Study: Kidney transplants from cadavers last as long as those from brain-dead donors
Wednesday, July 24th 2002, 12:00 am
By: News On 6
Kidneys transplanted from a cadaver keep working just as long as those taken from a brain-dead patient with a still-beating heart, according to a Swiss study that offers a promising way to ease the severe shortage of donor organs.
Some doctors have long believed that if they wait until a person's heart has stopped to remove the kidneys, the organs will become damaged from lack of oxygen and will not last as long when they are transplanted.
In the first long-term study comparing the two approaches, doctors at University Hospital Zurich followed nearly 250 transplant patients for up to 15 years and found nearly identical survival rates.
At 10 years, 79 percent of patients whose kidney came from a donor with no heartbeat were alive, as were 77 percent of patients whose organ came from a brain-dead donor whose heart was beating.
``That tells us that we should use these `non-heart-beating donors,' absolutely no doubt,'' said Dr. Pierre-Alain Clavien, chairman of surgery at the Swiss university. ``It would save lives for sure. I don't think it will solve the organ shortage, but it will help.''
Other research now under way on the liver, the pancreas and the lungs indicates those organs, too, can be taken from donors shortly after the heart stops. Some transplant centers have already been moving in that direction.
But this study could prove especially influential because it was a head-to-head comparison of the two approaches and was the first to follow patients for many years. It was published in Thursday's New England Journal of Medicine.
As of 2001, only about 2 percent of U.S. kidney transplants were done with organs taken from people whose hearts had stopped.
The United Network for Organ Sharing estimates nearly 53,000 Americans are waiting for a kidney transplant. Fewer than 15,000 each year get a kidney; 2,800 others die waiting.
By using organs from ``cardiac death'' donors, the number of kidneys available could increase up to 30 percent, meaning some 1,000 or more extra U.S. donors a year, experts estimate.
The Swiss researchers studied 244 patients who got transplants at the hospital from 1985 through 2000. Half had agreed to get kidneys from cardiac death donors, under strict rules requiring a doctor other than the transplant surgeons to wait 10 minutes after the heart stops to declare death.
The new kidney did not function properly for a week or two in 48 percent of those patients, requiring temporary dialysis. That happened to only 24 percent of patients whose organs came from a brain-dead donor.
At five years, however, the kidney was still working in 84 percent of transplants involving a cardiac death donor, compared with 82 percent from a brain-dead donor.
Dr. Dorian J. Wilson, a transplant specialist at the University of Medicine and Dentistry of New Jersey in Newark, said kidneys taken from those without a heartbeat may actually be better in some ways.
Animal experiments indicate that during the brief period when the kidney is not getting any oxygen, its cells undergo changes that protect it from the stress of transplantation, he noted.
In 2000, the federal Institute of Medicine recommended that all hospitals and organ procurement groups create policies for transplants from cardiac death donors.
Thirty-five of the nation's 65 organ networks now do such transplants, said Dr. Anthony D'Alessandro, a transplant surgeon and executive director of the University of Wisconsin Organ Procurement Organization.
Mounting evidence from several major U.S. transplant centers shows such transplants succeed _ and not just for kidneys.
``We have transplanted nearly 40 livers, 35 pancreases and eight lungs from cardiac death donors'' since 1993, said D'Alessandro, chairman of the UNOS committee on organ donation after cardiac death. ``There was absolutely no difference in survival.''
Still, for such transplants to become more common, the public, doctors and hospitals must be taught to accept them, Wilson said.