Transplants, once medical miracles, are now routine

Close to half a million people in the United States have had an organ transplant. Millions have had a tissue transplant: skin, bone, corneas, heart valves, tendons. Yet, although transplantation is an everyday procedure in hundreds of hospitals around the world, public opinionstill treats it as though it were on the fringe of medicine. Few people think about it at all until they become personally involved. It then takes over their lives. The sobering fact is that any one of us could need a new organ or tissue to save our lives -- and virtually every one of us could be a donor. Many people who become involved are ordinary men, women and children who one day were told that unless someone donated a new heart or liver, kidney, lungs or pancreas they could not expect to live much longer. At that moment, they realized, perhaps for the first time, that probably someone else would have to die to give them the organ they needed. Some of them have been sick all their lives, never knowing a normal day, going in and out of hospitals and aware that the end could come at any time. Others, including some world-class athletes, are seemingly in perfect health but are struck down without warning by a virus. Some are people whose lives, though not threatened, are miserably constricted or in chronic pain: blind, suffering from severe burns and bent spines, unable to walk or pick up their children. Into their world comes transplantation like a lifeline, some would say a miracle. It is not simply the best cure. For most of them it is the only cure. And because of the rapid advances in medical science, more and more people can benefit from it – sicker people, older people and people with more complex problems. It is the most egalitarian of cures, leaping over all the normal social barriers. White men are walking around with black men’s hearts inside them and vice versa. Asians are breathing through Hispanic lungs and vice versa. And -- dare I say it? -- Democrats see the world through Republican corneas and vice versa. Transplantation is not a cure-all. As with any surgical procedure, complications of all sorts are possible, the powerful medications that recipients have to take so the body will not reject the new organ can have serious side effects and patients, who were sick enough to get to the top of the long waiting lists, have often developed other diseases that undermine their health, regardless of the revivifying effect of the new organ. Even so, the results are astounding. However many times it happens, an inert organ, that has been taken from someone already dead, and springs suddenly into life in another dying body, still seems to most of us to have more in common with science fiction than regular medicine. Success rates have generally advanced steadily year by year and dramatically over the decades. Results vary widely depending on the organ but about 95 percent of patients who have had a kidney transplant are alive after one year, 80 percent after five years and 60 percent after ten years. About 90 percent of heart patients are alive after one year, 75 percent after five years and 55 percent after ten. For lung patients the figures are 85 percent, 50 percent and 25 percent. Given that all these people were terminally ill, that many were close to death at the time of their operation and that, over the years, some proportion of them will die from unrelated causes, the distance transplantation has come speaks for itself. The waiting lists are the most obvious indicator of the distance it has still to go. The people on those lists live perpetually on the edge, always aware of a winner-takes-all race between a wasting disease and a cure over which they have no control. Every day 22 of them die. In mid-2015 around 120,000 are waiting for an organ, compared with fewer than 20,000 twenty years earlier. But seen from another angle, those ever-lengthening lists are a measure of the progress of transplantation. As techniques have improved across the board, demand for the procedure has skyrocketed, moving it in a few decades from experimental to common therapy. The limiting factor, always, holding up everything, is the shortage of donated organs – and that limitation is a recurring theme of this blog.