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Transplant Then & Now

In December 1954, physicians in Boston did something revolutionary. They transplanted a kidney into a 23-year-old patient: the first successful organ transplant in history. Now, 64 years later, organ transplants save tens of thousands of lives each year. The U.S. Department of Health and Human Services (HHS) reports that U.S. transplant teams performed more than  19,000 kidney transplants in 2016 alone.

One of this country’s largest, most experienced kidney-transplant teams is at Barnes-Jewish Hospital, where nephrologists and transplant surgeons performed and provided care for more than 5,000 people with kidney transplants between 1973 and 2017. Projections for 2017 included 245 kidney transplants, 110 liver transplants, 85 lung transplants, 35 heart transplants and 15 pancreas transplants, for a total of 490. In fact, the hospital completed 506 transplantation surgeries in 2017, including a handful of multi-organ transplants: heart/lung, liver/kidney and heart/liver.

As volume and demand for transplantation have increased across the United States, transplant techniques have evolved from early experimental procedures to standard therapy for many conditions. William Chapman, MD, chief of the abdominal transplant section at Washington University School of Medicine, looks back on a career of more than 25 years and notes that transplant surgeries are now more streamlined and successful.

“The transplanted organs themselves have become better tolerated by patients, and there aren’t as many side effects [after transplantation]. At the same time, anti-rejection medications are also much better tolerated,” he says. These changes mean that sicker patients now are able to undergo transplants, and more donor organs are usable due to better preservation techniques.

Though most of us have seen television doctors whisking those organs through hospital corridors in styrofoam coolers on their way to surgery, this scenario is somewhat more dramatic than the typical routine. However, donated organs do still travel in coolers, “though they’re not usually styrofoam,” notes Gene Ridolfi, MHA, RN, the executive director of the Washington University and Barnes-Jewish Transplant Center.

“The donated organ is triple bagged and placed in a secure, locked cooler,” Ridolfi says. “Organs are harvested from deceased donors in our operating room or in a procurement-organization operating room. The organ is allocated to a recipient through a national database algorithm.”

Each donor organ is flushed with preservation solution and cooled to 4 degrees Fahrenheit to slow any ongoing metabolic activity. Washington University is part of a national multicenter trial exploring a new technique in which the organ is perfused with a blood-based, oxygenated preservation solution that allows it to remain at normal body temperature. “We’re seeing good evidence that this causes less injury to the organ than putting it on ice, and it helps marginal organs perform better,” Chapman says. 

Once the donor organ arrives in the operating room, the surgery itself takes far less time than it did a decade ago.  In the 1990s, for instance, a liver-transplantation surgery lasted eight to 10 hours or more. Now, Chapman says, the operation takes five hours or less. 

The teams that perform transplant surgeries tend to be tight-knit groups. In kidney transplants, for example, that team includes surgeons, transplant nephrologists, nurses and other personnel. Some specialize in surgery logistics; others in the care of the patient, from pre-surgery arrangements to post-surgery follow-up and long-term care. Tarek Alhamad, MD, MS, the medical director of the kidney and pancreas transplant programs at Barnes-Jewish Hospital, says “all the members of our team work together for one purpose, one thought, which is to provide the  best care possible so our patients will enjoy a better and longer life.” 

Perhaps the most gratifying part of the work he does, Alhamad says, is hearing from a patient that he or she no longer needs kidney dialysis. “Patient satisfaction and the opportunity to offer people better lives are the most exciting things about our work.”

Despite the advances in transplantation — or perhaps because those advances allow more people to qualify for transplants — the waiting list for donor organs is lengthy, and many of those on the list will die before an organ becomes available. HHS reports that more than 116,000 people are waiting for donor organs as of August 2017. About 83 percent of those are waiting for kidneys. 

“We’re very grateful to donors, both living and not living,” Chapman says. “There’s no reason why we shouldn’t all be signed up as donors.” With new scientific advances and increased awareness, organ shortages may someday be history, too. 

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