TRANSPLANTATION : WHO GETS WHAT , WHEN and WHERE
by KATHRYN VANCE
On April 12 , 2022 , the Cato Society held its monthly meeting and Dr . Charles Oberst , Chair , welcomed Dr . Sandy Florman to speak on transplantation . Dr . Florman is a Charles Miller , MD , Professor of Surgery and Director of the Recanati / Miller Transplantation Institute at the Mount Sinai Health System in New York .
The history of successful transplants is relatively young - the first kidney transplant with a live donor was in 1954 and the first deceased donor kidney transplant was in 1962 with lung , liver and heart transplants coming soon after . The first successful hand transplant ( done right here in Louisville ) didn ’ t come along until 1999 .
Every year more and more people are waiting for a transplant , and we can ’ t keep up with demand . Over the last 40 years , the number of donors has increased 4x , but it ’ s not enough . As of April 2022 in the U . S ., there are 90,000 + people waiting for kidneys , 11,000 + waiting for kidneys , 3,000 + waiting for hearts , and thousands more waiting for other lifesaving organs . The harsh reality of this disproportionate growth is that in 2021 , over 6,000 patients died while waiting - an average of 17 people every single day .
Dr . Florman specializes in transplants of the abdomen , so we first looked at kidney transplantation . Transplant success rates are outstanding ; the one-year survival rate from a deceased donor is 96 % and from a living donor is 97 %; at five years , it ’ s 85 % for a deceased donor and 90 % for a living donor . Interestingly , kidneys from deceased donors only last about seven years , while live donor transplants last about 15-20 years . In the U . S ., where you live makes a difference in how long your wait time can be for a transplant . In Kentucky , the average wait time is less than 1.21 years , while the wait time in California is about 10 years .
Kidney transplantation is shown to have a positive financial impact on society . In 2019 , kidney disease represented $ 50 billion ( 6.3 % of Medicare budget ) to take care of about 750,000 people with kidney failure . Of that , $ 4 billion was spent on patients who received or currently have a functioning kidney transplant and $ 33
26 LOUISVILLE MEDICINE billion on those getting dialysis . A cost analysis was done showing that dialysis costs about $ 94,000 per year while transplants cost about $ 38,000 per year . Transplant is estimated to have more than $ 300,000 lifetime benefit per patient .
Unlike kidneys , there is no dialysis to keep liver transplant patients alive while they are awaiting a new organ . The liver has the most complex anatomy in the body and variability is the rule , not the exception , Dr . Florman said . Living donor transplantation is common with livers as they can take 20 , 40 or even 60 % of an existing liver to transplant into the patient . Living donors bring advantages such as minimal preservation time and ischemic damage and independence from “ the list .” There are disadvantages as well , though . There is a finite risk of donor morbidity and mortality in an otherwise healthy person , increased incidence of biliary complications , and something called “ small-for-size ” syndrome where the recipient doesn ’ t receive a large enough piece of liver .
Dr . Florman said the next big phase in transplantation will be machine preservation . With this , you can take a liver from a deceased donor and keep it out of the body longer , but more importantly , livers can be reconditioned . Livers that might be too fatty or have some other problem that make them unusable can be put on the machine and reconditioned with medication or other treatment . This is widespread in Europe and Dr . Florman expects it to be widespread in the U . S . within the next five years .
Looking forward , transplantation is growing rapidly . Hand transplants are becoming more common , and some people have even received double hand transplants . Facial transplants are very rare but have remarkable results . There have been about 100 uterine transplants , with 40 in the U . S . Last year , Dr . Florman was part of a group at Mt . Sinai who did the first successful trachea transplant . The world of transplant surgery is continuing to grow and innovate - it ’ s only up from here !
To view this presentation or other programs from the Cato Society , please contact Kimberly Risinger at kimberly . risinger @ glms . org or 502-736-6366 .