Donating Beyond Bone Marrow

[okarol]

    * HEALTH JOURNAL
    * AUGUST 3, 2010

Donating Beyond Bone Marrow
      By MELINDA BECK

As of 6 p.m. on August 2, 2010, 107,808 Americans were waiting for organ transplants, according to the United Network for Organ Sharing. Living donors who are willing to spare a kidney, a portion of a liver or other organs, are helping to ease the shortage every day.

Being a living organ donor is a far bigger commitment than donating bone marrow or cord blood. "You need to be prepared physically, emotionally and financially," says Michael Murphy, who donated a kidney to his sister in 1991 and later set up a Web site, livingdonorsonline.org, to educate other potential donors. Major surgery is involved. Complications are common, and the donor's own health may be affected for life.

Last year, about 6,600 of the 28,463 organs transplanted in the U.S. came from living donors. The vast majority of those were kidneys; about 200 were liver sections. In rare cases, people have donated a section of lung, pancreas and intestine, though such procedures have declined in recent years.

Some 40 people have even been living heart donors since 1988—but only because they needed a lung transplant, received one as a heart-lung combination from a cadaver, and had a healthy heart to spare.

An organ donor and recipient do not need to be as closely matched as in a bone-marrow transplant, but they must have compatible blood types, and undergo more complex tests to insure the recipient's body won't reject the kidney. This can render even close relatives unsuitable, sometimes at the last minute, because people's immunities sometimes change.

In the past, many transplant opportunities were lost at that point. But, in recent years, new programs are bringing willing kidney donors and desperate patients together in creative ways. These sometimes involve lengthy chains of unrelated donors and recipients. The National Kidney Registry, a New York-based nonprofit matching service, has facilitated 151 kidney transplants since it began in early 2008, including one that included at least 20 surgeries, starting with one California man who gave a kidney to a complete stranger.

In general, donors must be between 18 and 60 years old and in good health, free of high blood pressure, cancer, kidney, heart and liver disease, as well as HIV and hepatitis. But with demand rising constantly, some rules are being waived for eager compatible donors.

Take Bill Freeman, a physician at the Northwest Indian College in Bellingham, Wa., who decided to donate a kidney to anyone who needed it, at the age of 66. Dr. Freeman was inspired by a patient who had saved her sister's life with a kidney donation in the 1980s. His good health and determination eventually persuaded doctors at the Swedish Medical Center, a major transplant center in Seattle, to take him on.

Until a few years ago, a kidney donation involved a major incision in the flank, cutting through muscles and often removing a rib. Nowadays, it is usually done with a laparoscopy, with a few small incisions and much less recovery time, generally one or two nights in the hospital. "I was giving a presentation in San Diego 10 days later, and I flew to Washington D.C. the week after that," says Dr. Freeman.

Earlier this year, he met the Philippine-American woman who got his kidney and their families hit it off. "The satisfaction of helping other people is pretty nice," he said, choking up in a telephone interview.

Still, donating a kidney is a major operation. At least two donors (out of nearly 100,000 since 1988) have died from surgical complications. Some have ended up needing dialysis or have wound up on the transplant list themselves.

Medicare or the recipient's insurance covers the cost of all medical testing, surgery and recovery for kidney donors, but the cost of lost wages, travel and any needed child or elder care while they are recovering can add up substantially. Organ donors cannot be compensated financially, under a 1984 federal law, although some states are considering giving them $10,000 tax deductions.

"Most living donors are ecstatic—they think it's a wonderful thing they've done," says Connie Davis, co-director of the kidney transplant program at the University of Washington and chair of the living donor committee of UNOS, which oversees both living and deceased transplants in the U.S.

"The vast majority of people say they would do it again," notes Mr. Murphy. "In fact, some people say, 'I gave a kidney. Can I give part of my liver too?' My response to that is 'Try blood donation'."

Platelets and other blood parts

Indeed, there's a continuous need for blood donations of every blood type all over the country. Donations of platelets, the portion of the blood that helps it clot, are particularly needed, and can be extremely helpful for patients on chemotherapy or recovering from transplants.

Donors need to be at least 17 years old, at least 110 pounds and in good health. The process takes about two hours. A needle is inserted in one arm, blood is withdrawn and run through a machine that removes the platelets and then your blood is returned to you through the other arm. Your own supply of platelets is replenished in about 48 hours; you can give platelets up to 24 times a year.

Similar techniques are used to donate plasma—another component of blood needed for some transfusions—and red blood cells alone. Call 1-800-RedCross to find local centers and ask about the greatest needs.

Giving after you've gone

There's also an on-going need for donations of organs and other tissues—including corneas, bones, veins, heart valves, cartilage, tendons, ligaments and skin, in addition to hearts, lungs, kidneys and livers—from recently deceased patients. Every day, about 77 Americans receive organ transplants, but another 19 die each day waiting for transplants because there are not enough.

See www.donatelife.net for information about being an organ donor in your state.

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