By Jim Warren


For the first time in the 20 years that the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN) has been collecting data on the number of organs donated annually, the number of both living and deceased donors declined over the previous year.   Data on the OPTN Web site, which a UNOS spokesperson cautioned is preliminary and possibly subject to some change, showed the number of deceased donors in 2008 decreased by 100 and living donors by 99.

The decline, of course, resulted in a decrease in the number of transplants performed. There 21,745 patients transplanted with organs from deceased donors in 2008, compared to 22,049 in 2007; and there were 6,213 patients receiving organs from living donors compared to 6,311 in 2007.  It was the fourth year in a row that the number of living organ donors has declined.

Because the overall declines in both live and deceased donors is so miniscule, the number of donors and transplants in most states in 2008 remained almost the same as 2007.  For example, the number of deceased donors in the state of Maryland were absolutely identical 119 each year. 

There were some swings in states each way, however, but they tended to balance out each way, a UNOS spokesperson told Transplant News.  Here are some other examples culled from the OPTN data provided to by the spokesperson.

• New York and Texas had noticeable declines in deceased donors: New York from 467 in 2007 to 373 in 2008; Texas from 670 in 2007 to 633 in 2008. 

• Pennsylvania, on the other hand, experienced a notable increased in deceased donors 594 in 2007 to 642 in 2008.

• Hawaii has had relatively few donors historically, but their increase in deceased donors in 2008 was approximately 76% -- 37 donors, an all-time record for the state and up from 21 in 2007.

Much the same was true with living donors by state.  Many were largely unchanged from 2007 to 2008. 

• The number of living donors in New York showed a modest increase 588 in 2008 compared to 544 in 2007.

• At the same time, there were decreases in living donors in both Ohio and Pennsylvania, historically among the higher-volume states.

Overall, the number of deceased donors by ethnicity remains proportional to the reported ethnic makeup of the United States. However, in 2008, there were modest declines in white and Hispanic donors, while the number of black and Asian donors increased slightly.  The number of  black donors has increased each of the last 10 years and totaled 1,277 in 2008.

UNOS also noted that the reported deaths on the transplant waiting list have decreased each year nationwide since hitting a peak of 6,926 in 2004.  The current data shows there were 6,229 reported deaths in 2008.  This figure may change based on additional data submission and verification.

Charles Alexander, CEO of Living Legacy Foundation (LLF) of Maryland in Baltimore, MD, and president-elect of the UNOS/OPTN board of directors, told Transplant News the 2008 slight decline in donors highlights some areas of concern that need to be addressed.

It is a lot more complicated that we all understand, Alexander told Transplant News.  We were off 100 deceased donors last year and almost all were standard criteria donors.  When were picking up more expanded criteria donors and we see minimal gains, we know we have to do a better job in developing our OPOs relationships with hospitals in order to expand the donor pool.  There seems to be a tendency to get more conservative and look for best cases with best outcomes and sometimes that results in using fewer expanded criteria donors.

Increasing the number of living donors after the four year slide also needs to be addressed, said Alexander.  There have been some reports that fewer people are opting to be live donors because of the current economic problems in the US.  Maybe they fear an extended stay in the hospital or perhaps they have lost their job and are doing part-time per diem work, he added. 

I think the four year declines points to more problems than the economy, Alexander continued.  I suspect has more to do with the system than the economy.  We have to look into long term insurability of donors, paying lost wages, areas which are probably within our control.  We need appropriations from the government to make it happen. We can look into providing tax credits and reimburse donors for all their expenses.

Finally, Alexander pointed to the current bill in Congress introduced by Senator Richard Durbin, which would provide $10 million in funding for HRSA/DoT organ donation and transplantation programs and also legislation which would provide lifetime coverage of immunosuppressive drugs. 

You shouldnt have to lose anything except the kidney, he concluded.  Were all working toward the same thing find the best way to provide long term follow-up of the donor to catch complications early and remove any financial disincentives.
     
 Mr. Warren is  editor and publisher of Transplant News.