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Scientific View

Transplants: The Gift of a Second Chance at Life

June 18, 1986|BETTY ANN KEVLES

The journalist Dorothy Dunbar Bromley spent the better part of her 89 years concerned with social issues. When she died last fall her family was not too surprised to learn that there would be no funeral. She had left her body to science (perhaps for use by medical students). Although she was too old to pass on vital organs, she had found a way to give her body to help the living.

Each one of us must come to terms with the fact of his or her own death as well as the deaths of those we love. Some find solace in religion. Others find additional strength knowing that parts of their bodies will sustain or improve someone else's life.

For decades Bromley's gift was the only way to leave our mortal remains for a social good. That was before the era of organ transplants, which began with cornea and kidney transplants. The latter had at first to be donated by a family member with matching blood and tissue type who could still live comfortably with only the remaining kidney.

An Important Development

Then came the development of cyclosporine, a drug that in 70% to 80% of operations combats the body's efforts to reject foreign cells, which was put on the market in 1983. A vast improvement over earlier medications, it enables surgeons almost routinely to transplant hearts, lungs, livers and now pancreas. We are at the beginning of a new medical epoch in which organs from the newly dead of all ages can be "harvested" to help the living.

Yesterday's miracle is become today's entitlement. Americans of all incomes and all ages expect access to this new technology. Unlike citizens of countries like Great Britain, where kidney dialysis is limited to patients under 55, Americans as old as 90 are on dialysis and funds are usually raised for those needing transplants.

Yet there are not enough donor organs to meet the demand. Most come from the bodies of healthy people who died in accidents. "Harley-Davidson" hearts, livers and kidneys, they often come from victims of motorcycle accidents, people who had not expected their own demise.

The implementation of a law mandating California hospitals to advise families of dying patients of the option of organ transplantation has made a big difference. The donor's family does not pay the cost of surgery and receives their loved one's remains to bury as they will. The option enjoys the blessings of rabbis, priests and many Protestant clergy who disavow the use of human remains for "fishing expeditions," that is to say, vague research, but support organ transplantation to save human life.

Fair Selection

The donor's family usually leaves the selection of recipient to the Organ Procurement Network. We are a people that believes in fairness but we are also a nation that worships celebrity and decisive action. We may wait patiently to catch a bus, but should we be in a hurry, many of us will not hesitate to jump the line.

That is what happened last week when two babies, one in California, the other in Kentucky, waited for an infant heart. (These are especially rare as babies do not drive motorcycles, and with the mandatory use of seat-belts, fewer babies are dying in accidents that leave their hearts healthy enough to transplant.)

The California family went public and the Kentucky family did not. Meanwhile, a Michigan family with a dying infant responded directly to the California case, by-passing a procedure that would have taken them through the Organ Procurement Network. With no national procurement procedure mandatory, the Michigan doctor was free to follow his inclination.

The public is left with a skewed idea of the whole system. To begin with, there is no "line." When a patient is judged a candidate for an organ transplant, he or she joins a pool of candidates. This person is not placed on the bottom rung.

Tricky Procedures

Transplants are still tricky. There is still a 1-in-5 chance of rejection. Both patient and donor have their blood and tissue types entered into a computer. Those with the best match are selected, taking into consideration the mental and all-over physical condition of the patient. Thus Mary who may have joined the pool yesterday may have a donor today while Peter, who has been waiting for a month, is still waiting.

The family that goes on TV does not necessarily have the best medical case. It is tragic that in lieu of a national system the choice of who is to receive what in a surgical procedure that is still experimental is decided by an applause meter.

However, the experimental era is passing. Last year the Regional Organ Procurement Agency of Southern California oversaw the transplantation of 22 hearts and 393 kidneys. As more people weary of dialysis machines there will be a greater demand for kidneys. And with the successful transplantation of pancreases, diabetics in the millions are projected to opt for freedom from insulin therapy.

It was lucky that another infant heart became available for the Kentucky baby. In short-cutting the system it is hard to know which baby was a better match, or which was in more dire straits. It is time to implement the Gore Bill that was passed in 1984 and fund a national computerized registry for donor hearts and livers.

As organ transplantation becomes routine, those who would like to be receivers should make preparations to become donors. For the record, heart donors must be under the age of 35; liver donors under the age of 45; kidney and pancreas donors under the age of 50, and corneas are good up to the age of 80. In the midst of grief, many mourners have echoed the sentiments of the Michigan parents who "feel good about giving another child a chance . . . Part of him will live on."

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