In 2021, over 40,000 patients received organ transplants in the United States. While the total smashed previous records, it’s still only a fraction of the number of people on transplant waiting lists.
Every day, roughly 17 people die waiting for a compatible organ. Someone new joins the waiting list every nine minutes. Despite this, evaluators discard approximately 4,300-4,900 donor organs each year.
Several factors contribute to the loss of potentially viable donor organs. But, the most significant is time.
Few organs remain viable for more than 24 hours after death. Lungs only stay useable for four-to-six hours post-mortem.
Given the urgency, healthcare leaders must maintain a sense of which patients are statistically likely to need an organ transplant soon. And, they must implement a streamlined system to deliver compatible organs to those patients.
This guide unpacks the ten most common reasons a patient may need an organ transplant. For each reason, it identifies the risks and limitations inherent to each type of potential organ recipient. Build on this information to anticipate transplant needs, mitigate risks, and optimize your organ sourcing and transplant procedures.
1. Surgical (-Ectomy) Cancer Treatment
Surgical cancer treatments remove cancerous organs from the patient entirely. Cutting cancer cells out of the body is a first-line treatment method. But, total organ removals are not.
An oncologist will prescribe an -ectomy surgery when cancer is localized to a single organ. In these cases, the surgery is potentially curative.
Patients sometimes opt for preventative -ectomies of non-essential organs. Some patients with BRCA1 or BRCA2 mutations choose pre-emptive mastectomies to prevent breast cancer. But, mastectomy patients do not need breast transplants to survive.
In contrast, a patient who receives a pneumonectomy or nephrectomy needs a transplant to survive long-term. People can live with a single lung or kidney, so long as the remaining organ is healthy. But if the remaining organ is damaged to some degree, patients can only live a few years.
Engineers have improved medical devices in the past few decades. But, these devices still aren’t long-term solutions for post-ectomy patients. So, assume patients who’ve had vital organs removed need organ transplants.
2. Organ Transplants After Severe Pathogenic Infections
Pathogens are infectious diseases. Advances in antibiotics and anti-viral drugs mean most infections are not life-threatening. Unfortunately, severe infections can still destroy organs.
When a patient is battling a severe infection in a vital organ, plan on adding that patient to the transplant waiting list. Infections that often lead to organ failure include:
- Myocarditis
- Acute pancreatitis
- Liver disease (hepatitis)
- Infective endocarditisis
- Ocular herpes zoster (shingles)
Patients need temporary interventions while they wait for a transplant. The only exceptions are patients with ocular damage from the shingles virus. Corneal transplants can restore patients’ sight, but there is no immediate treatment that can mitigate vision loss.
3. Congenital Disorders and Long-Term Chronic Illnesses
Certain congenital disorders and chronic illnesses can destroy patients’ organs. If efforts to manage a patient’s chronic or congenital disease fail, assume the patient will need a solid organ transplant. People who are born with or deal with the following illnesses face a heightened risk of organ failure:
- Type 1 diabetes
- Cystic fibrosis
- Eisenmenger syndrome
- Alagille’s syndrome
- Tyrosinemia
- Nonspecific interstitial pneumonia
- Polycystic kidney disease
This list is not comprehensive. But, patients with these conditions are more likely to need an organ transplant process than others.
4. Autoimmune Conditions
Autoimmune conditions are disorders wherein the immune system attacks the body. Some autoimmune conditions are localized to specific body parts. Others, like systemic lupus erythematosus (SLE), attack the whole body.
Several autoimmune conditions are easy to manage. Unfortunately, others are routinely severe enough to cause organ failure. A patient is more likely to need an organ transplant if they have one of these conditions:
- Goodpasture syndrome
- Autoimmune interstitial lung disease
- Systemic autoimmune rheumatic diseases
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
- Vasculitis
- Evans syndrome (autoimmune hemolytic anemia)
- Autoimmune pancreatitis
When an autoimmune condition seriously injures a patient’s heart, lungs, liver, or kidneys, transplants become the best treatment option.
5. Exposure to Pollutants and Environmental Toxins
Pollutants and toxins can damage organs past the point of recovery. The World Health Organization declared air pollution a public health emergency in 2019. Air pollution alone contributes to 8.8 million deaths globally each year.
International environmental protection agencies classify toxic substances in five categories:
- Carcinogens
- Neurotoxins
- Endocrine disruptors
- Persistent organic pollutants (POPs)
- Volatile organic compounds (VOCs)
People’s organs can accumulate pollutants and toxins over time. Some damage organic tissues quickly, while others only show signs of damage after they accumulate over years. Patients who live or work in places where they’re routinely exposed to toxins face a higher risk of organ failure.
Medical providers in highly polluted regions must plan on facilitating more organ transplants than those in cleaner locations.
6. Addiction and Substance Use Disorders
Addiction and substance use disorders can damage an individual’s organs to the point of failure. Alcohol use disorder, for example, carries a significant risk of liver failure. Substance use disorder can cause kidney disease and renal failure.
Addiction to tobacco products causes widespread physical damage. Smoking elevates a person’s risk of:
- COPD
- Lung cancer
- Coronary heart disease
- Acute pancreatitis
- Chronic kidney disease
Smoking tobacco products risks the survival of almost every organ in the body. Yet, while tobacco users are more likely to need transplants, the addiction makes them risky transplant recipients. Studies suggest nearly one-in-four lung transplant recipients resumed smoking after transplant.
Some officials ban smokers from the organ transplant list in their region. They argue donor organs should be given to people who will take good care of them. This position is controversial.
Substance use disorders are a challenging source of organ failure. High rates of disordered substance use in a community predict a greater need for local organ transplants.
7. Chronic Stress, Cortisol-Induced Organ Failure
Stress can cause organ failure. It can also exacerbate the damage done by other conditions. According to a 2017 meta-analysis, stress is most likely to cause or contribute to the following organs’ failure:
- Heart
- Pancreas
- GI tract
- Digestive system organs
Elevated stress causes or correlates with hypertension, high blood pressure, and depressed immune system function. These issues, in turn, contribute to lung tissue damage.
Immune system dysfunction increases rates of infection. As a result, kidney damage is another indirect effect of excessive stress. Factor distressing experiences like a high-intensity job, volatile relationships, and grief into your assessment of a patient’s organ failure risk.
Stress can be the difference between managing and needing a transplant.
8. Severe Organ Trauma (Blunt, Penetrating)
Severe organ trauma necessitates a transplant. Injuries, accidents, and violence can physically traumatize organs. Serious enough trauma can kill the organ in question.
The severity of organ trauma varies. Physical trauma may be blunt-force or penetrating. Penetrating injuries are typically more severe.
ER doctors have greater success treating blunt-force abdominal injuries with non-surgical interventions. In contrast, penetrating trauma is more likely to cause a hepatic injury. The liver is the organ most likely to suffer a hepatic injury.
Hepatic injury to the liver increases the risk of potentially lethal complications. Acute liver failure and hypovolemic shock can occur quickly post-injury. So, it’s wise to plan for an urgent liver transplant when patients come in with these injuries.
9. Limitations of Non-Transplant Treatment
A patient’s first organ transplant becomes necessary when they reach the limit of non-transplant treatment options.
Some organ failure never necessitates a transplant. A patient who undergoes a colectomy can resume their life—with the minor addition of a colostomy bag. Cholecystectomy patients don’t need any tools at all to adapt to their gallbladder-free life.
But other vital organs have no effective, long-term, artificial replacement.
Medical engineers have made great strides in recent years. For instance, the MARS artificial liver support system can mimic many detox functions of an organic liver.
Yet, the most ambitious goal of these technologies is to keep the patient alive until a transplant is available. And even that goal is out of reach more often than not.
Consider that hemodialysis is meant to mimic the function of the kidneys. Yet, dialysis machines cannot create and adjust hormones continually, to regulate blood pressure, as kidneys do. They cannot remove uraemic toxins as readily and reliably as real kidneys.
And because the machines require vascular access, dialysis users bear a high risk of infection. As a result, 28% of kidney disease patients choose to stop dialysis voluntarily. Instead, they focus on palliative care. Even if there is some slim chance of a transplant in the future, it’s no longer worth enduring the pain of the treatment today.
Experiments in long-term, man-made organ replacements are still in their earliest stages. Projects like the bioengineered artificial lung are reasons for optimism. But, for current patients, transplants are the only viable option to treat vital organ failure.
10. Barriers to Non-Human / Non-Organ Transplant Options
Organ transplants can be necessary when other transplant options fail.
In January 2022, a human patient received a heart transplant from a genetically modified pig. Transplants from animal donors may be more common with time. But, even if they do, human organs will stay the more reliable donor objects for years to come.
Healthcare practitioners may opt for infusions or tissue transplants, rather than organs, in the early stages of treatment. A person can donate bone, bone marrow, blood, and skin while they’re still alive. Since all except bone replenish, the shortage of donor tissue is less extreme than the donor organ shortage.
Hematopoietic stem cell transplants can treat some blood cancers. The long-term survival rate is 62%.
Unfortunately, if the patient’s leukemia has spread to their liver, the stem cell transplant can’t fix that. Their best bet would be at least a partial liver transplant. Typically, a practitioner would search for a compatible liver through the organ procurement and transplant network.
Streamlined, Accurate Organ Transplant Facilitation
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