Before 1954, dialysis was the only treatment option for individuals with end stage kidney disease. By the end of that year, one more option would be available. In December of 1954, a kidney donation operation between twin brothers gave us our first successful living donation transplant surgery. Less than ten years later, in 1962, Boston’s Brigham Hospital demonstrated that it was possible to successfully transplant a kidney from a deceased donor. However, donation did not become well accepted in the 1950s and 1960s when transplantation was still considered experimental.
As the field gained credibility, it also began to develop national governing bodies, national policies and deceased donor organ procurement and distribution systems to coordinate fair and efficient deceased donor organ allocation to transplant candidates. In 1969, the Medical College of Virginia created a foundation to conduct laboratory testing that would facilitate more effective organ matching. Thirteen years later, the Virginia foundation’s governing board authorized the creation of an independent, nationally-focused organization – the United Network for Organ Sharing (UNOS) - to facilitate deceased donor organ sharing among transplant centers. From 1982 to the present, UNOS has coordinated national standards for hospitals’ safety procedures regarding organ donation.
It took two more years for the U.S. congress to enact the National Organ Transplant Act that would create a federally sanctioned network to ensure equal access to organs. Congress immediately awarded UNOS the contract to oversee the network, called the Organ Procurement Transplant Network (OPTN).
Through the OPTN contract, UNOS administered the policy set forth in a new act, the Omnibus Reconciliation Act of 1986. This law required hospitals to create formal request procedures to approach families of deceased individuals about donating their loved one’s organs. It also required hospitals to refer the donor to a federally mandated OPO that would manage the equitable allocation of that organ and educate the public on the needs and benefits of organ donation. Data from 1988 to the present shows that the national rate of deceased donor organ donation increases slightly each year.
Donation rates are still not high enough to help everyone who needs a transplant. So, how can we help individuals on the national deceased donor waiting list? Effective public education on organ donation can alleviate a large part of the organ shortage. Simultaneously, scientific efforts have focused on how living donation can benefit the transplant community. Experience has helped transplant centers raise safety standards for an individual who wants to be a living donor. In a domino effect, the live donor transplant benefits more than the single transplant recipient. As that recipient leaves the waiting list, there is one more opportunity for another candidate to receive an organ from a deceased donor.
Medical breakthroughs make it easier for living donation. The 1990s saw the advent of the minimally invasive laparoscopic donor nephrectomy and the Incompatible Kidney Transplant Program (InKTP) at Johns Hopkins. The laparoscopic nephrectomy is already practiced by the majority of transplant centers in the U.S. Most recently, Johns Hopkins scientists have teamed up with transplant experts from various parts of the U.S. to bring some of the InKTP techniques to a national level. The success of these medical efforts hinge on the public acceptance of organ donation. If the state and national organ shortage is to be resolved, public education and medical efforts must proceed hand-in-hand.
Glossary
Organ Transplant Act (NOTA) - act established the Organ Procurement and Transplantation Network (OPTN) to maintain a national registry for organ matching. The act also called for the network to be operated by a private, non-profit organization under federal ontract. United Network for Organ Sharing (UNOS) - organization which coordinates US organ transplant activitiesOrgan Procurement Transplant Network (OPTN) -maintains the national patient waiting listOmnibus Reconciliation Act of 1986 - created policy on approaching families of deceased individuals about organ donation; required hospitals to coordinate organ donation through an organ procurement organizationOrgan Procurement Organization (OPO) - coordinates organ donations in a specific geographic areaLaparoscopic donor nephrectomy - minimally invasive surgery for removing a kidney from a living donorIncompatible Kidney Transplant Progam (InKTP) - Johns Hopkins’ specialized medical progams for kidney patients with incompatible donors; it is an array of programs for patients who have blood type antibodies and tissue type antibodies against their donors.
