A surprise surge in 'stranger' organ donations
A rapid rise in 'altruistic donations', i.e. strangers having a kidney removed for an unknown patient, has been reported by the UK's Human Tissue Authority (HTA). Although there have been just 15 stranger donations (three still await surgery),
the total includes a 50% jump since the 2007-8 period, which the HTA said is ‘remarkable’, since the law only came into effect in 2007. ‘We expected to see a small number of cases when we first started approving this type of transplant, but we did not expect to see the number rise so significantly after just one year,’ explained Vicki Chapman, HTA’s Director of Policy and Strategy. ‘Donating a kidney to someone you do not know really is an altruistic act; the medical tests take time and the procedure is not without risk.’ Part of the HTA’s work is to ensure that donors fully understand those risks.
The number of living donations from relatives also increased from 589 in 2005-2006 to reach 1,008 approved donations in 2008/2009. Over 1,000 more transplants were carried out using organs donated by the deceased. Still, up to 7,000 people are still on the kidney transplant list.
To alleviate the shortage of transplant organs, the Human Tissue Act was passed in 2006, which came into effect in 2007. The options for living-donor transplants now include paired/pooled as well as altruistic donation, i.e. a living kidney donation from someone who is neither related through marriage, nor genetically related to the recipient.
Vaginal kidney extraction could encourage living donations
Although diseased organs (kidneys, gallbladders and appendixes) have been removed through an incision in the vagina, a new procedure to procure living organs is heralded as potentially encouraging for future kidney donors. ‘Natural orifice transluminal endoscopic surgery is the final frontier to explore in making surgery scar-less, less painful and, for obese patients, much safer,’ said Dr Anthony Kalloo, Director of the Gastroenterology Division at Johns Hopkins University School of Medicine, Maryland, who pioneered the procedure.
At the end of January this year, this was used to remove a healthy kidney from a 48-year-old woman, for donation to her niece. A camera and operating tools were inserted through two small incisions in the abdomen and one in the navel. The kidney was cut from its attachments to the abdominal wall and the arteries and veins were stapled. The surgeons inserted a plastic bag through an incision in the vaginal wall, moved the severed kidney inside, and pulled it through the wall using the attached string.
Much the same as traditional laparoscopic surgery, the procedure took about three and a half hours. Today, the patient has only three pea-size scars on her abdomen, though one is hidden inside her navel.
Dr Robert Montgomery, who led the surgical team and heads the transplant division at Johns Hopkins USM, said: ‘Surgeons have been troubled by the need to make a relatively large incision in the patient’s abdomen after completing the nephrectomy to extract the donor kidney. That incision is thought to add significantly to the patient’s pain, hospitalisation and convalescence. Removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result.’
Organ transplants reports: Page 11
01.07.2009
