LOS ANGELES - The number of living donor organs available for transplant has progressively declined over the past five years, according to a new study. In addition, the study showed that for the first time, organs from deceased donors decreased in 2008.
"This decline has resulted in a widening gap between the number of organs available for transplant, and the number of patients who are awaiting a donor organ," said Andrew S. Klein, M.D., director of Cedars-Sinai Medical Center's Comprehensive Transplant Center and first author on the study.
According to the study, which is reported in the online edition of the American Journal of Transplantation, the number of living donors increased every year from 1999 to 2004, but has decreased progressively since 2004. Only the number of living kidney donors increased between 1999 and 2008, but the increases occurred between 1999 and 2004 and the numbers have fallen each year since. Donation of other organs by living donors decreased during that time frame.
At the same time, the number of deceased donors increased each year between 1999 and 2007, but not enough to offset the diminished living donor donations. The increase was most impressive between 2003 and 2006, but reached a plateau in the middle of the decade. In 2008, for the first time, there was a slight decrease from the previous year's donations.
"Ironically, the single largest factor in today's donor organ shortfall is that solid organ transplants have become so successful," said Klein. "Improved survival rates and the expectation that organ replacement will enhance quality of life have encouraged more doctors and their patients with organ failure to opt for transplantation," he added.
The study also identified a number of other factors that are contributing to the organ shortage. These include:
- Disincentives for living organ donation (transplant-related medical expenses if not covered by the recipient's insurance, loss of income while off work after the procedure, potential future insurability issues, etc.);
- Failure to engage the public in developing transplant policies (lack of input from donors and recipients that could result in better patient education, particularly about short- and long-term consequences of organ donation, such as insurability and health risks faced by living donors.)
- Low consent rates for deceased organ donation, driven partly by incorrect perceptions about the donation process, and partly by training gaps for medical personnel who request consent;
- The lack of transparency in disclosing and analyzing performance data for specific transplant centers and organ procurement organizations;
- A limited ability to accurately assess quality of donor organs based on currently available procurement testing. This may lead to discarding potentially transplantable organs.
"This study showed that many people have questions and concerns about organ donation," noted Klein. "Educating the public and improving transparency of the organ donation and transplantation process and performance are critical to narrowing the donor organ gap."
Beyond that, the study concluded, reassessment of high-risk donor definitions, as well as the benchmarks for donor screening, are areas which could potentially improve the safety, quality and volume of organ procurement in the future.
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TRENDS IN LIVING DONATION BETWEEN 2004 and 2008
- Overall, living kidney, liver, and lung donations declined, going from 7,004 in 2004 to 6,219 in 2008.
- Living liver donors in 2008 dropped to less than 50 percent of their peak (524) in 2001.
- There were 58 living lung donors in 1999, but no living lung donors in 2008.
- There were more living donors who were older and who were unrelated to the recipient.
- Percentages of Hispanic/Latino and Asian living donors increased, and African-American living donors decreased.
TRENDS IN DECEASED ORGAN DONATION BETWEEN 2004 and 2008
- The number of deceased donors increased each year between 1999 and 2007.
- In 2008, for the first time in the history of the Organ Procurement and Transplantation Network, deceased donor organs decreased compared to the prior year. The total number of organs recovered from deceased donors in 2007 was 28,405 compared to 27,958 in 2008.
- The percentage of organs obtained from young donors between 6 and 17 years of age decreased, while there was a corresponding increase in donors between the ages of 50 and 64. The percentage of donors above the age of 65 has remained largely unchanged over the last decade.
- Donation after cardiac death has increased progressively over the past decade, from 87 in 1999 to 848 in 2008, a nearly 10-fold increase.
- Substantial resources have been focused on increasing organ donation rates among African-American, Hispanic/Latino populations. Between 1999 and 2008, the number of African-American donors increased from 653 to 1,278 and the number of Hispanic/Latino donors increased from 612 to 1,112. Despite the increase in donors from ethnic groups, it has not kept pace with the growing number of patients from these groups on the transplant waiting list.
Citation: American Journal of Transplantation 2010; 10: 1-14