Linking Donors To Save Lives

Today I caught notice of a local newspaper article about donors linking together to save lives. Intriqued, I read the article and was quite amazed. It was about a local man who needed a kidney transplant and his sister was more than willing to donate her kidney but she turned out to not be a good match. So, they entered into this kidney chain.

This pay-it-forward kidney donation chain works to match living donors with those in need of a kidney transplant. Rising rates of diabetes, hypertension, obesity and longer lives has resulted in more kidney disease, making it the most-needed organ for transplant.

Photo Source: United Network for Organ Sharing
Theorectically, these chains could go on forever, but typically include a half-dozen pairs. Some chains end when the last willing donor has type AB blood. Participating in a donor chain provides many more chances...as long as you have a healthy friend/family member willing to share their kidney.

The national waiting list, in 2009, showed 16,831 kidneys were transplanted nationwide, 62 percent from deceased donors and 38 percent from living donors. Living donors must pass alot of tests but their kidneys transplant better than cadaveric kidneys.

What about the living donor? Live donors can live fine with just one kidney. If illness or injury does hurt a living donor's remaining kidney, they then move to the top of the list of people needing a kidney tranplant (a guideline set by the United Network for Organ Sharing). The surgery is minimally invasive with tiny incisions made in the lower abdomen wall, resulting in a much less needed hospital stay.

For more information:
United Network for Organ Sharing
www.transplantliving.org/livingdonation

Alliance for Paired Donation
www.paireddonation.org

National Kidney Registry
www.kidneyregistry.org

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Dr. Egan Receives $1.47 Million Grant For Lung Transplant Research

Wednesday, October 14, 2009 — The National Heart, Lung, and Blood Institute has awarded Thomas M. Egan, a professor of surgery at the University of North Carolina, a $1.47 million, two-year grant for research on perfusion and ventilation of lungs outside the body before transplant. The research could lead to a significant increase in the number of lungs available for transplant.

Thomas M. Egan, M.D., M.Sc.
Dr. Egan, a surgeon in the UNC Division of Cardiothoracic Surgery, is internationally known for his research on lung transplantation, which has been under way since he came to UNC in 1989 to start its lung transplant program.

His new grant was awarded under the NHLBI's Translational Research Implementation Program, a two-stage program designed to translate fundamental research ideas into proof-of-concept efficacy testing in patients. This Stage 1 grant is supported by the American Recovery & Reinvestment Act's Grand Opportunities (GO) grants program, for large-scale research projects that the National Institutes of Health says have "a high likelihood of enabling growth and investment in biomedical research and development, public health, and health care delivery." NHLBI is part of the National Institutes of Health.

Dr. Egan's project will perfect a technique to perfuse and ventilate human lungs outside the body (ex vivo) to determine if they are suitable for transplant, and will demonstrate safety of transplanting human lungs after ex-vivo perfusion in a pilot clinical study.

Lung disease is the fourth leading cause of death among Americans. Lung transplantation helps patients with end-stage lung diseases and improves survival, but transplants are critically limited by an inadequate supply of suitable lungs from conventional organ donors – people who have been declared brain-dead after a lethal brain injury and have been on ventilation before a controlled cardiac arrest when organs are retrieved for transplant. Lungs that have been offered for donation frequently cannot be used because lung function in the donor is poor, due to inflammation or infection or fluid build-up (edema) that occur after trauma and emergency treatment.

During transplant, the stopping and restarting of circulation to the lungs can cause ischemia-reperfusio n injury, which damages cells in the lung and leads to problems with lung function after transplant.

Only about 1,400 lung transplant procedures are performed each year in the United States; since 1995, 6,022 people have died while on the waiting list for lung transplants. This week, 1,867 people were on the national waiting list for lung transplants, according to the Organ Procurement and Transplantation Network, part of the U.S. Department of Health and Human Services.

Dr. Egan has designed an ex-vivo perfusion and ventilation circuit in which lungs are placed for evaluation and possible treatment before transplant. Ex-vivo perfusion and ventilation allow for lung function assessment, and also for possible treatment of lungs to reduce ischemia-reperfusio n injury in transplant. Thus, the lungs treated this way could have less graft dysfunction or failure and the transplant recipient could have an improved chance of survival. This would revolutionize lung transplantation, and could have a major impact on other types of organ transplants.

Michael Knowles, M.D., of the UNC Division of Pulmonary and Critical Care Medicine, a collaborator on Dr. Egan's project, called the research project "groundbreaking. "

"I have been involved in lung transplantation from its inception at UNC, and have seen, first-hand, the suffering and unnecessary death that results from the shortage of lung donors in the U.S.," Dr. Knowles said in a letter of support for the research.

The project has support of lung transplant physicians at several other universities as well as from Carolina Donor Services, the organ procurement organization serving most of North Carolina.

For the Stage 1 project, Dr. Egan's research team will use lungs from conventional organ donors that have been declined for transplant because of concerns about lung function, as well as lungs from DCD (donation after cardiac death) donors, patients who are not brain dead but whose next-of-kin have decided to withdraw life support because their condition is so poor. The lungs will be assessed in the ex-vivo perfusion and ventilation circuit.

In a Stage 2 study, Dr. Egan's project will also plan a large multi-center clinical trial to use the ex-vivo lung perfusion/ventilati on system to evaluate human lungs retrieved after death from non-heart-beating donors, patients who have died of sudden cardiac arrest outside the hospital or in the emergency room. Using animal models, Dr. Egan was the first scientist to show that lungs could be retrieved from non-heart-beating donors after death and safely transplanted. His research has shown that lungs are viable for substantial periods of time after circulation stops, because lung cells do not rely on perfusion (circulation of blood or other fluids) for cellular respiration.

Widespread use of lungs retrieved from non-heart-beating donors followed by ex-vivo assessment could provide much larger numbers of human lungs for transplant that may function better and last longer than lungs currently being transplanted from conventional brain-dead organ donors.

Investigators for his project, entitled "Ex-vivo perfusion and ventilation of lungs to assess transplant suitability, " are:

Thomas M. Egan, M.D., M.Sc., Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery (Principal Investigator) , UNC School of Medicine
Peadar G. Noone, M.D., Associate Professor, Division of Pulmonary and Critical Care Medicine, UNC Department of Medicine, UNC School of Medicine
Paul Stewart, Ph.D., Research Associate Professor, Department of Biostatistics, UNC Gillings School of Global Public Health
Eileen Burker, Ph.D., CRC, Associate Professor, Division of Rehabilitation Counseling and Psychology, Department of Allied Health Sciences, and Adjunct Associate Professor, Department of Psychiatry, UNC School of Medicine
Benjamin E. Haithcock, M.D., Assistant Professor, Division of Cardiothoracic Surgery, UNC Department of Surgery, UNC School of Medicine
William K. Funkhouser, M.D., Ph.D., Professor, Department of Pathology and Lab Medicine, UNC School of Medicine
Katherine Birchard, M.D., Assistant Professor, Department of Radiology, UNC School of Medicine
R. Duane Davis, M.D., Ph.D., Professor, Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine
For more information, contact Dr. Egan at (919) 966-3383.

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H1N1 Advisory for Heart/Lung Transplants

In light of the daily media attention and alerts to the spreading flu, it makes sense to provide some information relevant to the transplant community.

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NEW YORK, Oct. 26 (UPI) -- There are additional challenges for cardiopulmonary transplant recipients and donors if they catch H1N1 flu, U.S. researchers say.

Physicians representing the International Society for Heart & Lung Transplantation Infectious Disease Council issued an advisory for all programs in cardiothoracic transplantation that aggressive diagnosis and early treatment need be paired with active preventative measures to stem the impact of infection in the transplant population.

Since transplant recipients are treated with anti-rejection drugs, the advisory provides clear directions for specific dosing of anti-viral drugs and management of the background immunosuppression. Specific guidelines for evaluation and management of post-surgical transplant patients are also given, as well as recommendations for how and when to administer vaccines.

On the donor side, the advisory provides guidelines for how to evaluate and treat donors so that organs can be safely used and not wasted. Finally, it provides specific guidelines for the healthcare teams managing such patients.

"Nowhere is the threat of H1N1 (flu) more real than in cardiopulmonary transplantation", Mandeep R. Mehra, editor-in-chief of the Journal of Heart and Lung Transplantation, says in a statement.

"The ISHLT's Infectious Disease Council has developed what is assuredly the most comprehensive and clinically relevant direction for prevention and management of H1N1 flu in donors, recipients, care providers and family members."

The guidelines are published online in the Journal of Heart and Lung Transplantation.

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Robot Saves Patient's Transplanted Lung

In a first-of-its- kind procedure, physicians at the Methodist DeBakey Heart & Vascular Center used a robotic catheter to save a patient's transplanted lung.

Dr. Alan Lumsden, chair of the department of cardiovascular surgery at Methodist, and Dr. Miguel Valderrábano, chief of the division of cardiac electrophysiology, used a robotic catheter to place a stent in a patient's pulmonary artery when it became severely narrowed after his transplant, potentially damaging the new lung.

Pulmonary artery stenosis or narrowing of the pulmonary artery that carries oxygenated blood from the heart to the lungs, can occur where the transplanted lung is sewn to the patient's own pulmonary artery. Physicians use stents, mesh tubes that are used to prop open clogged arteries, to restore blood flow to the lungs.

The lung transplant patient Charles Brennen was in danger of losing his new lung when physicians could not get the new stent in his artery because it was too twisty to maneuver the stent through the catheter from the groin to the damaged pulmonary artery. Furthermore, the placement of the stent was hampered by the pulsing of the artery due to the beating heart on one end of the vessel.

"I'm hoping that the stent will get more blood flowing to my lungs so I'll have more stamina," said Brennen, an active 72-year old father of five. "I want to get back in shape, do more things."

Brennen is a retired marketing executive who spends time working on the Texas ranch that he shares with his family and sister.

Lumsden and Valderrábano used a Sensei® robotic catheter system designed by Hansen Medical for use inside the heart to successfully reach the narrowed part of the pulmonary artery. The robot allowed the physicians to compensate for the motion of the beating heart, and place the stent safely and accurately, providing the patient's new lung with a ready flow of oxygenated blood. This was the first time in the U.S. that the robotic catheter was used outside of the heart.

Valderrabano used 3D guided imaging to direct the robotic catheter to precisely the right spot to place the stent. With successful implantation of the stent, the patient avoided being placed again on the lung transplant list.

Source: Methodist Hospital, Houston

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The Butterfly: A Symbol of Lung Transplant

I love butterflies and how appropriate the butterfly has also become the symbol of lung transplant. If you have cystic fibrosis, at some point your doctor will discuss with you the need for a lung transplant. It is my hope the following story behind the symbol of newly transplanted lungs will provide you with hope and inspiration as you begin your transplant journey.

The Butterfly: Life has wings...or rather life should have wings. When Cystic Fibrosis damages the lungs with scarring from past infections, and antibiotics no longer give the relief they once did, and the quality of life is stalled, or the length of life is shortened when you are told, "you have only a couple of years left", you want those wings back to fly. Lung Transplantation is the option to get those wings once again and live your life dreams.

For those who are fortunate enough to witness the actual lung transplantation surgery, they will describe it as a moving experience that is emotional and awe inspiring. When the old lungs are removed, appearing much like raw liver, and the new lungs are taken from the cooler they have been transported in, the light pink, white new lungs are in such contrast to the old. But the more breath taking experience is to see the new lungs take life when they are connected. It is described as "like beautiful butterfly wings, opening for the very first time, they expand and you can see the beauty in life and in good lungs".




Like butterfly wings opening for the first time, so is the size and shape of the new lungs...a comparison that has great meaning to those with Cystic Fibrosis who get the gift of new lungs and a chance to live their dreams.

As you consider and journey through transplant, read inspiring stories of transplant survivors. Taking Flight -Inspirational Stories of Lung Transplantation is available through Amazon.

Interested in submitting your personal transplant journey for consideration on our website or blog? I'd love to hear from you! Just contact us for details.

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