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If you or a loved one is facing organ failure, you'll want to learn as much as you can about the complexities of organ donation and transplantation. Whether it's a new kidney or, more rarely, a liver, heart, pancreas, lung, or intestine transplant, your new organ may come from a living donor, or from someone who arranges to donate their organs after death. Today, as many as 165 million people in the United States are registered as organ donors in the event of death, according to the National Cancer Institute. OrganDonor.govA person can donate up to eight life-saving organs: heart, two lungs, liver, pancreas, two kidneys and intestines.
Related: Young black adults at much higher risk of dying after heart transplant
Whether you're on the waiting list or considering organ donation, here's what you need to know about organ transplantation.
1. Transplanted organs don't last forever
Replacing a diseased or failing organ with a healthy transplant can extend life, but transplants have limitations: Transplanted kidneys last an average of 10 to 13 years if they come from a living donor, and 7 to 9 years if they come from a deceased donor, according to the American Heart Association. Ohio State University Wexner Medical CenterMeanwhile, livers function for more than five years in 75 percent of transplant recipients. After a heart transplant, the average organ survival rate is 12.5 years. A transplanted pancreas, when combined with a kidney transplant, will continue to function for about 11 years. And transplanted lungs will continue to function for an average of about five years, although this extends to eight years if both lungs are transplanted, OSU notes.
Before transplantation, organs are tested for common infections and diseases to rule out any potentially dangerous contamination, and while infections are very rare – suspected in about 1% of transplant cases, far fewer are actually found. Centers for Disease Control and Prevention (CDC) “Donors are rigorously screened, and infections can be properly treated,” Dr. Classen said. “There's a risk-reward tradeoff, and the risks are relatively small,” he added.
West Nile virus and rabies are two examples of infectious diseases transmitted through organ transplants, according to CDC data, Classen said, adding that rare cases of transplant-related cancer have also been reported. NBC News According to reports, the organ transplant patient contracted COVID-19 from the lungs of his donor, who initially tested negative for the virus and showed no symptoms of the disease.
Doctors may be able to learn a lot about an organ's infection before a planned transplant. Take Hepatitis C, for example. “Fortunately, Hepatitis C has become a curable disease within the last five years, so we can use organs from Hepatitis C patients and treat the transplant recipient with Hepatitis C medication.”
Related: Signs and Symptoms of Hepatitis C
3. The cost of organ donation can be much higher than you think
Donating a kidney or part of a liver as a living donor can be life-saving, but the process can be surprisingly expensive. Organ donation can mean lost wages from time off work, travel expenses for surgery, and time off work for recovery — costs that Medicare and insurance don't cover. National Kidney FoundationIt is estimated that living kidney donors in the United States incur an average of $5,000 and up to $20,000 in out-of-pocket costs associated with a transplant. Past Reports.
However, according to the National Kidney Foundation, living donors do not have to pay any costs associated with the actual transplant procedure. National Living Donor Assistance Program others Similar programs It can help cover some of the costs associated with organ donation. Additionally, living donors may be eligible for sick leave and state disability leave under the federal Family and Medical Leave Act, and federal employees, some state employees, and certain other workers may be eligible for 30 days of paid leave, the National Kidney Foundation notes.
4. Living organ donation can mean losing your life insurance
Donating your organs as a living donor has the unintended consequence of changing your insurance coverage eligibility. Affordable Care Act Ensuring that you will not be denied health insurance because of a pre-existing condition National Kidney Foundation They note that some living donors report having difficulty finding life insurance or having to pay high premiums.
In such cases, the transplant center may contact your insurance company to inform you that, as a living donor, you are not at increased risk of death from organ donation, and you may be able to obtain life insurance through the insurance company. Living Organ Donor NetworkThis allows organ donors to purchase life and disability insurance in case any complications arise after organ donation.
Related: 9 Questions to Ask About Your Liver
5. Transplant tourism may be dangerous to health and unfair to organ donors
US law prohibits paying for organ donation. Cornell Law SchoolAccording to the World Health Organization (WHO), the sale and purchase of transplant organs from living donors is banned in many countries, but international organ trafficking occurs due to a global organ donation shortage. People who travel to other countries to receive organ transplants may not be aware that donors may be unwilling participants – prisoners, refugees or the poor, previous studies have pointed out. International Declaration on Organ Trafficking“It's illegal in most countries, and although it's permitted in some places, it's risky, dangerous and poorly regulated,” Classen said.
a Research published in June 2017 PLoS One The researchers noted that organ transplant tourism accounts for 10% of global organ transplants and has grown rapidly over the past 20 years. The researchers looked specifically at Taiwan and compared Taiwanese nationals who received kidney and liver transplants domestically with those who received kidney and liver transplants overseas. They found that the overseas group had poorer health outcomes. For example, the five-year survival rate for liver transplants in Taiwan was 79.5%, compared to just 54.7% overseas.
6. Liver transplants don't cure infections like Hepatitis C
According to the data, Organ Procurement and Transportation Network (OPTN)Currently, there are approximately 11,900 people waiting for a liver transplant in the U.S. In 2020, only 8,906 Americans received a liver transplant. optionHepatitis C is one of the leading causes of liver failure in the United States. Cleveland ClinicHowever, if you receive a liver transplant, you may be susceptible to hepatitis C infection once your new, healthy liver is in your body. This is because the hepatitis C virus can continue to circulate in the blood throughout your body, including in the liver.
But because hepatitis C is now curable, most people are treated before transplant, Classen said. WHOAntiviral drugs can cure more than 95% of people infected with Hepatitis C. These newer drugs are expensive to pay for out of pocket, but are covered by most health insurance plans. Paper published in December 2019 American Journal of Managed Care Note.
Related: What to know if you need a liver transplant for hepatitis C
7. In cases of kidney failure, kidney transplants may be a viable option.
If your kidneys are failing, your doctor should discuss the option of a kidney transplant before you start dialysis, she said. University of Pennsylvania School of MedicineHowever, one past study found that one-third of dialysis patients surveyed said they were unaware of the option of transplantation. Patients recalled that important kidney transplant discussions never took place. Be sure to ask about all your options, including transplantation, as studies have shown that people who are informed about transplant options are nearly three times more likely to receive one.
Still, getting a preventative transplant before dialysis isn't easy unless there's a living donor willing to provide a kidney, Classen said. “Typically, most people have to go on dialysis for a period of time before they can get a transplant, because they have to wait for a donor.”
8. Women are less likely to be diagnosed with kidney transplantation or receive a living donor kidney transplant
Although women are more likely to become living donors than men, they are less likely to receive a living donor kidney. Report published in October 2017 Journal of the American College of Nephrology (JASN) For example, in the United States, women make up 37 percent of living kidney transplant patients, but 63 percent of living kidney donors, the report highlighted..
So what's the cause? One reason for this discrepancy is biological. “In the case of kidney transplants, the limiting factor for women is that after giving birth, their immune systems become more sensitive, making it harder to find a matching kidney,” Classen explains. The JASN report also notes that while immune memory is considered an advantage today (especially during the COVID-19 pandemic), it also increases the risk of rejection, making it even harder to find a matching transplant.
Luckily, Classen says, the matching system gives people with highly sensitive immune systems an advantage in the rankings. March 2018 Journal Reports Trends in Immunology They point out that specific treatments that target hormone receptors may help close the gap between men and women in the future.
9. Weight may affect transplant availability
During your appointment with your doctor or transplant center, you may be advised to lower your body mass index (BMI) to below 30. While BMI is flawed and not an accurate measure of health for everyone, your target BMI in this case equates to less than 203 pounds for someone who is 5 feet 9 inches tall. National Institutes of Health BMI CalculatorWhy? A BMI over 30 is a sign of obesity, which can lead to poor wound healing and an increased risk of infection and kidney rejection. National Kidney Foundation “Obese people are at increased risk for surgery, and transplant procedures can be technically more difficult in this group,” adds Classen.
Just remember that your goal should be to lose weight in a healthy way. According to the National Kidney Foundation, it's important to talk to a registered dietitian to make sure you're not missing out on important nutrients or going to extremes that could put your health at risk. Your doctor may also talk to you about weight-loss surgery.
10. Where you live determines your waiting period
Waiting times for an organ transplant can vary from a few days to a few years, and doctors cannot predict the timing of individual cases—for example, the average wait time for a kidney transplant is 3.6 years. OrganDonor.govBut it depends on when an organ becomes available and if it's a good fit for your blood type and body type.
Wait times may also be affected by where you live. Data published in June 2018 American Journal of Transplantation“Some areas, like California and other densely populated areas, have longer wait times,” Classen explained.
Past research It has also been suggested that people living in the Southeast have the highest rates of end-stage renal disease and the longest wait times for kidney transplants in the United States. Other studies The study suggests that people living in New England have the shortest wait times for a kidney transplant, and the researchers point to staffing shortages and the need for more education about transplants for health care workers and patients as factors that could increase transplant rates.
But there is some good news. “A new kidney allocation system is due to be introduced in the second half of 2021, and one of its new features will be [of this system] It will help reduce geographic disparities,” Classen said.
