“For people who have end-stage organ failure, a transplant is the only option,” says David Klassen, MD, the chief medical officer at UNOS in Richmond, Virginia. And any transplant can have a significant impact: “For someone who needs a kidney transplant and is on dialysis, a transplant could mean a better quality of life,” he adds. About 107,000 people were on waiting lists for organ transplants in the United States as of February 2021, according to the Health Resources and Services Administration (HRSA) website OrganDonor.gov, and more than 80 percent are waiting for a kidney. The year 2020 set an all-time high for most lives saved by deceased organ donors, according to UNOS, with a 6 percent increase in deceased donors over 2019 (despite obstacles because of the COVID-19 pandemic). Yet the need for healthy organs far outpaces donations, and each day, 17 Americans die waiting for an organ transplant, HRSA says. RELATED: Young Black Adults at Much Higher Risk of Death After Heart Transplant Whether you’re on a waiting list or are considering donating, here’s what you need to know about organ transplants.
1. Transplanted Organs Don’t Last Forever
While transplanting a healthy organ to replace a diseased or failed organ can prolong life, transplants have limits. A transplanted kidney lasts on average 10 to 13 years if the organ came from a living donor and seven to nine years if it was from a deceased donor, according to The Ohio State University Wexner Medical Center. Meanwhile, a liver will function for five years or more in 75 percent of recipients. After a heart transplant, the median survival rate of the organ is 12.5 years. A transplanted pancreas keeps working for around 11 years when combined with a kidney transplant. And a transplanted lung continues to work for about five years on average, but this increases to eight years if both lungs have been transplanted, OSU also notes.
2. A Transplanted Organ Can Carry a Hidden Disease Along With It
Before transplant, organs are screened for common infections and diseases. This is to exclude any potentially dangerous contamination. And while transmitted infections are very rare, they are suspected in about 1 percent of transplant cases, though actually discovered in far fewer, data from the Centers for Disease Control and Prevention (CDC) shows. “Donors are screened rigorously and infections can be treated well,” says Dr. Klassen. “There’s a risk-reward tradeoff, and it’s a relatively small risk,” he adds. West Nile virus and rabies are two examples of infectious diseases that have been transmitted via organ transplantation, the CDC data shows, and Klassen adds that rare cases of cancer from transplants have also been reported. And, as NBC News reported, an organ transplant patient contracted COVID-19 from the lungs of the donor, who had tested negative for the virus initially and didn’t show any symptoms of the illness. Doctors may have full knowledge of an infection in the organ before it’s set to be transplanted. Take hepatitis C. “Fortunately, hepatitis C has become a curable disease within the last five years, so we can still utilize the organ of a person with hepatitis C, and then treat the recipient with hepatitis C medications.” RELATED: The Signs and Symptoms of Hepatitis C
3. The Financial Cost of Donating an Organ May Be Higher Than You Think
Offering to donate a kidney or part of your liver as a living donor can help save a life, but the process may come with surprisingly high costs. Donating an organ could mean lost pay from time away from work, travel costs for surgery, and time off to recover — and neither Medicare nor insurance covers these expenses, according to the National Kidney Foundation. It’s estimated that living kidney donors in the United States bear out-of-pocket transplant-related costs of $5,000 on average, and up to $20,000, according to a past report. But according to the National Kidney Foundation, a living donor won’t have to pay for anything connected to the actual transplantation surgery. The National Living Donor Assistance Program and other similar programs may help cover some donation-related expenses. In addition, living donors may be eligible for sick leave and state disability under the federal Family Medical Leave Act, the National Kidney Foundation also notes, while federal employees, some state employees, and certain other workers may qualify for 30 days of paid leave.
4. Being a Living Organ Donor Could Cost You Your Life Insurance
An unexpected consequence of donating an organ as a living donor is a change in your eligibility for insurance coverage. Even though the Affordable Care Act ensures that you can’t be denied health insurance because you have a preexisting condition, the National Kidney Foundation notes that some living donors report having a hard time finding life insurance or having to pay higher premium prices. In those cases, the transplant center may reach out to the insurance company to inform them that as a living donor, you’re not at increased risk of death because of the donation. You may also be able to get life insurance through the Living Organ Donor Network, which allows donors to buy life and disability insurance in case they do have complications after donating an organ. RELATED: 9 Questions You Should Be Able to Answer About Your Liver
5. Transplant Tourism May Be Risky for Your Health and Unfair for Organ Donors
U.S. law prohibits paying people to donate organs, according to Cornell University Law School. The buying and selling of transplant organs from live donors is prohibited in many countries, the World Health Organization (WHO) notes, but a lack of available organ donations globally has spawned an international organ trade. People who travel to other countries to have organ transplants may not realize that their donor could be an unwilling participant — a prisoner, refugee, or impoverished person — notes a past international declaration on organ trafficking. “It’s illegal in most countries. In some parts of the world, you can do it, but it’s risky, dangerous, and poorly regulated,” says Klassen. A study published in June 2017 in PLoS One noted that organ transplant tourism makes up 10 percent of world organ transplants, and has been increasing quickly over the past 20 years. The researchers looked at Taiwan specifically, and compared citizens who received kidney and liver transplants domestically to overseas. They found that the overseas group had poorer health outcomes — for example, the five-year survival rate for a domestic liver transplant was 79.5 percent, while overseas it was only 54.7 percent.
6. A Liver Transplant Won’t Cure an Infection Like Hepatitis C
According to data from the Organ Procurement and Transportation Network (OPTN), there are currently almost 11,900 people on the waiting list for a liver transplant in the United States. In 2020, only 8,906 Americans received a liver transplant, per the OPTN. One of the leading causes of liver failure in the United States is hepatitis C, according to the Cleveland Clinic. But if you get a liver transplant, the new, healthy liver can become infected with hepatitis C once inside your body. This is because the hepatitis C virus can continue to circulate in your blood throughout your body, including your liver. That said, because hepatitis C is now curable, most people are treated before the transplant, says Klassen. According to the WHO, antiviral medications can cure more than 95 percent of people who have a hepatitis C infection. These new medications are costly if paying out of pocket, yet are covered by most health insurance plans, as a paper published in December 2019 in the American Journal of Managed Care notes. RELATED: What to Know if You Need a Liver Transplant for Hepatitis C
7. A Kidney Transplant May Be a Real Option for You if You Have Kidney Failure
If your kidneys are failing, your doctor should discuss the option of kidney transplant with you before you start on dialysis, according to Penn Medicine. But one past study found that one-third of dialysis patients surveyed said they didn’t know about the transplant option. As far as the patients recalled, that important kidney transplant discussion never happened. Because the study showed that people informed about a transplant option are nearly three times as likely to have one, be sure to ask about all your options, including transplant. Even so, getting a preemptive transplant before dialysis isn’t easy to do, says Klassen, unless you have a living donor who wants to donate their kidney to you: “Usually, because of the need to wait for a donation, most people have to be on dialysis for a period of time before the transplant happens.”
8. Women Aren’t as Likely to Be Evaluated for Kidney Transplants, or Get Living-Donor Transplants
Even though women are more often living donors than men, they are less likely than men to be the recipient of living donor kidneys, as a report published October 2017 in the Journal of the American Society of Nephrology (JASN) revealed. In the United States, for example, women made up 37 percent of the living-donor kidney recipients, while they were 63 percent of the living kidney donors, the report highlights. So what gives? One reason for the discrepancy is biological: “With kidney transplants, a limiting factor for women is that after they’ve had children, their immune system is more sensitized, which makes it harder to find a match,” explains Klassen. The JASN report points out, too, that even though immune memory is seen as an advantage these days (especially during the COVID-19 pandemic), it makes receiving a transplant match even harder because of the increased risk of rejection. Luckily, Klassen notes, the matching system gives people with a highly sensitive immune system a boost in the rankings. And a March 2018 report in the journal Trends in Immunology notes that certain therapies that target hormone receptors may help make up for the difference between men and women in the future. RELATED: A Brave New World of Women’s Health Tech: What Turned Heads at CES 2020
9. Your Weight May Affect Whether You Can Receive a Transplant
When you meet with your doctor or your transplant center, you may be advised to bring your body mass index (BMI) down to 30 or less. Although BMI is flawed, and it is not an accurate measure of health for everyone, in this case the goal BMI would correspond to less than 203 pounds for a person who is 5 feet 9 inches tall, according to the National Institutes of Health’s BMI calculator. The reasoning? A BMI of 30 or greater is a sign of obesity, which puts a person at greater risk for poor wound healing, infection, and kidney rejection, the National Kidney Foundation notes. “For obese people, their surgical risk goes up and it can be technically harder to do a transplant on this group,” adds Klassen. Just know that the goal should be a healthy approach to weight loss — and it’s important to meet with a registered dietitian nutritionist so that you aren’t missing out on key nutrients or doing anything extreme that puts your health in jeopardy, according to the National Kidney Foundation; your doctor may discuss weight loss surgery with you, too.
10. Where You Live May Determine How Long You Have to Wait
Your wait time for an organ can range from days to years, and doctors cannot predict the timing for any individual case. The median wait time for a kidney transplant, for example, is 3.6 years, per OrganDonor.gov, but it all depends on when an organ becomes available and whether it is the right fit for your blood type and body. Wait time can also be affected by where you live, as shown by data published in June 2018 in the American Journal of Transplantation. “For some parts of the country, such as California and dense urban areas, the waiting times are longer,” explains Klassen. Past research has also suggested that in the United States, people living in the Southeast have the highest rates of end-stage renal disease and the longest waits for kidney transplants, while other research has suggested that people living in New England have the shortest wait times for kidney transplants. Researchers point to understaffing and a need for more provider and patient education about transplants as some of the factors that could increase rates. Some good news though: “A new kidney allocation system is coming out later in 2021, and one of the new features [of this system] will help reduce geographical disparities,” says Klassen.
