March 26th, 2019

Advances offer hope for future of transplants

By Medicine Hat News Opinon on January 8, 2019.

There has been a remarkable acceleration in B.C.’s organ-transplant program. Ten years ago, we had one of the worst records in Canada. Today, our rates have doubled, and we are first in the country. How did this come about?

There are two immediate parts to this story. One is that in years gone by, organ retrieval was not always a priority in hospital ICUs.

B.C. Transplant — the agency responsible for overseeing organ recovery — took the step of encouraging hospitals to hire transplant co-ordinators. This brought focus and physician buy-in to what had been, at best, a haphazard process.

This turnaround is one of the major success stories in our provincial health-care system. Credit is due to all involved.

The second part is more difficult to tell, because it involves an element of tragedy. A decade ago in B.C., the number of organs collected from people who died of opioid overdoses represented just five per cent of the total.

Because of the fentanyl crisis, today that figure is 30 per cent. This, too, has boosted the supply of recoverable organs.

It might be thought that tissues retrieved in this way would be unusable  that the fentanyl would be transmitted to the recipient. But organs are fully flushed before they are transplanted, and even in overdose cases, the amount of opioids at any one location in the body is small.

Painful as this is to relate, perhaps it might bring solace to family members who have lost a loved one to this devastating scourge.

But there are also forward-looking elements in the transplant picture. It is possible to create new organs using 3D computer printing. While the technology is still in the early stages, and not yet available in B.C., computer-printed bladders have already been transplanted in the U.S.

Efforts are also under way to manufacture more complex organs, such as kidneys. It will take time, but there is the promise of a major new source of transplantable organs.

Better still, printed tissues do not provoke rejection in the host patient.

And devices are becoming available that enable organs to be kept stable much longer, once retrieved from the donor s body.

This, too, will ensure more patients receive a gift that might save their lives.

There is also a remarkable clinical trial underway in Ontario. Traditionally, potential donors who had hepatitis C were not considered suitable. The disease might carry over and, until recently, was often fatal.

Of the 12 patients in the trial who were given transplants from hepatitis C donors, 10 did not contract the disease, and two did.

What made this option possible is the emergence of new drugs that are almost universally successful in treating this ailment. The two patients who were infected had treatment with anti-viral medications and both were cured.

This is an important step forward, both in its own right and because it points the way to other possibilities as new medications become available.

The implications are profound. Currently, 665 British Columbians are on the wait list for a transplant. Of these, more than 100 will die before an organ becomes available.

The problem is not a lack of public support. More than one million British Columbians have joined the donor registry. You can add your name online at transplant.bc.ca. A single donor can save up to eight lives.

The problem is that historically, less than one per cent of fatalities occurred in a way that would enable a tissue transfer. Now that is changing.

It might take another decade before some of these new technologies come to fruition. But progress is being made, and perhaps the day is not too far off when no one need die waiting for an organ transplant.

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