Organ Donations From Less Than Ideal Patients Are Saving Lives
After 2 1/2 years on Michigan's waiting list for a liver, Fredric Bennitt, who had gotten weaker and sicker, changed his mind about taking a less-than-perfect donor organ.
The liver he got last November at the University of Michigan came from someone who died of a heart attack, a donation considered somewhat riskier because organs of heart patients might go longer without a blood supply that affects the success of a transplant.
But with no increase in organ donations nationwide and not enough organs to go around, Americans must decide whether to take an organ from an older person or from someone with a chronic health issue. Bennitt, 63, was told another U-M patient declined the organ he got.
The issue is an eye-opener for some patients and their families "who assumed we only offered the best and were reluctant to consider anything but the best," said Dr. Michael Volk, a liver specialist at U-M.
In a survey Volk led, more than 42% of 95 U-M patients said they would rather wait than take a liver from a nontraditional source. Some patients don't understand that the risk of dying while waiting for an organ is often greater than risks they take with an organ from a less-than-perfect source, doctors say.
Bennitt is doing well after his November transplant and hopes to return to hobbies such as golfing. "I think there's more than one tomorrow," he said.
Long waits for transplants drive change in organ use
The nation's critical shortage of donor organs is triggering a change in the use of organs once considered less than perfect.
For a half-century, most organ donations have come from young or middle-age people who died in auto and other accidents. These organs have been considered the best because they are usually in good condition and undamaged.
But today, with people waiting for organs far outnumbering donations, more centers are asking patients whether they would consider an organ from a nontraditional source: a person older than 50; someone with high blood pressure or kidney issues, or someone who died after a heart attack, leaving an organ without blood, a factor that can affect its viability.
"The donor demographics are changing," said Rich Pietrowski, executive director of Gift of Life Michigan, the state's federally designated organ-recovery program. It oversees all aspects of donor retrieval in the state.
The change is necessary, said Dr. Darla Granger, transplant surgeon at St. John Hospital & Medical Center in Detroit.
"When so many people are waiting, we need to be more creative in our use of organs," she said.
Last year, more than four of every 10 donors in Michigan fell into nontraditional categories, according to Gift of Life.
Michigan ranks among the nation's best for organ donation and use of nonstandard organs.
In 2010, it was third nationwide in total organ donors; second in donations of all organs from people who died of heart-related causes, and 10th in retrieving nonstandard organs, according to Gift of Life spokesman Tim Makinen. He attributes the state's success to exhaustive work with hospitals and others educating the public and health care staffers about organ donation.
Still, "we realize that as long as there continue to be deaths on the waiting list and until the waiting list starts plummeting, we have a lot of work to do," he said.
What is a quality organ?
Joan Smith, 69, of East Lansing, who has waited two years for a liver donor, said she is open to accepting an organ that is not perfect. "It's not my preference, but I'd like to have the choice," Smith said.
Many others choose to wait, however -- even in a state where 173 people died in 2010 waiting for an organ transplant, a number that has stayed steady for several years, according to Gift of Life.
Dr. Michael Volk, a University of Michigan liver specialist who is developing a new Web-based tool for patients and doctors to discuss organ selection, tells patients: "Organs are not simply good or bad; most are somewhere in between."
The quality of an organ depends on factors that include donor age, which is more relevant for some organs that tend to deteriorate with age, such as the liver; the time an organ spends on ice in transport, and other factors, such as a liver's fatty content.
Even organs from a younger accident victim may be hampered by the same issues, doctors say. That's why transplant doctors such as Dr. Jeffrey Punch, head of the U-M Transplantation Surgery section, cringe at hearing patients call some donations high risk or lower quality because "it implies that the patient is taking a chance by accepting organs from these donors" when "that is absolutely untrue."
"Every good organ we throw away causes someone to die or not live as long as they would have," Punch said.
Time, health factors
Waiting times are longer for a traditional organ. A Detroiter waiting for a kidney from a standard donor, for example, typically would wait five years and five months at Henry Ford Hospital in Detroit but only three years and two months there for a nonstandard organ, according to a tool on the consumer website www.ustransplant.org.
Hospitals use nonstandard donor organs for many types of transplants, even lungs, though kidneys are the most common. Nonstandard organ donations don't require much different monitoring before and after surgery, doctors say.
Some transplant centers keep separate lists of patients interested in nonstandard donations. "We don't ask everyone to be on that list," said Dr. Darla Granger, a transplant surgeon at St. John Hospital & Medical Center in Detroit. St. John lists only patients for nonstandard donations if they are older than 50 or have diabetes and are on dialysis, she said.
The sicker people get, the more likely they are to consider a nonstandard organ, said Dr. Alan Kofron, chief of transplant surgery at Beaumont Hospital in Royal Oak. He tells patients, "If you are doing well and you aren't sick, we want the best organ possible. But if you decompensate and are in the hospital ICU, how far do you want us to go? At that point, it becomes a no-brainer."
Nonstandard organs may have higher rates of failure in the first one to three years, depending on the organ. A person's odds of dying without a transplant are much greater, said Dr. Marwan Abouljoud, director of Henry Ford Hospital's transplant institute in Detroit, when asked whether he'd take a non-standard organ.
"I tell them, 'If I wouldn't use it on myself, I wouldn't use it on you.' "
'A great option'
It took two and a half years for Fredric Bennitt, 63, to change his mind.
Under no circumstance would he let any member of his family give him a portion of their liver, he told his three children and their families. Too risky for them, he argued.
He didn't want any organ, either. He gave the decision no more thought until last year, when his health plummeted and he moved into the Hamilton home of his 34-year-old daughter, Kerri Brown, with her husband and their young daughter.
A truck driver and avid golfer for years, Bennitt's depression grew with the move and his loss of independence, along with his declining health.
He admits he gave up hope.
"The worst thing I thought was, I didn't want to die in the house where my granddaughter lived," Bennitt said. "She was 6 then. I was just hoping I had time before it happened that I could get out of the line of sight."
Last summer, U-M doctors brought up the issue of non-standard donations with Bennitt and his family and by then, thinking he had only months to live, they agreed it was the best way to go.
The donation came in November from a U-M patient who died after a heart attack. Another patient declined the organ. Bennitt said his doctors told him the organ "was in good shape."
Bennitt and his family recalled leaving their Grand Rapids-area home around 12:15 p.m. and "they were hauling him away by 3:40 p.m." for surgery, said his daughter Kelli Daniero of Caledonia.
Bennitt has been hobbled by an infection from his surgical drainage tube. He was hospitalized last week for the problem again but is feeling better and happier, Daniero said.
He traded in his smaller car for a bigger Jeep Liberty that accommodates more of his family, and he's talking to his son about his hopes of getting back on the golf course this spring.
"They told me that in six months, I'll be as normal as any other person," he said.
"This turned out to be a great option for me." He wishes he had come to that conclusion two and a half years ago.