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Organ Transplants: 50 Years of Sharing Life

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THURSDAY, July 29 (HealthDayNews) -- Ronald Herrick may not be remembered as one of the pioneers of modern medicine.

But a half-century ago, he performed a revolutionary act by donating one of his kidneys to his identical twin brother, Richard.

It was the first successful transplant of a major organ, something that before 1954 had been considered fodder for science fiction.

Now, organ transplants have become almost commonplace, with a success rate that increases every year.

"There are people still alive who have had their new kidneys for more than 40 years," said Catherine Paykin, transplant program director for the National Kidney Foundation, which is helping to celebrate July as the 50th anniversary of organ transplantation.

In 2002 alone, there were more than 14,500 kidney transplants in the United States, according to the federal Organ Procurement and Transportation Network -- about 4,500 more than all kidney transplants conducted between 1954 and 1973.

And if you are a transplant patient, your chances of surviving with a successful graft are higher than ever. People undergoing a kidney or pancreas transplant these days have a better than nine-in-10 chance of surviving, and a better than eight-in-10 chance their body will not reject the new organ, experts say.

There are a number of breakthroughs that have allowed the success rate to grow, chief among them the development of immunosuppressive drugs.

"These drugs trick the body into thinking the foreign organ is its own organ and not attacking it," Paykin explained.

Before the development of these drugs, transplants could only take place between identical twins or close family members, Paykin said. The refinement of those drugs now allow transplantation between completely unrelated people.

Another breakthrough involved the development of tissue typing, said Dr. John Fung, of the transplant center at the University of Pittsburgh Medical Center. This let doctors better assess whether an organ from an unrelated donor stood a chance of surviving in a patient's body.

Tissue typing is similar to blood typing, but much more complex. "In blood typing, you have A, B and O," Fung said. "In tissue typing, there are now more than 300 types."

Tissue typing and immune system suppression with drugs was first used in a human kidney transplant in 1962, paving the way for transplantation of other organs.

The 1960s provided breakthrough after breakthrough in the field -- the first liver transplant, the first pancreas transplant and the first heart transplant.

But it wasn't until the 1980s that a pair of events -- one medical, the other governmental -- combined to make transplant science even more commonplace.

The first was the discovery and widespread use of the immunosuppressive drug cyclosporin, which was so effective in preventing rejection that it opened up a new era in transplant surgery, Paykin said.

It made transplant surgery so successful that in 1984 Congress stepped in to create the Organ Procurement and Transportation Network to help patients in need of a transplant find donor organs. "That ushered in a new wave of management and treatment of transplants," she said.

In the 1980s, the federal government also made transplant surgery more available to all patients by allowing Medicare to pay up to 80 percent of the cost of immunosuppressive drugs, Paykin said.

"The drugs are so expensive that poorer people could not afford transplants," Paykin said. "But the doctors were able to argue that even though the drugs are so expensive, they are cheaper than going on dialysis."

The major problem now facing transplant doctors isn't a matter of death and rejection, but rather supply and demand.

There is a critical shortage of available organs in the United States. Currently there are more than 85,000 people waiting for an organ that could save their lives.

This has caused doctors to go back to the use of living organ donors, something that the field had grown away from in the 1970s and 1980s with the successful use of organs from brain-dead donors, Fung said.

"The use of living donors has opened up a huge Pandora's box of ethics," Fung said. "The risk is it will now start up a huge black market of organ marketing," with people paying donors on the sly to give up a kidney or lung.

Transplant doctors also are using donated organs from older and older people, as well as donations from people who died suddenly from cardiac arrest.

"The transplant community is pushing the envelope as to getting organs," Paykin said. "This is possible because we have better techniques for surgery, better drugs and we've learned a lot more."

The lack of human donors also has prompted continued research into inter-species organ transplantation. Transplants from primates have been outlawed due to concerns over transmission of diseases such as AIDS, but research involving the organs of genetically modified pigs is continuing.

However, those sort of transplants are so expensive that Fung said they are of limited usefulness now.

"To be honest with you, a lot of people don't think it's going to work very well in the near future," he said.

More information

To learn more about organ transplants, visit the United Network for Organ Sharing.

SOURCES: John Fung, M.D., University of Pittsburgh Medical Center; Catherine Paykin, transplant program director, National Kidney Foundation
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