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Everything You Need to Know About Getting an Organ Transplant


One of the wonders of the information age is the amount of information that is available on almost any subject.  I am constantly on the alert for new, helpful information about organ donation and transplantation and usually expect to find what I need from sources like the Mayo Clinic, Johns Hopkins, Cleveland Clinic and a score of other highly credible medical organizations.  Sometimes, though, ones gets surprised as I was when I found this information on About dot com.  http://surgery.about.com/od/beforesurgery/a/ListedForTx.htm

How to Get on the Waiting List For an Organ Transplant

Evaluation For a New Organ

By Jennifer Heisler, RN, About.com Guide

Starting the Transplant Process

Your road to an organ transplant starts with the physician or specialist who is providing your care. If he or she determines that you are in organ failure or may soon be in organ failure, you will be referred to a transplant center. The transplant center may not be the closest center to you, as the organs transplanted at each center vary.

Once you have a referral, you will need to make an appointment for an evaluation. The initial appointment will probably include a physical examination and blood draws for a wide variety of lab studies. These blood tests will help determine how well your organs are functioning and your general state of health.

Once your organ function is determined, your transplant surgeon will be able to determine if testing to determine your suitability for an organ transplant should continue. At this point you may be told that you are currently too well for consideration, not a candidate or that testing will continue.

Additional Medical Testing Required for Transplant

If you are a candidate for an organ transplant, you will undergo further testing. If your organ failure happened quickly, is progressing quickly or is considered an emergency, the testing may occur in a matter of days rather than weeks.

Your testing will also evaluate your ability to tolerate surgery. For example, if you are seeking a liver transplant, you may still be tested for heart, kidney and lung function to make sure you are able to tolerate surgery and anesthesia.

You will be evaluated for the presence of cancer, as an active case is cause for exclusion from transplantation. There are exceptions, such as skin cancer, which would not prevent you from receiving a new organ.

If you are in need of a kidney transplant, your testing will include blood tests that look at your genetic makeup since it is a component of matching organs with recipients.

Psychological Evaluation Before Transplantation

Your evaluation as a potential transplant patient will include appointments with social workers, psychologists and financial counselors. You will also be evaluated for your ability to understand instructions and your treatment.

Patients who have untreated psychiatric or mental disorders may be disqualified for treatment if the disorder prevents the patient from caring for themselves. For example, a schizophrenic patient who is not taking medication and is having delusions would not be considered a good candidate for an organ transplant. Mental retardation is not an automatic exclusion from receiving a transplant.

The stress of waiting for a transplant can be difficult for families, and the social workers and psychologists will work to evaluate how well you and your loved ones will cope with the wait. It is essential that you are candid as part of the evaluation includes determining how best to provide you with the support you need.

Financial Counseling for Transplantation

The financial counselor will help determine if you can afford to pay for a transplant, as well as your ability to pay for the numerous and expensive medications that help keep your body from rejecting the organ after surgery.

Not being able to afford a transplant does not mean that you will not be considered for surgery. The social workers and financial specialists will help determine if you are eligible for Medicare, Medicaid or other assistance.

Evaluation of Addictive and Harmful Behaviors

If your disease is the result of addictive or abusive behaviors, such as cirrhosis caused by alcoholism, you will be expected to be free of such behaviors. Transplant centers vary on their policies regarding the length of time a patient must be drug-free to qualify for a transplant, but most will test for drugs regularly.

Social workers will help you seek counseling and support groups for your addictions, if needed. An inability to control addictive behaviors will exclude patients from being listed for a transplant.

Your Ability to Manage Your Health Before Transplant

The transplant center will be looking for indications that you are able to manage your health and that you care about maintaining your health whenever possible. For example, if you are waiting for a kidney transplant but you are not following your doctor’s instructions, you may not be considered a candidate. The post-transplant regime is rigorous and requires diligence; your ability to follow your current regimen will be considered an indication of your willingness to take care of yourself after surgery.

The Decision — National Waiting List or Not?

You will be notified if you have been approved for transplantation once the evaluation has been completed and the different members of the team have made a determination of your suitability. The decision is not made by any one person; the team as a whole decides if you will make a good candidate for a successful transplant.

If you are approved, you will be expected to maintain an ongoing schedule of appointments designed to keep you in the best possible health during your wait, and to monitor your organ function. For some organs, the level of organ function (or the extent of your organ failure) helps determine your place on the wait list, so recent lab results are essential.

Being listed for a transplant is a very exciting time, but it is essential to remember that most transplant recipients have an extended wait before their surgery. It is not uncommon to wait several years for a kidney transplant, for example.

If the transplant center declines to add you to the list of patients waiting for transplant, you have some options. At some centers, you can appeal the decision and attempt to have the team reconsider its decision. You can also be evaluated at a different transplant center that may have different criteria for selecting patients.

After Organ Transplant Surgery

The average recipient spends months or even years anticipating organ transplant surgery, waiting and hoping for the day that will provide a second chance at a healthy life.

Out of necessity patients must focus on dealing with their life-threatening illness and hoping for surgery rather than learning skills to help them cope after a transplant that may not happen. With the emphasis on maintaining heath and hope preoperatively, many patients are unprepared for the changes in their lives and health after the transplant surgery.

Coping with these changes requires support, diligence and a willingness to prioritize a healthy lifestyle and maintain a healthy organ.

Emotional Issues After An Organ Transplant

There are issues that are unique to organ transplantation that the average surgery patient does not experience. In the majority of cases, a patient who is waiting for an organ knows that for an organ to become available an appropriate donor must die.

There is an emotional struggle between maintaining hope for a transplant and dread, knowing that a stranger will die before that becomes possible. Transplant recipients often acknowledge that they feel survivor’s guilt, having benefitted from the death of another.

It is important for recipients to remember that family members of donors report feeling that being able to donate organs was the only positive thing to happen during a heartbreaking time. The correspondence they receive from organ recipients can help the feeling of total loss after a loved one dies.

Being able to establish a relationship with a donor family, even if by mail only, can bring a sense of peace. For the donor family, a part of their loved one lives on. Some families and recipients choose to meet after corresponding, forging a bond over their shared experience.

Addiction & Depression After A Transplant

The weeks and months immediately following surgery can be very stressful for an organ recipient, making it an especially difficult time to maintain sobriety for those who are battling addiction.

Alcohol, tobacco and drugs are routinely tested for when patients are waiting for transplant, as abstinence is a condition of being on the waiting list at most transplant centers, but once surgery takes place the temptation to return to old behaviors can be overwhelming.

It is essential for recipients to maintain their healthy habits, as these drugs can be toxic to the new organs. There are many 12 step programs available for patients battling addictions and their families, inpatient and outpatient treatment programs and support groups.

Smokers can discuss anti-smoking prescriptions with their surgeon and many other types of therapies for smoking cessation are available over the counter.

Depression after surgery is not isolated to people with unrealistic expectations, it is common with chronic illnesses and major surgeries. While many have a tendency to deny there is a problem, confronting depression and seeking treatment is essential to maintaining good health.

Patients who are depressed are more likely to return to addictive behaviors and less likely to take an active role in their recovery and long term health.

Living Related Donor Organ Transplant Issues

A minority of organ recipients have a liver segment or kidney donated by a living family member or friend, which presents entirely different issues than those of an anonymous donor. A living donor may have a significant period of recovery after surgery, with additional time spent recuperating at home.

While surgery bills are paid for by the recipient’s insurance, lost wages and pain and suffering are not, and may cause hard feelings among family members. Disability insurance may provide financial relief, but there may be issues after a donor is discharged regarding whose insurance pays for medications that are part of aftercare.

A feeling of “owing” the friend or relative who is a donor is not uncommon. There are also donors who have complications after surgery. There are instances of the “sick” family member having a transplant and being discharged from the hospital before the “well’ donor.

Some people also experience depression after donation, a serious low after the euphoria of being instrumental in saving a life. Surgical complications or psychological issues after donation may cause the recipient to feel guilty for having “caused” these problems.

Ideally, a conversation regarding all the issues of donation should happen prior to surgery, and should include the financial and emotional aspects of donation, in addition to the physical issues. The discussion should also include the expectations of everyone involved, and whether or not these expectations are realistic.

When this conversation is taking place after surgery, a frank discussion may be necessary to determine what is a realistic expectation and what is not. An organ donor may have expectations of the recipient that are beyond financial issues, but are equally important, regarding the recipient’s health and wellbeing.

A donor that gives a section of their liver to a relative who needed it after abusing alcohol may be very sensitive to seeing that person drinking eggnog at Christmas when it has never been an issue previously.

The donor has an emotional investment in the health of the recipient that has been changed, and abusing the organ may feel like a slap in the face. These issues must be discussed in an honest and open way, without judgment, to have a healthy ongoing relationship.

Concerns About Illness Returning After An Organ Transplant

Concerns about organ rejection or the need for another transplant are also common with those who have had transplant surgeries. After the long wait for surgery, the fear of a return to the waiting list and poor health is a natural concern.

Taking an active role in maintaining good health, following the instructions of physicians and being proactive about exercise and diet, helps recipients feel that they are in control of their health instead of being at the mercy of their bodies.

Returning to Work After an Organ Transplant

There are issues that are not unique to transplant recipients yet still must be dealt with after surgery. Health insurance and the ability to pay for anti-rejection medications is an issue, especially when the patient was too sick to work prior to surgery. Financial difficulties are common in people with chronic illnesses, and transplant recipients are no exception.

If returning to work is feasible, it may be essential to the financial survival of the entire family, especially if the patient was the primary source of income. Obtaining, or even retaining, health insurance is a priority with the high cost of prescription medications and doctor visits.

For patients who are not well enough to return to work, it is essential that resources be found to assist with the costs of care. The transplant center should be able to refer any patient in need to sources of assistance, whether it be from the social services, low cost drug programs or sliding scale fees.

Pregnancy after Organ Transplantation

Younger female patients who are able to return to a full and active life may have concerns about pregnancy, their ability to become pregnant and the effect anti-rejection may have on the unborn child.

In some cases, the surgeon may recommend against conceiving as the body may not tolerate the extra stress caused by pregnancy and childbirth. In these cases, patients may benefit from a support group dedicated to infertility or a transplant support group.

For women who have a physician’s approval to conceive, discussions with both the patient’s transplant surgeon and potential obstetrician may answer questions and alleviate any concerns.

Transplant surgeons are an excellent source of referrals to an obstetrician with experience caring for pregnant organ recipients.

Pediatric Organ Transplant Recipients

Pediatric transplant recipients, or patients under the age of 18, often present a unique set of problems that adult recipients do not. Parents indicate that after coming close to losing a child to illness, it is difficult to set limits and establish boundaries with their behaviors.

Siblings may feel neglected and begin to act out when an ill child requires more time and care, demanding the attention of their parents.

After a successful transplant a child may require more limits than before and become difficult to manage when they do not understand these new rules. Friends and relatives who do not understand the rules may not enforce them when babysitting, causing difficulties and friction between the adults.

Establishing a routine and rules that are adhered to regardless of the caregiver can alleviate the conflict between the adults and help to set a consistent pattern for the child.

There are books and support groups available for the parents of sick, or formerly sick children, to help with the issues that come with parenting a chronically or critically ill child. Most emphasize that parents need to send the same message by acting as a team and enforcing the rules equally. Parents cannot undermine each other’s authority by failing to discipline bad behavior or disagreeing about punishment and failing to act.

Reestablishing Relationships After an Organ Transplant

Relationships can be strained by long term illnesses, but over time families learn to cope with a loved one who is desperately ill. Family members and friends become accustomed to stepping in and providing care and support to the patient, but often struggle when the situation is rapidly reversed.

A wife who has become accustomed to helping her husband take baths and providing meals can feel completely elated, but helpless, when her spouse is suddenly doing yard work.

The patient can be frustrated when they are feeling like their old self yet their family continues to try to do everything for them. Children who are accustomed to going to their father for help with homework or permission may inadvertently neglect to give mom the same courtesy when she is ready to take a more active role in parenting.

The amount of assistance needed should be determined by the way the recipient is feeling, not on established routines from before the transplant surgery. Too much too soon is not a good thing and can lengthen recovery, but independence should be encouraged whenever possible.

The situation is not unlike a teenager who wants independence and a parent who wants their child to be safe, struggling to find a happy medium that they can both live with.

Expectations After Organ Transplantation

While good health can seem like a miracle after years of illness, transplant surgery is not a cure for everything. Financial problems do not disappear after surgery, nor do addictions or marital problems.

Transplant surgery is a cure for some patients, but unrealistic expectations can leave a recipient feeling depressed and overwhelmed. A healthy organ does not cause immunity to the normal problems that people face every day; it provides a chance to face the challenges of life as a healthy person.

Physical Changes After an Organ Transplant

There are physical changes that transplant patients face after surgery that go beyond the immediate recovery period. Many patients find themselves dealing with weight gain and fluid retention, a normal reaction to the anti-rejection medications necessary after transplant.

Along with a rounder face, these meds can cause mood swings and emotional changes that are difficult to predict and harder to deal with. The symptoms typically diminish once the proper dosage is determined, but being aware that this is a normal part of therapy helps patients tolerate the effects in the short term.

Support Groups & Volunteerism After Organ Transplantation

Because of the unique nature of transplantation, many patients are drawn to others in the same circumstances. Support groups are an excellent way to find others who have had the same experiences and challenges that are unique to organ recipients. Groups are available nationally, with online meetings and groups local to transplant centers for adults and pediatric patients.

There are also websites devoted to the transplant community, allowing patients and families to discuss all aspects of donation and transplantation.

Many families of recipients and donors find volunteering for organ procurement organizations and transplant services to be rewarding and an excellent way to stay involved in the transplant community.

The added benefit of volunteering is that most volunteers have a personal connection to transplantation and are happy to share their experiences. There are volunteer groups for mothers of donors, for families of recipients and a variety of other people affected by donation.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,600 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our newest video, “Dawn Anita, The Gift of LIfe” on YouTube either under that title or this link https://www.youtube.com/watch?v=eYFFJoHJwHsvideo.  This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

 Espanol

Bob Aronson Newheart de Bob es un receptor de trasplante cardiaco 2007, el fundador de Facebook cerca de 2.600 miembros de la Iniciativa de Trasplante de Órganos y el autor de la mayoría de los blogs de donación / trasplante.Puede comentar en el espacio proporcionado o por correo electrónico sus pensamientos a mí en bob@baronson.org. Y – por favor, difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si usted convence a una persona de ser donante de órganos y tejidos puede salvar o afectar positivamente a más de 60 vidas. Algunas de esas vidas pueden ser personas que conoces y amas.Por favor ver nuestro nuevo video, “Dawn Anita, El don de la vida” en YouTube ya sea en virtud de dicho título o https://www.youtube.com/watch?v=eYFFJoHJwHsvideo este enlace. Este video fue producido para promover la donación de órganos por lo que es libre y no se necesita permiso para su uso.

Si quieres correr la voz acerca de la donación de órganos personalmente, tenemos otra presentación de PowerPoint para su uso libre y sin permiso. Sólo tienes que ir a http://www.organti.org y haga clic en “Life Pass It On” en el lado izquierdo de la pantalla y luego sólo tienes que seguir las instrucciones. Esto no es un espectáculo independiente, sino que necesita un presentador pero es profesionalmente producida y sonido hechos. Si usted decide usar el programa le enviaré una copia gratuita de mi libro electrónico, “Cómo obtener un pie” O “que le ayudará con habilidades de presentación. Sólo tiene que escribir a bob@baronson.org y por lo general usted recibirá una copia del mismo día.

Además … hay más información sobre este sitio de blogs sobre otros donación / trasplante temas. Además nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos Cuantos más miembros que obtenemos mayor será nuestra influencia con los tomadores de decisiones.

Official UNOS Response On Transplants for Non U.S. Citizens


As our readers know, I published a blog a while back questioning U.S policy on providing organ transplants to some non-U.S. citizens.  That blog raised even more questions and comments from our readers so I sent the following note to Anne Paschke one of the communications executives at the United Network for Organ Sharing, (UNOS) in Richmond, Virginia.  Below is my note to Anne followed by the official UNOS response.

Email to Anne Paschke

Hi Anne:

Some time ago I published a blog on foreign nationals getting transplants in the United States from American Donors.  I have only a passing familiarity with the issue and I”m hoping you can offer some clarification.  What is our official policy on non-U.S. Citizens getting transplants from American donors?  Does this policy only include foreign nationals with a passport or visa to visit the U.S. or does it also cover illegal immigrants?

My second question deals with the lost Angeles Times story of about five years ago where it was reported that the University of California, Los Angeles Medical Center transplanted four Japanese gangsters http://articles.latimes.com/2008/may/30/local/me-ucla30.  Did that happen and if so how did it slip through the “Blind” system.

When I receive your answer I will likely publish it but without editing.  All I really want to be able to do here is to offer my readers the UNOS point of view on these issues.

Here is UNOS’ response:

 Before addressing more specific issues, it’s important to note a few facts and principles that guide how the Organ Procurement and Transplantation Network (OPTN) addresses transplantation of foreign nationals.  United Network for Organ Sharing (UNOS) operates the OPTN under federal contract.

  • An individual transplant hospital makes the decision to accept and list any transplant candidate according to its own evaluation process and its own medical judgment.  The OPTN has no authority to approve or deny an individual candidate’s listing or influence a listing decision made by a transplant center.
  • Federal law and regulation that guides the OPTN directs that allocation policy be based only on medical criteria and, to the greatest extent possible, utilize objective medical evidence.  The OPTN cannot develop allocation policy that addresses what may be considered “social worth” factors about any candidate.  The OPTN does not have authority to enforce laws regarding any individual’s citizenship or residency.
  • As the United States is a world leader in many forms of medical treatment, historically we have not denied access to transplantation for non-residents.  In some instances, people who have sought transplantation in the U.S. would have no chance to receive a transplant of the needed organ in their home country.
  • Transplant recipients who are U.S. citizens or residents occasionally benefit from organs donated by citizens or permanent residents of other countries.  This may be in the form of organs imported from other nations (chiefly but not exclusively Canada) or from non-residents who become donors in the United States.  Also, although there are some exceptions, most countries that perform transplants do not limit their services to their citizens only.  The principle of reciprocity is important to maintaining goodwill and trust in organ donation.

Given these facts and principles, the OPTN has developed policies to accomplish certain objectives:

  • To allow non-residents or non-citizens access to transplant services in the United States, while generally ensuring that the great majority of recipients are U.S. citizens or foreign nationals
  • To ensure that no individual transplant candidate gets more or less consideration for available organs based on non-medical factors, including citizenship or residency
  • (In recent times) to study patterns of donation and transplantation from non-residents to guide the development of future policy and keep the U.S. transplant system consistent with international guidelines and recommendations.

Recent changes to OPTN policy have made it differ somewhat from the policy that existed in the early years of the OPTN.  We’ll outline what has been in place and then discuss the current requirements and initiatives.  We’ll also discuss the most recent national trends.

Prior requirements and policies

The early history of OPTN policy was based on guidance from an advisory task force convened after the 1984 National Organ Transplant Act was passed.  The task force debated the principles outlined above and recommended that allocation policy generally allow limited access for non-residents to be considered for transplants, with no difference in how the individual candidate gets priority for a transplant.  The task force recommended that the OPTN strive for a ratio of no more than ten percent of transplant recipients as non-resident foreign nationals.

The OPTN does not control the listing of individual transplant candidates and could not set an up-front listing limitation.  Instead, it established a process to review the number of transplants performed each year at each transplant program.  Initially, if more than ten percent of the people transplanted at the program were non-resident foreign nationals, the OPTN would send the program an audit letter.  The program would be asked to provide more information about the non-resident recipients transplanted and any reasons why the program exceeded the threshold. Exceeding the audit threshold was not in itself a violation of OPTN policy.  However, if the audit revealed a persistent and intentional pattern of transplanting a high number of non-residents, the OPTN could consider further review or action against the member.

In practice, even though some transplant programs exceeded the review threshold, none ever did so by a very high margin.  Generally the programs had sufficient reasoning for the number of transplants they performed for non-residents.  Many have been in areas serving large non-resident patient populations, and often their local area has a similar proportion of non-resident organ donors.  (Among non-resident recipients of living donor transplants, it’s fairly common for the living donor to be a relative or acquaintance from their home country and who travels to the United States to donate, thus not affecting the ratio of access for U.S. citizens or residents.)

In 1995, the OPTN reevaluated the threshold policy, in part because very few transplant programs met or exceeded the ten percent audit threshold.  The review threshold was lowered to five percent of recipients and remained so until last year.

For purposes of the policy, the OPTN only applied the review threshold to non-resident foreign nationals; resident foreign nationals were considered on the same basis as U.S. citizens.  There was no definitional separation of legal non-resident status (such as a medical or student visa, work permit, etc.) from an illegal status.

The OPTN has never had authority or resources to verify legal residency status among candidate listings.  Anecdotally, however, it appears that the majority of non-residents as defined by the policy have had legal non-resident status.

Recent policy

In September 2012, the OPTN adopted a substantial revision to policy regarding transplantation of non-resident foreign nationals.  The changes were approved in part to address what the OPTN is most able to enforce within its authority.  They were also intended to gather more information to study potential future policies that may be developed, as well as to reflect consensus guidance from recent international transplant conferences.  You can read the policy in its entirety on the OPTN website: http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_18.pdf.

The new policy eliminates the threshold for a transplant program to receive an audit letter if it transplants a certain percentage of non-resident transplant recipients.  In its place, the OPTN will gather data on all citizenship information supplied by member transplant programs and develop a public report on listing and transplantation of non-U.S. citizens and non-U.S. residents at U.S. transplant hospitals.  This report has yet to be prepared but should be completed sometime this year.

The OPTN is also asking members to report more specific information about listing and transplantation of non-U.S. residents, including their country of residence and whether they traveled to the United States specifically for a transplant listing.  This information will be included in the annual report and will help identify any specific patterns or trends in groups of non-residents listed and transplanted.

We wouldn’t be able to answer any detailed questions about individual non-resident candidates or recipients listed or transplanted at a U.S. program.  This is due largely to the fact, noted above, that the OPTN is not involved in any hospital’s individual decision to list or transplant any candidate.  In addition, medical confidentiality statutes limit public disclosure of patient-specific information unless the person(s) involved provide their consent, or unless the information may be publicly accessible for some other reason.

Data and trends

Non-resident aliens account for roughly one percent of both transplant recipients and donors nationwide.  The rate (not the number) of non-resident recipients in the United States is roughly the same as the rate of non-resident donors.  The vast majority of both recipients and donors are U.S. citizens, with resident aliens accounting for another three to four percent.

In 2011 (the latest year with complete data available), more than 95 percent of transplant recipients in the United States were U.S. citizens (27,180 out of 28,537).  Resident U.S. aliens accounted for an additional 3.7 percent of recipients (1,071 out of 28,537).  The remaining one percent (286 recipients) were reported in some other category, most as non-resident aliens or non-citizens residing in the U.S.  (Some of the data are being reported differently now to conform to the new definitions mentioned above.)

Similar proportions exist for deceased donors in the United States.  In 2011, more than 95 percent were U.S. citizens (21,424 out of 22,518); another 3.9 percent were resident aliens (880 out of 22,518); and approximately one percent were reported in some other way, mostly as non-resident aliens (214 out of 22,518).

Similar proportions also exist among living donors.  In 2011, more than 95 percent were U.S. citizens (5,756 out of 6019); 3.2 percent were resident aliens (193 out of 6019); and 1.1 percent were reported in some other category, primarily non-resident aliens (70 out of 6019).

These ratios of transplants by reported citizenship have remained largely the same since 1988, the first full year of national data collection by the OPTN.  However, there were a substantial number of “not reported” fields in the early years of OPTN data collection; today the number of recipients with unreported citizenship/residency is virtually zero.  We would be happy to supply the entire table of data by citizenship by year upon request.

Among candidates currently listed for a transplant in the United States, the ratios are much the same (although citizenship is not currently reported for about 2.8 percent of candidates, possibly because they have only recently been added and the citizenship field is not yet filled in).  Of the candidates where citizenship is reported, about 93 percent are U.S. citizens, roughly 4.5 percent are resident aliens, and about two percent are listed in some other category.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

Human Organs From Pigs — But You’d Have to Kill One to Get One.


What if we could end the organ shortage tomorrow and everyone on the list could get a transplant within a few weeks?  Would you be willing to endorse this new source of organs?  If the source were a pig would you be willing to kill it to save your own life?

Xenotransplantation is the process of transplanting organs from animals into humans and historically that hasn’t worked too well. The human immune system immediately and violently attacks organs from animals and even our most powerful immunosuppressant drugs are ineffective but scientists are working on the problem because if we could use animal organs (ethical questions aside for now) we could end the organ shortage almost immediately.

The answer may lie in raising transgenic animals – animals that carry genes from other species or in the case of humans, animals that have been genetically modified so that their organs are transplantable into human beings.

According to www.actionbioscience.org  Transgenic animals are not a pipe dream either, they are already being produced.  The majority has been mice but scientists have also produced rabbits, pigs, sheep, and cattle. The primary question is not if we can raise pigs to produce organs for humans but when that is likely to happen and it’s possible it could happen relatively soon.  In Korea scientists have already cloned a genetically altered pig with hopes of using its organs in humans but that has, to my knowledge, not yet been done successfully.

There are distinct medical applications to the process of transgenics and providing a ready supply of transplantable organs is one of them.  Presently there is a single protein that can cause rejection but researchers think they can eliminate that problem in the not too distant future by replacing it with a human protein.  It is also possible that animals could be raised to be disease resistant which would benefit both the animal and humans to which some animal diseases can cross.

Pigs are currently thought to be the best candidates for organ donation. The risk of cross-species disease transmission is decreased because of their increased phylogenetic distance from humans. They are readily available, their organs are anatomically comparable in size, and new infectious agents are less likely since they have been in close contact with humans through domestication for many generations.

Aside from growing organs for transplantation, milk producing animals are desirable, too, because they can be used to producenutritional supplements and pharmaceuticals.   Products such as insulin, growth hormone, and blood anti-clotting factors may soon be or have already been obtained from the milk of transgenic cows, sheep, or goats. Research is also underway to manufacture milk through transgenesis for treatment of debilitating diseases such as phenylketonuria (PKU), hereditary emphysema, and cystic fibrosis.

So, yes, there are great possibilities with transgenic animals but there are also ethical concerns that must be addressed.  For example:

  • Should there be universal protocols for transgenesis?
  • Should such protocols demand that only the most promising research be permitted?
  • Is human welfare the only consideration? What about the welfare of other life forms?
  • Should scientists focus on in vitro (cultured in a lab) transgenic methods rather than, or before, using live animals to alleviate animal suffering?
  • Will transgenic animals radically change the direction of evolution, which may result in drastic consequences for nature and humans alike?
  • Should patents be allowed on transgenic animals, which may hamper the free exchange of scientific research?

Animals like pigs offer hope for the thousands of people languishing on the national transplant list.  Unfortunately these things take time and while scientists and then politicians and bureaucrats investigate the possibilities thousands will die waiting for organs.  The altruistic system that we have in place in America just isn’t enough.  We must do more to save the lives of those who need organs.  Hope lies in xenotransplantation, regenerative medicine, therapeutic cloning and artificial organ development.  We must keep that hope alive by support these efforts.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

60% of People Who Smoke Will Die From it — But You Can Quit!


Besides causing cancer and any one of a number of other health problems, smoking can destroy organs like the heart and lungs and can seriously damage or destroy others. 

There are about 110,000 people in the U.S. waiting for organ transplants and there are not enough donor organs, so each year thousands of our loved ones, friends and neighbors die waiting. The number of organ donors is not increasing fast enough to end the shortage any time soon so one way of dealing with the crisis is to prevent the need for organ transplants.  One way to do that is to quit damaging our organs by quitting smoking. 

From time to time I will be publishing blogs from guest writers.  The following post was written by Dr. Michael Burke, Ed.D, Assistant Professor of Medicine at the Mayo Clinic School of Medicine and Program Coordinator at the Mayo Clinic Nicotine Dependence Center.  Dr. Burke is a highly respected expert in the field of tobacco addiction and smoking cessation. 

There is nothing that is healthier for a person who smokes than to stop. Within a short time after one stops smoking, lung function and circulation improve, risk of heart attack and stroke diminish, and the likelihood of acquiring 14 different cancers begins to drop. 

Symptoms from illnesses as different as diabetes, sleep apnea, and Crohn’s disease get better after a person stops smoking.  Stopping before surgery significantly improves surgical outcomes through less infection, better wound healing and bone mending.  Stopping smoking leads to less skin wrinkles and better erectile function, and the list goes on and on. Although people usually underestimate how dangerous smoking is, nearly everybody knows that it is unhealthy.  However, about 1 in 5 Americans continue to smoke, and each day in the US, as many people die from smoking as three fully loaded 747’s crashing.   Worldwide 100 million people died from smoking in the 20th century.  Predictions are that one billion people will die from smoking tobacco this century.  So why doesn’t everyone quit? 

One reason is that cigarettes are quite addicting.   A cigarette delivers nicotine to the brain more quickly than a hypodermic needle.  It is probably the best drug delivery device ever created by man.  It delivers volatile high dose nicotine that, for some people, causes physical changes to a part of the brain that is responsible for pleasure, attention and stress.  I say ‘for some people’.

Smoking affects people differently.  Stopping smoking is actually physically harder for some people than it is for others.  The differences are in large part due to genetics. To shed light on these genetic differences a group at the Mayo Clinic is, oddly enough, studying Zebra fish. http://discoverysedge.mayo.edu/zebrafish-genetics/ Dr. Steve Ekker’s group has discovered two genes that make the fish more reactive to nicotine.  If exposed to nicotine when in the larvae stage Zebra fish bred to have these two specific genes will become sensitized to the nicotine.   Later in life they will move and dart more quickly in the water when nicotine is added to the tank.  However, if these genes are ‘knocked out’ the fish won’t become sensitized to nicotine and then later will not react when exposed to nicotine.   It is wonderful to have a geneticist with a sense of humor.  Dr. Ekker’s group named the nicotine activating genes Humphrey Bogart and Bette Davis after those two Hollywood stars whose style of smoking became iconic.

Although it is a more complex story in human beings, some people have Humphrey Bogart and Bette Davis genes.  These people experience a heightened reward from cigarettes when they first start smoking and more intense craving and withdrawal when they try to stop.  Too often these people feel ashamed, think that they just have less willpower, or think that they just don’t want to stop badly enough. Instead these folks can stop, they just need more tools and ammunition.

I once treated a woman, a nurse, from Bayonne NJ.  She was clearly a strong lady.  My dad would have admirably described her as a ‘tough old broad’.  “People tell me I’m weak, that I should just quit smoking” she said “But, when I go half a day without a cigarette, I’m on my knees in tears I just feel so awful”.  “I’m not weak” she went on.  “I left a bad man, raised three kids, worked sometimes two jobs, bought my own home, and sent all three kids to college.  I’m not weak! What is it about this that is so hard?” she asked me.  She was most likely genetically set to have a more difficult time stopping, and she needed treatment to match that extra difficulty.   We provided treatment and one year later she was still tobacco free.

Many people try and stop ‘cold-turkey’.  That’s good if it works.  However, less than 5% of the people who use this method are successful at six months.  Counseling and medications have been proven to significantly increase the chances of successfully stopping smoking.  You can learn more about how counseling works by viewing the short video at this link. http://www.youtube.com/watch?v=5EDaA26unVw  

Your health care provider may provide counseling or they may have a Tobacco Treatment Specialist in the office or local area.  Professional help is also available through a telephone Quit line.  Every state in the US, and province in Canada have one that can be accessed through calling 1800 QUIT NOW.   One online resource that many people find helpful is www.becomeanex.org.  Mayo Clinic also has a Residential Treatment Program – an 8 day program that works for people who have ‘tried everything’.  http://ndc.mayo.edu

There are seven ‘first line’ medications that have been proven to be safe and effective for helping people stop smoking.  Five are nicotine replacement products and two are pills available by prescription: varenicline (Chantix) and bupropion (Zyban).  

There is too much confusion about nicotine replacement.  Nicotine replacement medications have saved many lives and can save many more. Nicotine is not the ingredient in cigarettes that causes health problems.  Smoking health problems are caused by 4,000 other chemicals that people ingest when they smoke.  Some of these chemicals are natural to tobacco others are added by the tobacco industry.  Nicotine replacement helps manage cravings and withdrawal symptoms safely, while eliminating exposure to the awful toxins in tobacco.  We encourage people to take enough of these medicines for long enough to stop smoking.

People who smoke can also talk to their health care provider about two other medications varenicline and bupropion.  These medications are proven to help people safely stop smoking.  Like most medications, there are some potential side effects and you should talk to your health care provider before taking these medications.   But remember, if the tobacco industry had to list the side effects from smoking, it would probably fill a telephone book.  Cigarettes are the only product that will kill over 60% of the people who use it in the way it is intended.   Stopping smoking, by any means necessary, is the healthy choice.

Please comment in the space provided or email your thoughts to me at bob@baronson.org.  And – spread the word about the immediate need for more organ donors.  On-line registration can be done at http://www.donatelife.net/index.php  Whenever you can, help people formally register.  There is nothing you can do that is of greater importance.  If you convince one person to be a donor you may save or positively affect over 50 lives.  Some of those lives may be people you know and love.  

You are also invited to join Organ Transplantation Initiative (OTI) http://www.facebook.com/#!/group.php?gid=152655364765710 a group dedicated to providing help and information to donors, donor families, transplant patients and families, caregivers and all other interested parties.  Your participation is important if we are to influence decision makers to support efforts to increase organ donation and support organ regeneration, replacement and research efforts. 

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