Liver Donor Living Kidney Donor

More Info on UPMC living donor transplant programs

With the news that a surgeon and a nurse have been suspended over the infected living donor kidney episode, and that UPMC has temporarily halted both their living kidney and living liver transplant programs, I thought this might be a good time to pull up some ‘official’ data*.

[forgive the formatting; text editor was not cooperating]

Kidney transplants:

………. 2010 … 2009 … 2008 … 2007 … 2006 … 2005
Living …. 62 ….. 73 ….. 55 ….. 69 ….. 80 ….. 77
Deceased .. 90 ….. 94 ….. 109 …. 97 ….. 215 …. 133

Liver transplants:

………. 2010 … 2009 … 2008 … 2007 … 2006 … 2005
Living …. 17 ….. 13 …… 4 ….. 19 ….. 36 …. 36
Deceased .. 108 … 113 …. 102 …. 164 …. 147 …. 186

So how does this compare to other US transplant centers?

Johns Hopkins:

……… 2010 … 2009 … 2008
Living ….92 … 97 … 88
Deceased ..115 … 154 … 78

……….. 2010 … 2009 …. 2008
Living ….. 1 …… 0 ……. 3
Deceased … 38 ….. 64 ……. 57

Lahey Medical Center:

………. 2010 … 2009 … 2008
Living …. 20 …. 14 …… 20
Deceased .. 22 …. 18 …… 19

……….. 2010 … 2009 … 2008
Living ….. 19 …. 24 …… 27
Deceased … 37 …. 35 …… 23

UCLA Medical Center:

……… 2010 … 2009 …2008
Living … 138 … 140 … 131
Deceased ..166 … 137 … 169

……… 2010 .. 2009 .. 2008
Living …. 1 ….. 3 ….. 2
Deceased . 195 … 189 … 226

*this data is public knowledge from the OPTN site. I encourage everyone to go over there and browse around awhile.

Living Kidney Donor OPTN

Disease Transmission in Organ Transplantation

With the news that UPMC has temporarily halted their living kidney donor program due to hepatitis transmission to a recipient, I thought I’d pull some OPTN data for my fair readers’ perusal.

These slides are from OPTN’s 2011 spring presentation. (click to enlarge, just be prepared to hit your back button)

The Disease Transmission Advisory Committee classifies these cases into four categories:

Proven: disease in donor and at least one recipient (think deceased donor)
Probable: disease in one or more recipients with suggestive data about donor.
Possible: evidence to suggest but not proven transmission
Intervention Without Documented Transmission: no transmission occurred most likely because antimicrobals were used.
Unlikely: limited evidence to suggest transmission could have occurred but no transmission documented.

2006-2010 (only through October 2010) Proven and Probably transmissions:

5 events involving blood borne pathogens (HIV, HBV, HCV)
7 events involving other viruses
24 events involving bacteria
11 events involving fungi
7 events involving ‘other’ transmissions
30 events involving malignancy (cancer)

This committee has issued ‘guidance’ documents to transplant centers to reduce/eliminate disease transmission and collaborated with OPTN’s Living Donor Committee to improve screening of prospective living donors. While this is obviously a good and necessary thing, the motivation is not quite so crystalline. After all, it’s not as if this increased testing arose out of a need/want to protect and care for living donors. No, the sole concern, as always, is for the recipient.

Informed Consent Liver Donor Living Donor Protections

Brothers Sue UPMC Over Informed Consent

Two brothers who participated in a living liver donor transplant at University Pittsburgh Medical Center is suing the hospital and Dr. Marcos, former transplant chief, for “fail[ing] to give the brothers all of the information concerning the dangers of live liver transplantation.”

UPMC was involved in a scandal involving improper liver transplants, resulting in (among other things) the termination of Marcos, so it would be easy to dismiss this lawsuit, or its basis, the lack of Informed Consent, as an aberration or at the very least, relegated to a single transplant center. However, anecdotal evidence and at least one published study say different.

Housawi (2007) surveyed 203 transplant professionals at 119 cities and 35 countries* regarding the risks disseminated to prospective living donors during the Informed Consent process. While at least 77% claimed** to discuss hypertension and proteinuria, the worrisome prospect is that that 23% do not. Worse, 84% of those surveyed did not believe having a kidney removed increases the risk of cardiac disease despite the plethora of published evidence that any amount of renal insufficiency (drop in kidney function) is strongly correlated with cardiac issues.

Housawi’s inquiries were relegated to longer-term consequences of living donation and not the information dispensed about possible surgerical or short-term complications, which is what the UPMC lawsuit focuses more closely on. But story after story from living kidney and liver donors taking place on forums, message boards and mailing lists indicate that transplant centers are failing in that regard too. Nerve damage and hernias are most frequently reported, as well as gastic-intestinal blockage and damage, yet surgeons are neglecting to inform their prospective LDs of the possibility. Testicular swelling and sensitivity requiring surgical intervention occurs in approximately 10% of male LDs (more frequently in men who have undergone vasectomies), but men with the complication report months of haggling with their physicians over the cause and treatment of their issue, mostly because the medical professionals didn’t know it was a possible consequence of the surgery (!) It’s a reasonable assumption then, that prospective male LDs are not being asked if they have undergone vasectomies, nor warned of this potential complication.

There have been other lawsuits filed against transplant centers for a variety of living donor complications and deaths. Unfortunately, each and every one settled before they ever saw the light of a courtroom. This allows the transplant industry to continue their negligent behavior, complete with confidentiality agreement.

The complications incurred by the plaintiffs in the UPMC case are tragic. While nothing can be done to undo their pain or sense of betrayal and violation, they are in a position to improve how living donors everywhere are treated. A courtroom precedent can go a long way toward sending the message that living donors are deserving of respect, and being related to the recipient does not give the transplant industry license to decieve and abuse them.

*Most transplant professionals were from North America(45.1%) (USA 39.6%, Canada 4.0%, Mexico 1.5%),followed by Europe (31.7%) (UK 8.4%, Germany 6.4%, Belgium 2.5%, Netherlands 2.0%, Czech Republic 2.0%, Norway 2.0%, France 1.5%, Italy 1.0%, Sweden 1.0%, Switzerland 1.0%, Denmark 0.5%, Finland 0.5%, Northern Ireland 0.5%, Poland 0.5%, Serbia 0.5%, Spain 0.5%, Cyprus 0.5%, Scotland 0.5%), Asia (14.4%) (Saudi Arabia 8.4%, India 1.0%, Korea 1.0%, Lebanon 1.0%, United Arab Emirates 1.0%, China 0.5%, Thailand 0.5%, Kuwait 0.5%, Syria 0.5%), Australia (4.5%), South America (2.5%) (Brazil 1.5%, Argentina 1.0%) and Africa (2.0%) (Egypt 1.5%, Libya 0.5%).

**even the researchers acknowledge that there may be a difference between what survey participants report and their actual behavior.

Advocacy Informed Consent Living Donor Misinformation Living Donor Protections Living Donor Risks Psychosocial Risks

UPMC’s Hamar Clouds Truth of Living Donation

In a recent interview, Dr. Abhinav Humar, University of Pittsburgh Medical Center’s transplant chief stated his intention to increase the use of organs from the living to over 60%. While his motivation to help those with liver and kidney disease should be lauded, it should not come at the expense of another group of healthy people – namely, Live Donors.

Dr. Human is quoted as saying “The live-donor kidney transplant poses few complications for the…donor”. This is a purposely misleading, if not completely disingenuous distortion of the facts.

The Living Organ Donor Network found:

– Post-operative and wound healing complication rate of 23.07%.

– 37.5% complication rate only ONE YEAR post-donation. (Many health-related issues, such as hypertension or severely reduced kidney function will not appear for many years, so this number will only increase.)

The first living kidney donor transplant occurred in 1954, but until 2000, the medical community severed ties with Live Donors upon their hospital discharge. Even now, transplant centers are only required to submit the most basic follow-up form for two years, and the examination is done by the Live Donor’s primary care physician and not the original surgeon or nephrologist.

Dr. Humar, like many transplant surgeons and Live Donor Proponents, is deliberately manipulating the truth, utilizing the lack of comprehensive data regarding Live Donors’ health and well-being as proof that physically and permanently compromising a person by removing an essential organ is ‘safe’. Absence of proof is not proof of absence.

Dr. Humar is also quoted as saying, “Surgeons…can limit [complications] by following regimented procedures, carefully screening patients and preparing for problems that occur.”

Except, they don’t. Instead of ‘regimenting’ procedures to minimize risk to Live Donors, transplant centers across the U.S. have been broadening their criteria to include people previously deemed unacceptable due to age or a health-related concern (hypertension, obesity, etc). Worse, they are given almost total discretion over their evaluation and care procedures, so there are no concrete standards, quality control, nor punitive measures to be taken for incompetency.

Informed Consent requires that prospective Live Donors be FULLY informed of the risks of live donation, yet they are regularly not told about the nearly 200 live kidney donors since 1993 that have needed their own transplant, nor are they informed of the risk of vascular injuries (renal artery, renal vein, aorta, common iliac artery, vena cava and mesenteric veins), bowel injuries, spleen laceration, liver laceration, pneumothorax, diaphragm injury, cardiac arrhythmias, urethral strictures, atrial fibrillation, small bowel obstruction requiring return to the OR, sepsis, respiratory distress, pneumonia, retroperitoneal hematomas, hernias, testicular swelling, adrenal gland dysfunction, nerve damage, hypertension, adrenal gland dysfunction, lymph leakage, and severely reduced kidney function.

It is also known that Live Donors suffer from depression, anxiety, anger and PTSD, yet transplant centers offer no mental health or supportive aftercare services. Even though a 1972 Medicare benefit exists to cover all Live Donor-related expenses, transplant centers and CMS violate the law by seeking reimbursement from the recipient’s insurance, resulting in the Live Donor paying out-of-pocket for any mental health services needed.

If Dr. Hamar and the transplant professionals at UPMC are such proponents for Live Donation, I suggest they begin by having themselves tested as prospective kidney and liver donors. Their first-hand knowledge of the Live Donor process will not only prove invaluable to their patients, and it will instill the public’s confidence. After all, there is no substitute for leading by example.