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Lung transplant system meets success
September 25, 2006 In: Process Improvement

Despite reports about widespread problems with the national organ transplant system, many lung disease patients are getting a new lease on life because physicians have revamped the lung transplant system and have improved methods for harvesting lungs from organ donors. Previously, doctors didn't know how best to preserve the organs from brain-dead patients. In addition, organs used to be given to patients who'd been waiting the longest rather than to patients who needed them the most. As a result of the changes, more lung disease patients now have a better chance of surviving. "The number of lung transplants has risen to 1,405 in 2005, 248 more than the year before. Fewer people are dying on the waiting list: 360 in 2005, down from 488 in 2004," notes the New York Times.

Lung patients see a new era of transplants
 Excerpted from The New York Times, Sunday, Sept. 24, 2006

A quiet revolution in the world of lung transplants is saving the lives of people who, just two years ago, would have died on the waiting list.

In the past 16 months, waits have shortened, lists have shrunk, and the number of lung transplants has gone up. Further improvements are expected this year.

The changes have all but erased the need for transplants from live donors -- desperate, last-ditch operations requiring two donors per patient, usually relatives and friends who risk major surgery in hopes of rescuing a loved one whose time is running out. ...

Recent changes have revitalized lung transplantation. Starting in May 2005, new rules nationwide put patients who needed transplants most at the top of the list -- people who would soon die without a transplant, but who had a good chance of surviving after one.

Previously, lungs went to whoever had been waiting longest, even if another patient needed them more. The waiting time was often two years or more, so there was little hope for people with lung diseases that came on suddenly or progressed rapidly.

Another major change is that more lungs from cadavers have become available, for two reasons: more people are becoming organ donors, and doctors have figured out ways to salvage lungs that previously would have been considered unusable. The new methods use drugs, respirator settings and other techniques to prevent damage to the lungs and keep their tiny air sacs open in brain-dead patients. ...

The new system has also changed the types of patients who receive the most transplants. Before, a majority had emphysema, a lung disease nearly always brought on by smoking. They received transplants because the disease moves slowly and they could wait, outlasting patients -- often younger ones -- with other lung diseases.

"People with pulmonary fibrosis or pulmonary hypertension can be diagnosed and go downhill very, very rapidly," said Dr. G. Alexander Patterson, a surgeon at Washington University in St. Louis, which has one of the country's largest lung transplant programs, with about 55 to 60 adult patients and 25 to 30 children a year.

Pulmonary fibrosis causes extensive lung scarring, and its cause is often unknown. Patients can die within a year of the diagnosis. But patients with emphysema can often live for a long time. As a result, Dr. Patterson said, many people thought the old system gave an unfair advantage to emphysema patients.

On the waiting list, 5 to 10 percent with emphysema died each year, compared with 30 to 40 percent among those with cystic fibrosis or pulmonary fibrosis.

"It was an ethical dilemma," Dr. Patterson said, adding that some doctors were troubled to see so many transplants go to people with emphysema, which is caused by smoking, whereas "others have disease they didn't produce."

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