Drugs Preserve Organs for Transplant

By LAURA MECKLER
.c The Associated Press

WASHINGTON (AP) - Without recruiting a single new organ donor, more than
2,300 additional transplants could be performed every year, researchers say.
The trick is to get more organs from each existing donor.

The strategy: a trio of drugs administered to brain-dead patients that help
preserve organs.

``There's a lot of effort being placed at getting more donors. Another way to
get more organs is to see if you could get better utilization out of the
existing donors,'' said Dr. Myron Kauffman, a medical consultant to the
United Network for Organ Sharing.

Last year, 6,083 patients died awaiting transplants, network officials said
Tuesday. Theoretically, one-third could have received transplants had the
drugs been universally used, according to a review of 18 months of data
comparing donors who were given the drugs and those who were not.

``That's a phenomenal number of organs nationally,'' said Ed Kraus, director
of organ recovery for the Upstate New York Transplant Services in Buffalo. H
is organ bank uses the drugs, but typically only for trauma victims.

``I suspect this paper will have very far-reaching effects,'' he said. ``Will
it change and become the national standard? I wouldn't be surprised if it
did.''

The research was presented Tuesday at the American Transplant Congress.

At issue is the use of hormonal resuscitation drugs, first recommended in the
late 1990s by a British heart surgeon who found they helped preserve hearts.

The drugs are administered after patients have been declared brain dead, and
their families have agreed to donation. When someone is brain dead, brain
activity has ceased with no chance of recovery, and the person is legally
dead. Machines can keep the heart beating and blood circulating to preserve
the organs until they can be removed.

Researchers examined all brain-dead donors between January 2000 and June 2001
and found 584 had received the drug trio and 8,185 had not.

Transplant programs will use any organs that are medically suitable. Those
who had received the drugs donated an average of 3.8 organs; for those who
didn't, the average was 3.1.

Researchers extrapolated the difference in donation rates for each organ to
all 5,921 brain-dead donors in 2001, adjusting for differences including age,
sex, race and cause of death. They found that applying the higher donation
rates to the entire group yielded an additional 2,362 organs.

Specifically, it produced 924 more kidneys, 278 hearts, 290 livers, 414 lungs
and 456 pancreases.

``There's no reason why it couldn't be used theoretically on every donor,''
Kauffman said. ``We hope by getting the message out with this presentation
that it will be used more widely.''

The only downside is money: The drugs cost $2,000 to $3,000 per donor. The
costs are added to other expenses involved with procuring organs and charged
to the transplant recipients and their insurers.

``When you consider the costs saved by transplantation, that's just a drop in
the bucket,'' said John Rosendale, a lead researcher and biostatistician at
the transplant network.

He said the study makes it clear that the drugs have not been widely used,
with just 6 percent of donors getting them in 2000 and the first half of
2001.

The drug combination, known as the Papworth Cocktail, includes a
hydrocortisone bolus and infusions of vasopressin and tri-iodothyronine.
Together, they prevent cell linings from inflaming, improve cardiac function
and stabilize blood pressure.

The decision to use the drugs typically is made by the organ transplant
coordinators who arrange for donations. All organ banks use the drugs at
least on occasion, but it may be difficult to persuade them that they need to
use them more often.

Spokeswoman Anne Paschke of the United Network for Organ Sharing said the
network plans to publicize the results in publications and mailings aimed at
transplant coordinators and others.

Lynn Driver, executive director of the Indiana Organ Procurement
Organization, isn't convinced that his organ bank should use the drugs more
often.

``I think we're doing a fairly good job in knowing when to use it and when
not to,'' he said. ``Sometimes it works, and sometimes it just doesn't
work.''

On the Net: United Network for Organ Sharing: http://www.unos.org