Organ transplants rise nationally, in Iowa

'The opioid epidemic has opened up a whole new category of donors'

(File photo) Devices used to take blood pressure, temperature, and examine eyes and ears rest on a wall inside of a doctor’s office in New York March 22, 2010. (REUTERS/Lucas Jackson)
(File photo) Devices used to take blood pressure, temperature, and examine eyes and ears rest on a wall inside of a doctor’s office in New York March 22, 2010. (REUTERS/Lucas Jackson)

IOWA CITY — For the fifth consecutive year, health care providers across the nation in 2017 set a record for the number of organ transplants, an increase that underscores the uptick in such surgeries at Iowa’s largest transplant center.

Nationally, doctors performed 34,768 organ transplants last year from both living and dead donors — a 3.4 percent bump over 2016, according to the United Network for Organ Sharing, which is contracted by the U.S. Department of Health and Human Services.

In this state, the University of Iowa Hospitals and Clinics has performed the most transplants of any center in Iowa by far — achieving 3,929 transplants between Jan. 1, 1988, and Dec. 31, 2017, the time period for which the national network has data.

Organ transplants last year reached 143 at UIHC — the most since 2011, according to the data. Those numbers include mostly heart, kidney, liver and lung transplants, but not bone marrow and cornea transplants, which the university also performs. Including all organ and tissue transplants, the university reported 576 in the 2017 budget year, up from 565 in 2016 and from 524 in 2015, according to annual reports.

Kidneys account for the largest chunk of solid organ transplants on the university medical campus, said Alan Reed, professor of surgery and director of the UI Organ Transplant Center.

His center performed 88 kidney transplants in the 2017 calendar year, up from 67 in 2016 and 54 in 2015.

“Every year has been better than the last,” Reed said, reporting nearly 900 patients were referred to his clinic for transplant evaluation last year.

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More than 117,000 people in the United States are waiting for an organ transplant, including 686 people in Iowa.

But in 2016, more than 7,000 Americans died while still on a waitlist or within 30 days of leaving the list without a transplant for personal or medical reasons.

Medical professionals are making inroads toward improving those statistics, records show. The national network this month reported that deceased organ donors in 2017 exceeded 10,000 for the first time, according to preliminary data.

Reed credits the increase at the UI to several factors, including good results at the university, complementary services, and efficient processes.

On the national and local level, Reed said, technological improvements, medical advancements and the type of donors who are dying have allowed practitioners to become “more aggressive.”

The nation’s opioid epidemic has helped create a disquieting phenomenon — more opportunities to use organs from deceased patients who could pose risks.

“The opioid epidemic has opened up a whole new category of donors,” Reed said. “We’re getting much more aggressive about using donors who are at risk for transmitting diseases but might not actually have them.”

The national epidemic of people dying from heroin or prescription painkiller overdoses has caused a spike of high-risk donors — those who surgeons continue to be wary about, but who also can provide lifesaving organs for some patients.

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Younger people seeking an organ, for example, might not want to gamble on a donor who could have had hepatitis C, Reed said. But older patients at risk of imminent death might be more willing to try.

“There’s the right organ for the right patient at the right time, and we’re learning to be better about that,” he said.

Reed pointed to national programs that help medical centers understand risks, trade-offs and competing priorities that aid in the optimal use of donated organs.

“We’re getting better at explaining to our patients what the trade-offs are in accepting those organs versus staying on dialysis or staying on a waitlist for a liver transplant,” he said.

Even if a donor has a disease, Reed said, many illnesses are more treatable than in the past.

“We can treat hepatitis C now with good results,” he said. “Five years ago, hepatitis C was a lethal disease. That’s remarkable.”

In Iowa, kidneys are the most sought-after organ — with 594 candidates waiting for one out of a total 686 seeking a transplant. On the national scale, kidneys have accounted for 59 percent of transplants — or 425,193 — since 1988.

The second-most common transplanted organ is the liver.

Transplant firsts in Iowa, all performed at UIHC:

1969 — Kidney

1979 — Pancreas

1979 — Kidney and pancreas

1983 — Heart

1984 — Liver

1988 — Lung

1988 — Heart and lung

l Comments: (319) 339-3158; vanessa.miller@thegazette.com

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