Quality of organ donations dropping
New Canadian research is highlighting what experts in transplant medicine say is their new reality: organ donors are older, heavier and sicker than they once were, a phenomenon that’s contributing to suboptimal organs for transplant.
Montreal researchers who studied 1,040 brain-dead organ donors over 13 years found an “overall worsening” in their health status, with recent donors more likely to have a higher body mass index, a smoking history, coronary artery disease and abnormal blood fats than donors a decade ago.
It’s not clear what this means for the proportion of organs recovered — and discarded — the researchers say, or how well organs procured from bodies of “somewhat deteriorated” quality perform after transplant.
But others in the field say the finding reflects the growing use of “more marginal” organs, especially when the alternative may be no transplant, or even death.
“Transplant surgeons and transplant physicians are being faced with difficult decisions: Do we accept this organ, or don’t we?” said Dr. Andreas Kramer, medical director of the Southern Alberta Organ and Tissue Donation Program in Calgary, who was not involved in the study. “That’s sometimes a tough decision. But if the alternative is for a person to remain on dialysis, or with end-stage liver or end-stage lung disease, it may still make sense for them to accept the more marginal organ.”
Organs were once harvested exclusively from people declared brain-dead. Most were young victims of car crashes who suffered devastating brain injuries but who, by virtue of being young, also tended to have healthy kidneys, livers, hearts and other organs and tissues.
Today, safer cars, seatbelt laws and more aggressive, sophisticated care of head traumas mean fewer people who suffer severe head injuries are progressing to “brain death.”
Now, with organs in chronically scarce supply, doctors are expanding the pool of donors. They’re using “split liver” transplants — surgically splitting donated livers into two so that two lives are saved — kidneys from living donors and “donation after cardiac death,” where organs are harvested from people whose hearts have stopped beating.
In addition, doctors have expanded the criteria for eligible donors to include older people and those with underlying health conditions, such as stroke, that would have disqualified them in the past.
The new study looked at brain-dead organ donors aged 18 and older who donated one or more organs to a patient from the McGill University Health Centre between 2000 and 2012.
The median age of donors was 47; slightly more than half (56 per cent) were men. Overall, almost half were, or had been, smokers, 24 per cent had high blood pressure, seven per cent had diabetes and five per cent had coronary artery disease.
However, when they divided the donors into two time periods — 2000 to 2005, and 2006 to 2012 — the researchers found a significant increase in BMI above 30 (the cutoff for obesity) over time, as well as other health conditions they say have been associated with “worse outcomes” after transplantation. There were also more “expanded criteria” donors, meaning older, sicker donors.
“Our data suggest that the characteristics and comorbidities of brain-dead organ donors have somewhat deteriorated over the last decade,” the researchers report in the most recent issue of the Canadian Journal of Surgery.
They didn’t look at the function of the organs donated, though other researchers have shown that older donor age and higher BMIs are associated with “organ non-recovery.”
The study involved only one centre, and the researchers cautioned their findings couldn’t be generalized. However, Kramer said, “There’s no reason to believe that what was observed in Montreal would not be observed in other parts of Canada.”