Preservation drugs could produce more than 2,300 new organs for transplant

Tuesday, April 30th 2002, 12:00 am
By: News On 6

WASHINGTON (AP) _ More than 2,300 additional organs could be available for transplant each year without recruiting new donors, researchers said Tuesday. The key: a trio of drugs administered to brain-dead patients that help preserve the organs.

The drugs allow transplant programs to retrieve more usable organs from each existing donor, according to a review of 18 months of data comparing donors who were given the drugs and those who were not.

``There's a lot of effort being placed at getting more donors. Another way to get more organs is to see if you could get better utilization out of the existing donors,'' said Dr. Myron Kauffman, a medical consultant to the United Network for Organ Sharing.

Last year, 6,083 patients died waiting for transplants, network officials said Tuesday. Theoretically, one-third of them could have received transplants had the drugs been universally used, according to the research presented at the American Transplant Congress.

``That's a phenomenal number of organs nationally,'' said Ed Kraus, director of organ recovery for the Upstate New York Transplant Services in Buffalo. His organ bank uses the drugs, but typically only for trauma victims.

``I suspect this paper will have very far-reaching effects,'' he said. ``Will it change and become the national standard? I wouldn't be surprised if it did.''

At issue is the use of hormonal resuscitation drugs, which were first recommended in the late 1990s by a British heart surgeon who found they helped preserve hearts.

The drugs are administered after patients have been declared brain dead and their families have agreed to donation. When someone is brain dead, there is no brain activity, no chance of recovery and the person is legally dead. But machines can keep the heart beating and blood circulating to preserve the organs until they can be removed.

Researchers examined all brain-dead donors between January 2000 and June 2001 and found 584 had received the drug trio and 8,185 had not.

Transplant programs will use any organs that are medically suitable. Those who had received the drugs donated an average of 3.8 organs; for those who didn't, the average was 3.1.

Researchers extrapolated the difference in donation rates for each organ to all 5,921 brain-dead donors in 2001, adjusting for differences including age, gender, race and cause of death. They found that applying the higher donation rates to the entire group yielded an additional 2,362 organs.

Specifically, it produced 924 more kidneys, 278 hearts, 290 livers, 414 lungs and 456 pancreata.

``There's no reason why it couldn't be used theoretically on every donor,'' Kauffman said. ``We hope by getting the message out with this presentation that it will be used more widely.''

The only downside is money: The drugs cost $2,000 to $3,000 per donor. The costs are added to the other expenses involved with procuring organs and charged to the transplant recipients and their insurers.

``When you consider the costs saved by transplantation, that's just a drop in the bucket,'' said John D. Rosendale, a lead researcher and biostatistician at the transplant network.

He said the study makes it clear that the drugs have not been widely used, with just 6 percent of donors getting them in 2000 and the first half of 2001.

The drug combination, known as the Papworth Cocktail, includes a hydrocortisone bolus and infusions of vasopressin and tri-iodothyronine. Together, they prevent cell linings from inflaming, improve cardiac function and stabilize blood pressure.

The decision to use the drugs is typically made by the organ transplant coordinators who arrange for donations. All organ banks use the drugs at least on occasion, but it may be difficult to persuade them that they need to use them more often.

UNOS spokeswoman Anne Paschke said the network plans to publicize the results in publications and mailings aimed at transplant coordinators and others.

Lynn Driver, executive director of the Indiana Organ Procurement Organization, isn't convinced that his organ bank should use the drugs more often.

``I think we're doing a fairly good job in knowing when to use it and when not to,'' he said. ``Sometimes it works, and sometimes it just doesn't work.''