How many transplant organs are damaged by long-distance transit?

November 21, 2006 9:09 PM

How many donor organs (specifically kidneys) are unable to be used for transplants due to damage sustained in transport?

My roommate and I are having a disagreement. She believes that a large number of donor organs (specifically kidneys, but other organs more generally) are unviable for transplant when they arrive at the recipients' hospitals because they sustain damage during long transports. She says that if we were to reform the organ allocation system to reduce transport distances, we would significantly increase the number of successful transplants, reducing the organ shortage.

I have found no evidence for this claim and tend to believe that the organ allocation system is largely efficient in terms of ensuring that organs are viable when they arrive at the recipients' hospitals. I believe that while some organs may be damaged in transport, the damage is not due to transport distance or time in transit. I do not think that reforming the allocation and transport system would significantly impact the shortage of viable donor organs.

Who is more right? Can anyone provide statistics about the number of organs that arrive unviable due to transport distance?

posted by decathecting to Health & Fitness (10 answers total)

This is just a start, but if you look here select "donor" then "all donors" and when the screen comes up change the "organ" tab from "all donors" to "all recovered" you see there were 33,726 organs recovered in 2005.

Then, going back to the original screen here selecting "transplant" and "transplant by donor type" in step two you see there were only 28,108 transplants in 2005.

So, there's a discrepancy of about 5000 organs between recovery and transplantation. I have no clue what that discrepancy is due to, but it's definitely a starting point to know 5,000 organs are discarded after recovery.
posted by jourman2 at 9:49 PM on November 21, 2006

Also, a quick search through google scholar reveals this study that found 27% of hearts were damaged during transportation. There's probably some more random studies about organ transportation out there...but me so sleepy. I used this thread to on google scholar to find that first study maybe you can find another on kidneys.
posted by jourman2 at 10:03 PM on November 21, 2006

She says that if we were to reform the organ allocation system to reduce transport distances, we would significantly increase the number of successful transplants, reducing the organ shortage.

Along with the reduction in damaged organs, you'd also be getting fewer compatible matches since you would be necessarily limiting consideration of donors to those within a certain local radius of the patient. So patients would die waiting from lack of transplant instead of a failed transplant due to the organ being damaged along the way. "Sorry maam, there's nothing I can do about it... but you do live in the middle of nowhere, too bad you didn't live in LA, that hotbed of donors."

I don't see how this could result in a net savings of lives, and if it did, don't you think there's enough on the line (thousands of human lives) that somebody would have implemented it if there was even a remote chance that it might help? Or put another way, isn't the burden of proof on her to show that this crackpot idea is any better than the system that's been tuned and refined for the last 50 years?

Apologies for a content-free answer, and I'm sure you've already been over this in your argument.
posted by Rhomboid at 10:44 PM on November 21, 2006

I believe some techniques associated with cryogenics are also being used to preserve organs. One special on cryogenics showed that the technology exists to completely freeze and later thaw out a kidney (or similar organ) without damaging the tissues. I'm not sure how commonly this is used but when in place it will probably solve the transportation problem.
posted by Deathalicious at 12:30 AM on November 22, 2006

I do know that transport is definitely an issue. I remember hearing a story on NPR three or four years ago, in which they discovered that kidneys are able to survive better than they thought. They had been rejecting kidneys that didn't look healthy from being out of a body too long, and not transplanting them, but they discovered that they heal up very nicely even when they don't look very good when they go in.

So kidneys, at least, may not be as affected by transport as other organs, but until fairly recently, they didn't know that.
posted by Malor at 2:44 AM on November 22, 2006 [1 favorite]

rhomboid, I thought the reform suggested was to add distance as a factor, not the only factor. Currently, if I need a liver, and joe needs a liver, if he's on the list before me, even though I'm 10 miles from the donor, and he's 1000, he'd get it first, even though it increases the chance the liver won't be trasplantable after the journey. This doesn't change the number of transplant recipients, it just shifts the physical location of them. No one is saying, "if no one in 10 miles needs the liver, we're throwing it away, even though we know joe needs it too."
posted by nomisxid at 8:46 AM on November 22, 2006

You'd never throw a liver away, because there would always be someone that can take it. That's not what I was trying to say. I guess what I was thinking was that by making location a more significant factor you bias the equation towards large population centers. A large population center will have large numbers of both donors and recipients, and thus if you factor locality into the equation what will tend to happen is that patients in need of organs in densly populated regions will tend to get them promptly, and people in remote locations would rarely get them. The only time someone in a remote location would get one would be if either there was a local donor that happened to be a match (not likely due to the small population) or if there were no waiting recipients in the big city (not likely either due to the large population.) You'd end up with a few clusters where it would be much easier to get a transplant (LA, NY, New England, Chicago, etc) and a lot of places where it would be much harder. For a system that has always been based on the founding priciple of being as fair as possible based only on medical need and order of being added to the list (for example it's absolutely prohibited that someone could pay to get higher on the list) that seems like an awfully bad change... Rich people could just buy their way into transplants by relocating to large population areas.
posted by Rhomboid at 9:27 AM on November 22, 2006

I don't have any statistics but a friend and former coworker of mine currently works in organ recovery. She isn't a transplant surgeon - she organizes all the logistics for recovering an organ from the time the call is received that a matching organ is available to when the organ is successfully implanted.

Once you hear her describe her day-to-day, you realize the extraordinary efforts hospitals make to recover viable organs from the relatively scarce donors. A typical call consists of organizing the transplant team who does the dual duty of recovering and implanting the organ (same team does both), supplying food and transportation (shuttle, private jet, helicopter), filling out paperwork, prepping and checking in with both hospitals. The surgical procedures are timed so that the donor's organ is only exposed just when the receiving hospital's surgeon is entering the OR and the recipient's failed organ is exposed just when the same surgeon has returned. They do this specifically to minimize the time the organs are out of the body.

The sad fact is that there aren't really any time-based efficiencies to wring out of the recovery process. Her transplant team will often travel from San Francisco to Las Vegas or San Diego simply because organs are that scarce. If it were possible to reduce organ transport distances, believe me, they would have done it. A typical trip to San Diego to recover an organ consists of the entire team being picked up by the organ recovery firm's in-house shuttle/limo driver, delivered to a private jet at the SFO airport, landing in San Diego, getting into another shuttle, recovering the organ in the SD hospital, and doing the same trip in reverse back to their SF hospital. In some cases, they've gone straight from the airport tarmac to the hospital's roof by helicopter (for say heart transplants). There aren't any faster ways of getting from A-B.
posted by junesix at 10:58 AM on November 22, 2006

AnecdotalFilter: In three years I have never experienced an organ discarded due to 'damage' during transport. When talking kidneys in particular there is not a corner of the continental US to which a kidney cannot find itself in a very reasonable amount of time.

NotAnecdotalFilter: The current UNOS allocation scheme is already based on distance in the form of regions/zones. The only exception to this (sticking with non multi-visceral transplants), is when a zero mismatch kidney or pancreas is available.

So tell your roommate you both win.

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Many of the ‘discrepancies’ you will see when looking over the OPTN data are simply organs that were unable to be placed. For example a fatty liver or a kidney with plaque extending into the renal artery or any other anatomical issues which would not arise until the organ was recovered from an otherwise ‘standard’ donor. These organs will be allocated, in many if not most cases, until there is quite literally nobody left on the lists to allocate too.
posted by paxton at 10:59 AM on November 22, 2006

Edit: UNOS allocation is partly based on distance, there are a number of factors that influence placement on a waiting list. Distance is just one of them.
posted by paxton at 11:21 AM on November 22, 2006