August 30, 2002

Rejected lungs could have been used: study

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Dr. Lorraine Ware

Rejected lungs could have been used: study

Nearly half of the donated lungs currently rejected for transplantation may actually be suitable, according to a preliminary study by scientists at Vanderbilt University Medical Center and the University of California, San Francisco.

The study, published in the Aug. 24 issue of the journal Lancet, concluded that existing criteria for rejection might be too rigid. Researchers used physiological, microbiological and other methods to assess 29 pairs of rejected lungs and found that 40 percent of the rejected lungs might have been candidates for transplantation — more than doubling the number of potentially suitable donor lungs. Currently more than 85 percent of lungs are considered unusable for transplantation.

“Our results, combined with reports of successful outcomes with lungs from marginal donors, highlight the urgent need for a prospective, scientific assessment of selection of donors for lung transplantation,” said Dr. Lorraine B. Ware, assistant professor in the division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt. Ware is lead author of the paper.

“If twice as many donor lungs are truly suitable for transplants, we could save an additional 1,000 lives a year in the U.S. alone,” said Dr. Michael A. Matthay, senior author on the paper and professor of medicine at UCSF. Matthay is associate director of the intensive care unit at the UCSF Medical Center.

In 2000, 1,522 lungs were recovered in the United States for transplantation. This number only increased by 77 organs compared to 1999.

The most worrisome statistic is that in 2000 only 16 percent of all lungs consented for donation were recovered nationally while approximately 3,600 patients were waiting for lung transplants in the United States. This is according to data from the 2001 U.S. Organ Procurement and Transplantation Network.

Over the last 12 months VUMC’s Lung Transplant program, under the surgical direction of Dr. Mathew Ninan, assistant professor of Cardiac & Thoracic Surgery, has performed 11 transplants with a 90 percent survival rate after 30 days.

“We’ve worked very hard to get good results and have a good team here,” said Ninan. “But if we don’t run a busy program, we won’t get the best chance at available organs and won’t look as attractive to insurance carriers who are very conscious of a program’s statistics.”

Ninan agrees with the importance of Ware’s study, saying that in order to perform more lung transplants surgeons have begun to use more “extended donors” that might not have been considered in the past. “That’s the difference now. We use donors that would have not been traditionally accepted before,” he said.

Ninan is better able to make this careful consideration because he usually goes to harvest the organs himself. He says in this manner a surgeon can make a full evaluation of all factors when considering an extended donor, such as a thorough examination of the organs, the patient’s current health status, or a history of smoking.

“We’ve been able to harvest more organs during the last six months than we did during the 2000-2001 period,” he said.

Despite VUMC’s program being busy with transplants, there are always a number of patients awaiting their chance for a new set of lungs, said Dr. Aaron Milstone, assistant professor of Medicine in Allergy/Pulmonary & Critical Care Medicine, and medical director of the Lung Transplant program.

“Even though we’ve had a busy year so far performing many transplants, we consistently have eight to 10 patients who are waiting for new organs,” said Milstone.

“By the end of this year, we will have evaluated about 100 patients as potential transplant candidates. More than 80 percent of those patients are Tennesseans. So far this year, we’ve already done 72 evaluations.”

Tennesseans rank high nationally as suffering from pulmonary diseases. Milstone said that at VUMC the primary reasons for patients needing transplantation are chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, followed by primary pulmonary hypertension, and cystic fibrosis.

Jimmie Sanders received a single-lung transplant at VUMC on Dec. 17. The 55-year-old resident of Dickson, Tenn., suffered from COPD and was completely disabled for more than four years. Saunders was so ill prior to transplantation he spent the last year and a half tethered to an oxygen tank 24 hours a day.

“I feel great now,” said Sanders. “ I celebrated my six-month anniversary in June with no infections or (organ) rejection. When you’re about to die and someone saves you like that with the generosity of organ donation, it’s tremendous. I’m blessed. I’m on a mission now trying to educate people in my community about the importance of organ donation and transplantation.”

Milstone said that very soon some of Tennessee’s residents needing lung transplants, those insured by the state’s managed care program TennCare, will face a tougher time.

“New rules say a patient can enroll in TennCare, but then must wait a mandatory six months before he or she will be authorized to receive an evaluation for a possible transplant,” he said.