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Old Organs Used in Transplant Shortage

Posted on: Tuesday, 13 September 2005, 15:00 CDT

Surgeons forced to use donors they would have rejected previously.

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TRANSPLANT patients are getting organs from old or diseased donors as a chronic shortage bites.

Surgeons have been forced to take organs they would have turned down a decade ago. With fewer healthy young people dying on the roads and about 400 people waiting for organs, doctors are taking what they can get. They say the situation is worrying, but they are careful to manage the risks.

Last year, the age of donors ranged from 14 months to 78 years. Four donors were 65 or older and the average age was 43.

Of the 40 donors, one had type 2 diabetes, nine had a history of high blood pressure, 13 were smokers, three former smokers and three tested positive for exposure to hepatitis B. Organs were provided for 114 people.

"It is a huge issue," kidney and liver transplant programme director Stephen Munn said.

"We are having to extend the criteria for donors dramatically. Potentially, we are not getting as good-quality organs -- not giving (recipients) as long a life or as good a quality of life. The average age of donors has risen by more than a decade in the past 10 years. It used to be young accident victims, now it's old people with strokes, old fat people with strokes and hepatitis."

In 1998, road accident victims made up 24 per cent of all donors. In 2004 that had dropped to 17.5 per cent.

As well as older people whose organs might not last as long, surgeons are accepting donors with diseases such as hepatitis and diabetes, which can hinder an organ's function.

"Once upon a time we would never have taken the organs of a person with hepatitis C. Now if the liver is only mildly damaged we still use that in a patient with hepatitis C -- it's still better than what they have got."

Doctors try to immunise waiting list patients against hepatitis B, so they can receive organs from donors who have had the disease.

Kidney transplant physician Ian Dittmer said the growing need to use marginal organs was a worldwide problem. He accepted donors he would not have taken four or five years ago.

Surgeons were also transplanting kidneys from much younger, and much older, braindead donors, he said. Instead of rejecting older donors outright, doctors did biopsies of marginal kidneys to see if they were usable.

Surgeons were constantly pushing the boundaries to use every organ possible, and in some cases might have gone too far. But in others the developments were positive -- they could accept kidneys from children as young as two.

Auckland Hospital audits all its transplants, paying special attention to failures. Surgeons were careful to manage risks, Dr Dittmer said.

Heart transplants appear to be less affected. Heart transplant unit cardiologist Peter Ruygrok said the average age of heart donors had remained fairly static from 1993 to 2004, at 30 to 35. But every case was different. "If you have a critically ill person who is going to die tomorrow, and you get offered the heart of a 60-year- old person, you might well take it."

Professor Munn said it was too early to tell if the changing donor profile was affecting survival rates. Everyone agreed action was needed to improve donor rates, but attempts to increase consents -- including a plan to set up a donor register -- were unlikely to be enough.

Source: Dominion Post

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