Lung Transplantation: Lung Transplantation: What? Who? When? What? Who? When? Marshall I. Hertz, MD University of Minnesota Medical School and Fairview-University Medical Center Medical Director, Lung Transplantation Director, Center for Advanced Lung Disease
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Lung Transplantation: What? Who? When? Marshall I. Hertz, MD University of Minnesota Medical School and Fairview-University Medical Center Medical Director,
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University of Minnesota Medical School and Fairview-University Medical Center
Medical Director, Lung Transplantation
Director, Center for Advanced Lung Disease
Topics for DiscussionTopics for Discussion
Organ transplantation in the USOrgan transplantation in the US
Overview of lung transplantationOverview of lung transplantation
Inadequate supply of lungs for Inadequate supply of lungs for
transplantationtransplantation
University of Minnesota
Major Biomedical Advances Major Biomedical Advances 1954-20041954-2004
VaccinesVaccines AntibioticsAntibiotics Life support technologiesLife support technologies Open heart surgeryOpen heart surgery Molecular geneticsMolecular genetics Organ transplantationOrgan transplantation
University of Minnesota
Organ Transplantation in the United StatesOrgan Transplantation in the United States1 Jan 1988 – 31 Jan 20051 Jan 1988 – 31 Jan 2005
OrganOrgan NumberNumber
KidneyKidney 201,846201,846
LiverLiver 69,05769,057
Pancreas*Pancreas* 16,67416,674
IntestineIntestine 977977
HeartHeart 36,76436,764
Lung*Lung* 13,32213,322
TotalTotal 338,640338,640
www.unos.orgUniversity of Minnesota
1963: First kidney transplant in Minnesota1963: First kidney transplant in Minnesota 1966: First pancreas transplant in the world1966: First pancreas transplant in the world 1966: First intestinal transplant in the world1966: First intestinal transplant in the world 1968: First successful human bone marrow transplant1968: First successful human bone marrow transplant 1978: First heart transplant in Minnesota1978: First heart transplant in Minnesota 1978: First living-donor pancreas transplant in the world1978: First living-donor pancreas transplant in the world 1981: First pediatric heart transplant in Minnesota1981: First pediatric heart transplant in Minnesota 1986: First heart-lung transplant in Minnesota1986: First heart-lung transplant in Minnesota 1988: First lung transplant in Minnesota1988: First lung transplant in Minnesota 1991: First living-related lung transplant in Minnesota1991: First living-related lung transplant in Minnesota 1996: First living donor liver transplant in Minnesota1996: First living donor liver transplant in Minnesota
U of M Firsts in TransplantationU of M Firsts in Transplantation
Organization of Transplant Services Organization of Transplant Services in the United Statesin the United States
Department of Health and Human ServicesDepartment of Health and Human Services– United Network for Organ SharingUnited Network for Organ Sharing
– Scientific Registry of Transplant RecipientsScientific Registry of Transplant Recipients
Organ Procurement Organizations (LifeSource)Organ Procurement Organizations (LifeSource) Transplant CentersTransplant Centers
““The Growing Need”The Growing Need”Organ Donors vs. Wait Listed PatientsOrgan Donors vs. Wait Listed Patients
Based on OPTN data as of January 26, 2004. www.life-source.org
The Donor Shortage:The Donor Shortage:Possible ApproachesPossible Approaches•Use more non-living donors
•Increased public awareness
•Presumed consent laws
•“Breakthrough collaborative”
•Use more living donors
•Xenotransplants, bioartificial lungs, stem cells
•Make better use of existing non-living donors
University of Minnesota
Current Lung Allocation System (1990)Current Lung Allocation System (1990)
Who?Who?– Based on active waiting time onlyBased on active waiting time only– 90 days of “extra” waiting time assigned to 90 days of “extra” waiting time assigned to
idiopathic pulmonary fibrosis patients (1995)idiopathic pulmonary fibrosis patients (1995) Where?Where?– Lungs offered first to recipients within the Lungs offered first to recipients within the
donor OPOdonor OPO– Then to recipients within concentric 500 mile Then to recipients within concentric 500 mile
circlescircles
University of Minnesota
Goals of the new lung allocation planGoals of the new lung allocation plan
Reduce waiting list deathsReduce waiting list deaths Improve overall survivalImprove overall survival