Organ Donation: A Doctor’s Perspective

Posted 10/05/2016 | By HealthCorps

HealthCorps recently embarked on a new effort, helping to raise awareness about the need for organ donors. If you regularly read our blog, then you know how important it is to consider becoming an organ donor and you’ve likely learned about some of the myths surrounding organ donation.

Doctors involved in heart transplants have a unique perspective on organ donation. We recently spoke to Dr. Alan L. Gass, M.D., the Director of Cardiac Transplantation and Mechanical Circulatory Support at Westchester Medical Center and Associate Professor of Medicine at New York Medical College. He has been involved in transplant medicine since 1991. Dr. Gass also sits on the HealthCorps Board of Advisors.

The following is a Q and A with Dr. Gass:

From a transplant surgeon’s perspective, is there an urgency to get more people to sign up as organ donors?

Right now there are about 5,000 patients waiting for a heart, and nationally we perform about 2,500 (heart transplants) a year. Sadly, this means that about 15-20 percent of patients will die waiting. Many will undergo placement of a heart pump known as a Left Ventricular Support Device (LVAD) to keep them alive until a donor becomes available. These devices have evolved dramatically over the last 10 years and patients can have a good quality of life outside the hospital, but there are complications, and not everyone is a candidate. I addition, it does represent a major heart surgery usually in a patient that is critically ill.

Do you often have patients desperately waiting for a heart?

Although there is a national wait list, hearts are distributed on a regional basis, so some parts of the country are better than others as far as waiting time and survival to transplant. For example, Region 9 or New York State is one of the worst in the country with only about 15 percent of potential donors being registered. In Europe there is “presumed consent” where you’re a “born donor” and you can then opt out, if you so choose. When this became law in those countries, organ donation went up dramatically; waiting periods decreased and mortality rates from serious heart disease fell.

Can you describe the patient’s emotional state as they wait for a heart, once they are sick enough to need a transplant in order to survive? Can you also describe the relationship that you have with these very sick patients who are waiting anxiously for a heart transplant? 

The wait is not only medically challenging for the physicians to keep patients alive, stable and optimal surgical candidates, but this period is also emotionally difficult for the patients and their families. A large part of my job is maintaining a strong personal relationship with my patients to maintain their faith and tap into something in them to keep them going. Depending on their blood type and other factors they may have to wait several months in the hospital or years outside if they are on an LVAD. I try to find something in them to share with every day to keep up their spirits and “distract” them from their precarious predicament. Whether it’s talking about sports, religion, family, books or something else, my visits to the bedside are often “social” but equally as important as the medicines running in their veins. I recently had one very religious and spiritual woman share a passage from the bible every day because I asked her to teach me about God. She waited four months, and is now doing great, and I (personally) learned a lot.

The wait list is based strictly on urgency and blood type, and a 15 year old is equal to a 65 year old. I recently had a 19 year old college student wait desperately for a heart and she underwent several life-saving surgeries to keep her alive. Her town on Long Island held many prayer vigils, a concert and a midnight mass which, I believe, kept her alive. She is now back in college and she is doing great.

Have you personally encountered any myths that patients have about organ donations?

The number of organ donors has basically remained the same for the 25 years that I have been doing this. Some common false myths are:

Organs go only to the rich and famous
This perception is not true. There is a government agency that maintains the strict rules that all centers must adhere to in order to maintain our waiting lists so that they are faceless.

Patients are treated differently if they are donors
This is not true. There are medical, legal and ethical statutes, laws and guidelines regarding brain death and organ donation.

Religious restrictions prevent organ donations
None exist – even Jehovah’s witnesses that will not accept blood transfusions allow organ donation.

Why donate if the transplant patient will only live a few months?
We now measure survival in decades. I personally have four patients out from transplant who have lived for over 20 years

Can you share any insights into any recent advances in heart transplant surgery that might inspire someone to become a donor – have survival rates improved?  Is the match process more optimal? Have post-transplant surgery immuno-suppressive drug regimens improved, lowering risk of a heart being rejected?

The medications after transplant have become extremely effective and with little or no side effects. The quality of life is equal to anyone else (who is healthy) and the potential is without limits. Patients go back to school, work, have kids and run marathons, compete in triathlons and even climb mountains (Mount Killimanjaro included). I have personally accompanied one of my patients in the NYC marathon, skied with two of them, went to several weddings and saw one deliver twins.

Have any significant changes occurred in the heart transplant arena that the public should be aware of that might inspire them to become donors?

The prognosis in a person with advanced heart disease is worse than most cancers and in some (patients) is measured in days. Despite this, the public is unaware, misinformed and for the majority, not registered to become a donor – a simple act that will insure decades of life and happiness to these desperately ill patients.

Dr. Gass summed up his position on organ donations by sharing that, “The truth is that one is more likely to “need” an organ, than (to likely consider to) ever become a donor. An accident or organ failure can happen to any one of us, family or friends. Thus, for the better of all, sign your donor card.” It’s such a simple act that has the power to save lives.

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