WILL ANY ORGAN DO?
July 19, 2005
Transplant surgeons are now using organs from just about anyone -- drug users, the obese and the very ill -- placing them in the midst of a myriad of complex medical and ethical questions, says Gretchen Reynolds (New York Times Magazine).
In the early 1990s, 20,000 people in the United States were on waiting lists for organs; today, 88,000 are and the number of donors has not come close to keeping up the pace. Last year, only 20,000 transplants were completed and on average, 18 people on waiting lists die every day.
Due to this increased need, surgeons have abandoned their strict list of qualifiers -- young age (between 15 and 45), average weight, a history of healthy behavior and no diseases -- for more lenient ones:
- They now accept lungs from people who smoke, hearts and kidneys from those who had high blood pressure or had been obese and organs from alcoholics and drugs users.
- Age and a history of infectious disease are no longer automatic disqualifiers.
- Additionally, marginal (extended criteria) organs -- ones that come from a deceased person over 60 or one over 50 with two of three characteristics -- stroke, hypertension or abnormal kidney function -- are becoming the majority in organs used for transplants, says Reynolds.
Recent studies found that older kidneys can function almost as well as younger ones, but a United Network for Organ Sharing (UNOS) report found that they just don't work as long; about a third of extended-criteria kidneys fail within three years.
So, should a patient be told that the organ he is about to receive is marginal? The answer is not clear, but New York's Department of Health is examining the use of marginal organs and formulating recommendations about what a patient should be told and what kinds of organs should be allowed.
Source: Gretchen Reynolds, "Will Any Organ Do?" New York Times Magazine, July 10, 2005.
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