co-authored a plan to change the system. .

This plan, developed by the National Academy of Sciences, Engineering and Medicine, sets a five-year timeframe for improving every part of the complex transplant system, including teams that collect organs from deceased donors, transplant centers that decide which ones use, as well as government agencies that regulate both.

“Focusing on just one aspect of the transplant process is not really going to achieve the goal,” Landers said. “There are many other components of the process, each of which must fall into place.”

More than 400,000 people in the US are living with transplanted functioning organs, UNOS reported Friday. Of the total rescued each year, more than 105,000 people are on the national list, still waiting for a new kidney, liver, heart, or other organ, and about 17 people a day die waiting.

Too often, potentially usable organs are not being harvested from potential donors, and too many hospitals are discarding organs that are in “non-perfect” condition but still could give a good result for the eligible patient, the National Academy report says.

Kidneys are the most sought-after organs, but almost a quarter of these donor organs were “screened out” by hospitals last year for various reasons.

A Senate Finance Committee investigation uncovered additional problems, including testing failures that between 2008 and 2015 resulted in 249 transplant recipients developing disease from donor organs, 70 of whom died. In other cases, organs being transported from one hospital to another were lost en route or delayed so long that they could not be used.

This kind of error should never happen at all, say critics of the system, but these cases still make up a fraction of the tens of thousands of transplants performed over the above period of time.

Solutions to the more common problems – acquiring more organs and ensuring their use – are more difficult, but attempts are being made: kidney transplants increased by 16% last year and by 23% among black patients, due to a change in the order of allocation of organs ordered by UNOS, which now allows kidneys to be sent to more needy (sick) patients rather than offering them first to hospitals close to where they were received.

In July, UNOS ordered hospitals to stop using a certain formula to test kidney function, which may have led to an underestimation of the need for their transplantation in black patients and made their waiting times longer than in white patients with similar conditions.

Some Organ Purchasing Organizations (OPOs) harvest organs from deceased donors at much higher prices than others. The federal Medicare system completed new rules this year that require everyone to do better. Otherwise, inefficient programs may be closed in 2026.

OPOs are reluctant to harvest “imperfect” organs that they know won't be accepted by nearby hospitals. Some hospitals can always refuse, for example, kidneys from donors over 70 years old or from diabetics. Soon, there will be new quality criteria by which transplant centers will track kidney intake.

Dozens of hospitals are already using new computer filters to reject donor offers they are unable to accept. Such triage could allow these donor offers to reach places like the Yale Transplant Center, known for its success with less-than-perfect kidneys, before those organs have been frozen too long to be used.
< br /> “You can't criticize OPO for not being able to regenerate organs unless you start holding everyone involved in the transplant program accountable for the decisions they make,” said kidney specialist Dr. Richard Formica, director of transplant medicine Yale University.

“We need to find ways to encourage people to change their behavior,” he added.