Lung transplants present variety of challenges

Before Robert Goulet died Tuesday, the veteran entertainer played a part thousands of Americans already know well: people who await the fortuitous match of donor and recipient that is the keystone of all organ transplants.

Goulet needed a lung transplant.

While it's an operation many know little about, combined heart-lung transplants have been done successfully for about 30 years, and lung transplants -- of either one or both lungs -- for about 20, said Joel Newman, spokesman for the United Network for Organ Sharing, the nonprofit organization that oversees organ procurement and allocation in the United States.

So far this year, about 858 people have received lung transplants in the United States, according to the Organ Procurement and Transplantation Network, which maintains the national waiting lists for transplants. In 2006, a total of 1,405 lung transplant operations were performed.

As of last week, 2,301 people were on the network's lung transplant waiting list, while another 114 were waiting for a combined heart-lung transplant, according to the OPTN.

Any donor organ is a scarce commodity, but in the case of the lung, the scarcity becomes more acute because of some additional, practical considerations.

First, donor lungs, like any donor organs, must be undamaged. However, injuries that lead to traumatic death -- auto accidents, for example -- often leave the lungs damaged and unsuited for transplant. Nor, Newman said, are the lungs of someone who has spent an extended period of time on a respirator before his or her death suitable for transplant.

Also, the lungs are very susceptible to infectious disease processes, noted Ken Richardson, executive director of the Nevada Donor Network, one of the 58 federally designated organ banks in the United States. "So we don't see as many lung donors as we do, say, kidney donors."

Another hurdle stems from the relative perishability of the lungs. Once removed from a donor, a lung must be transplanted into its recipient in four to six hours, compared to, say, the liver (a maximum of about 12 hours) or the kidney (about 18 hours optimum).

In fact, Newman says, four hours "is preferable, six would be acceptable."

Logistically, that reduces the geographical area from which a donor lung can be obtained. Most donor lungs "will be used in a relatively local area, probably a 500-mile radius," Newman said. "Even if it's not the same local area, it could be transported by helicopter or chartered jet.

"But it's certainly not a coast-to-coast situation, where a kidney can be recovered on one side of the country ... and transplanted on the other coast. Hearts and lungs have a limited time frame."

When a suitable donor lung does become available for transplant, it's matched to potential donors through a nationwide computer network operated by the United Network for Organ Sharing.

Each prospective recipient age 12 and older is given a number, a "lung allocation score" based on criteria that include age, blood type and tissue matches, body mass index, the patient's diagnosis and the results of medical tests and evaluations. The idea, Newman said, is to obtain a picture of both how well a potential recipient can be expected to do after the transplant and how sick a person is at the moment.

That last is one key way in which the lung allocation process differs from that used for some other organs: People who are closer to dying without a transplant have that reflected in their lung allocation score, Newman said, primarily because there is "no long-term therapy replacement" for someone who needs a lung.

For example, dialysis isn't an ideal substitute for a new kidney, but it at least can keep somebody alive until a donor organ can be found. In contrast, Newman said, the only treatment available for someone who's suffering from end-stage lung disease is a new human organ.

Information and lung allocation scores of people who are accepted onto the transplant waiting list are entered into the computer system. When a donor lung becomes available, the system creates a prioritized list that ranks the donor lung to the potential recipients who are most suitable for it and who most urgently need it.

Richardson said he knows of nobody locally who is awaiting a lung transplant.

"We do have patients from Nevada who are on waiting lists for other organs," he said, adding that valley residents who are awaiting a lung actually are listed on the waiting lists of the transplant center where their surgery will be done.

In Southern Nevada, Sunrise Hospital and Medical Center and University Medical Center are federally designated kidney transplant centers. There is no lung transplant program here, although Southern Nevada can make donor lungs available to lung transplant centers elsewhere.

If, for example, a donor lung would become available here, the hospital performing the transplant would activate a team that would come to Las Vegas to recover the organ, then transport the organ to the center where another team would perform the operation.

Richardson said that, whenever a celebrity needs or receives an organ transplant, it tends to lead to greater public awareness of the value of organ donation.

On the downside, it also raises questions about the fairness of the system and the notion that celebrities "get some sort of special treatment," Richardson said.

But, Newman noted, in every case, for every organ and across the board, recipients for donor organs are chosen on the basis of well-defined criteria that don't take into account someone's wealth, public profile or fame.

Actually, many unknown people are fortunate in receiving relatively quick transplants, Newman said. "You just don't hear about them because they're not known outside their own communities."

Nor is it true that every celebrity receives a donor organ in time as Goulet demonstrates. NFL great Walter Payton, for example, died while waiting for a liver transplant, Newman noted, while humorist Erma Bombeck waited for a kidney transplant for about four years and died soon after receiving one.

There probably is a public belief that celebrities are treated differently, Newman said, "but there's no basis to it."

Contact reporter John Przybys at jprzybys@reviewjournal.com or (702) 383-0280.

DONOR TRAIL

Last week, more than 97,000 people around the country were on waiting lists to receive transplants, including: 73,854 who are waiting for kidney transplants; 1,654 who are waiting for pancreas transplants; 16,732 who are waiting for liver transplants; 217 who are waiting for small intestine transplants; and 2,665 who are waiting for heart transplants.

In Southern Nevada, about 267 people are awaiting kidney transplants, and 60 to 70 of the procedures are performed here each year, according to Ken Richardson, executive director of the Nevada Donor Network.

While most Southern Nevadans know that kidneys and hearts and livers can be transplanted, the array of organs and tissues that can be donated for transplantation probably would surprise them.

There's bone, which can be used in dental restorations. Skin, which can be used in reconstructive surgery and in treating burn patients. Corneas, to treat vision problems. Even tendons, which can be used in orthopedic repairs.

Nor are many Southern Nevadans aware that a single donor could help many people with numerous needs.

If, for example, a Southern Nevadan who has chosen to become an organ donor dies, "we could have, say, a heart team from the Mayo Clinic in Arizona, a lung team from Cedars-Sinai (in California), our local kidney team and a liver team from Salt Lake City all (here) at the same time," Richardson said.

Including such tissues as bone and skin, it's possible that a single donor could help as many as 50 to 100 people, Richardson added.

In Nevada, someone who chooses to become an organ donor simply can have that decision noted on his or her driver's license. When that happens, the prospective donor's name is entered into a statewide donor registry.

According to Richardson, federal regulations require that hospitals notify a designated organ procurement organization -- here, the Nevada Donor Network -- whenever there's a death in the facility. Here, the Nevada Donor Network would see if the deceased is listed in the registry and, if so, get the wheels moving to make a transplant happen.

But while the driver's license notation is a legal document, it never hurts that those who choose to become donors talk over their decision with family members. Almost always, Richardson said, family members who didn't know loved ones wanted to donate organs are relieved to discover that they have.

For more information about organ donation, visit the Nevada Donor Network Web site (www.nvdonor.org) or call 796-9600.

By JOHN PRZYBYS

ABOUT INTERSTITIAL PULMONARY FIBROSIS

Robert Goulet reportedly was diagnosed with interstitial pulmonary fibrosis, a condition in which the lung's air sacs, or alveoli, become damaged and in which scarring, or fibrosis, occurs in the tissue between those air sacs.

The American Lung Association's online database (www.lungusa.org) notes that as the disease progresses -- which can happen rapidly or gradually -- the tissue in the lungs becomes stiff and no longer is able to transport oxygen.

Causes, according to the association, can include: exposure to anything from asbestos and metal dusts to hay and materials used in farming; certain medications; radiation exposure, such as that used in treating cancer; and such connective tissue and collagen diseases as rheumatoid arthritis and systemic sclerosis.

There may be a genetic or familial predisposition to it, the association notes. And, sometimes, it's simply of idiopathic, or unknown, origin.

Symptoms of interstitial pulmonary fibrosis include shortness of breath, a dry cough, and, in severe cases, heart failure with swelling of the legs.

Treatment can include oxygen therapy, medications -- corticosteroids, for instance -- and, ultimately, transplantation of one or both lungs.

By JOHN PRZYBYS