The death of a 28-year-old British woman who contracted pneumonia after receiving a lung transplant from a donor who had smoked for 30 years sparked an uproar.
But the practice of transplanting organs from donors with less-than-ideal medical histories, such as smokers and cancer survivors, isn't unusual and is, in fact, a necessity, given the shortage of donor organs, transplant specialists say.
"In a perfect world, if we were able to build organs from scratch . . . everyone would get a perfect organ," says Dr. Giuliano Testa, director of liver transplantation at the University of Chicago Medical Center. "But those perfect organs in nature are only in a minority of cases."
Organ donors who are HIV-positive or who have actively spreading cancer are automatically ruled out for transplants. But transplants involving donors who have just about any other chronic medical condition are still possible, according to the United Network for Organ Sharing.
Transplant centers make decisions on whether to use organs from donors with pre-existing medical conditions based on factors such as how ill the would-be recipient is, how likely it is another organ would be found for that person and whether there's a risk of disease transmission from the donor, says Dr. Michael Ison, a specialist in transplant infections at Northwestern Memorial Hospital who chairs the organ-sharing organization's Ad Hoc Disease Transmission Advisory Committee.
Disease transmission from donated organs is extremely rare, occurring in 0.2 percent of cases, Ison says. The United Network for Organ Sharing requires organ donors to be tested for HIV, hepatitis B and C and the Epstein-Barr virus.
The transmission of HIV and hepatitis C to four transplant recipients in Chicago from a single donor in 2007 were the first known cases in two decades.
A far greater risk for people on the transplant waiting list is dying because they didn't get a transplant. There are currently more than 100,000 people on the waiting list for an organ transplant. About 25,000 people receive transplants each year, while on average 18 people a day die waiting.
"All of transplantation is a cost-benefit ratio," says Dr. Howard Sankary, chief of intra-abdominal transplantation at Loyola University Medical Center in Maywood. "If a liver patient is going to die from their liver disease, and there's no other organ available, you would take the less-than-perfect organ because they have a chance of living."
People in need of organs are usually informed of the potential risk of disease transmission from donors when they join the transplant waiting list, Ison says. If a potential problem with a donor is identified, it's also standard policy for recipients to be notified of these issues at the time an offer is made. Ison says patients usually have one hour to decide if they'll accept the organ, though Testa says he gives his patients longer to decide.
"The majority of patients that are offered this are more than willing to accept that organ, and even in many of the disease transmission cases . . . many people still say they don't regret accepting the organ," says Ison, who is conducting a study on the subject.
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