Kidney transplant patients seek life without drugs with experimental immune system procedure
Transplanting some of the kidney donor's immune-producing cells along with the new organ March 8, 2012

Lindsay Porter's kidneys were failing rapidly when a friend offered to donate one of his. Then she made an unusual request: Would he donate part of his immune system, too?

Every day for the rest of their lives, transplant recipients must swallow handfuls of pills to keep their bodies from rejecting a donated organ. The Chicago woman hoped to avoid those problematic drugs, enrolling in a study to try to trick her own immune system into accepting a foreign kidney.

It's one of a series of small, high-stakes experiments around the country that has researchers hopeful that they're finally closing in on how to help at least some transplant patients go drug-free. The key: Create a sort of twin immunity, by transplanting some of the kidney donor's immune-producing cells along with the new organ.

"I'm so lucky," says the 47-year-old Porter, who stumbled across the research at Chicago's Northwestern University. Porter was able to quit her pills last summer, a year after her transplant, and says, "I feel amazing."

These experiments are a big gamble. If the technique fails, patients could lose their new kidney, possibly their lives. Doctors stress that no one should try quitting anti-rejection drugs on their own.

Why risk it even in a careful scientific study? Anti-rejection medications can cause debilitating, even deadly, side effects, from fatigue and infections to an increased risk of cancer and kidney damage.

Without the drugs, "the hope for me is I'm able to keep this kidney for the rest of my life," Porter says.

Across the country, Stanford University is testing a slightly different transplant method - and hosted a reunion earlier this month for about a dozen kidney recipients who've been drug-free for up to three years.

"These people who are off their drugs, they're cured," says Dr. Samuel Strober, who leads the study of Stanford's approach. "If they have to be on drugs the rest of their life, it doesn't have the same meaning of `cure.'"

Anti-rejection drugs work by ratcheting down the immune system, suppressing it from attacking foreign cells. For decades, scientists have sought ways to eliminate the need for the drugs by inducing what's called tolerance - getting one person's immune system to live in harmony with another person's tissue.

The experimental approach: Transplant the seeds of a new immune system along with a new kidney. It's the 21st-century version of a bone marrow transplant, and possible for now only if the transplanted kidney comes from a living donor.

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 FACTS ABOUT ORGAN DONATION:
104,748 U.S. patients are currently waiting for an organ transplant; more
than 4,000 new patients are added to the waiting list each month.

1. Every day, 18 people die while waiting for a transplant of a vital organ,
   such as a heart, liver, kidney, pancreas, lung or bone marrow.


2. Because of the lack of available donors in this country, 4,573 kidney
   patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in
   2008 while waiting for life-saving organ transplants.


3. Nearly 10 percent of the patients currently waiting for heart transplants
   are young people under 18 years of age.


4. Acceptable organ donors can range in age from newborn to 65 years or more. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone and for total body donation.


5. An estimated 12,000 people who die each year meet the criteria for organ
   donation, but less than half of that number become actual organ donors.


6. Donor organs are matched to waiting recipients by a national computer
   registry, called the National Organ Procurement and Transplantation Network
   (OPTN). This computer registry is operated by an organization known as the
   United Network for Organ Sharing (UNOS), which is located in Richmond,
   Virginia.


7. Currently there are 58 organ procurement organizations (OPOs) across the
   country, which provide organ procurement services to 250 transplant
   centers.


8. All hospitals are required by law to have a "Required Referral" system in
   place. Under this system, the hospital must notify the local Organ Procurement
   Organization (OPO) of all patient deaths. If the OPO determines that organ
   and/or tissue donation is appropriate in a particular case, they will have a
   representative contact the deceased patient’s family to offer them the option of
   donating their loved one’s organs and tissues.


9. By signing a Uniform Donor Card, an individual indicates his or her wish to
   be a donor. However, at the time of death, the person's next-of-kin will still
   be asked to sign a consent form for donation. It is important for people who
   wish to be organ and tissue donors to tell their family about this decision so
   that their wishes will be honored at the time of death.


10. All costs related to the donation of organs and tissues are paid for by the
    donor program. A family who receives a bill by mistake should contact the
    hospital or procurement agency immediately.


11. Tissue donation can enhance the lives of more than 50 people. Donated heart
    valves, bone, skin, corneas and connective tissues can be used in vital medical
    procedures such as heart valve replacements, limb reconstruction following tumor
    surgery, hip and knee joint reconstruction and in correcting curvature of the
    spine.


12. In 2008, a total of 14,208 organ donors were recovered in the U.S. Of these,
    7,990 were cadaveric donors, which represented a decrease over the total of
    8,019 in 2006. Living donors decreased from 6,732 in 2006 to 6,218 in 2008.


13. Donor organs and tissues are removed surgically, and the donor’s body is
    closed, as in any surgery. There are no outward signs of organ donation and open
    casket funerals are still possible.


14. Acceptable organ donors are those who are "brain dead" (whose brain function
    has ceased permanently) but whose heart and lungs continue to function with the
    use of ventilators. Brain dead is a legal definition of death.


15. Organ transplant recipients are selected on the basis of medical urgency, as
    well as compatibility of body size and blood chemistries, and not race, sex or
    creed.


16. Advances in surgical technique and organ preservation and the development of
    more effective drugs to prevent rejection have improved the success rates of all
    types of organ and tissue transplants.


17. About 94.4 percent of the kidneys transplanted from cadavers (persons who
    died recently) are still functioning well at one year after surgery.


18. The results are even better for kidneys transplanted from living donors. One
    year after surgery, 97.96 percent of these kidneys were still functioning
    well.


19. Following are one-year patient and organ graft survival rates:

FACTS ABOUT ORGAN TRANSPLANTATION:
The Need Is Real: Data
During your visit to organdonor.gov someone may have been added to the
waiting list. It happens every 11 minutes.


Each day, an average of 75 people receive organ transplants. However, an
average of 20 people die each day waiting for transplants that can't take place
because of the shortage of donated organs.


Organ transplantation has become an accepted medical treatment for end-stage
organ failure. The facts prove it. But only you can help make it happen.


Statistics can sometimes be overwhelming and difficult to understand. One
thing to remember is that every number in the statistic you view is a person, a
person who either needs your help and is waiting for a lifesaving transplant or
a person who has left a lasting legacy through organ and tissue donation. Either
way each number represents a life, a mom, a dad, a brother, a sister or a child,
someone who is important to someone else, maybe even you.


Statistics change. Some change day to day and some can even change minute to
minute. So you may see different numbers each time you return to organdonor.gov
or some of the other sites linked from here. You may ask why this happens. There
are several reasons.


One of the most confusing statistics is the number of persons waiting for a
transplant. Patients are allowed to register at multiple transplant centers so
you may see a higher number if you count "registrations" rather than
"candidates."


Additionally, one of the great things that may happen is that donations and
transplantations may be taking place at any time, so while the waiting list
might continue to grow the number of donors may also rise. The reality is that
the number of candidates waiting continues to dwarf the number of donor organs
available, and only you can change this.



Here are some interesting facts:

• As of May 4, 2009, the percentage of recipients who were still living
  5-years after their transplant is noted below for kidney, heart, liver, and
  lung.
  
  
  
  • Kidney: 69.3%
  
  
  • Heart: 74.9%
  
  
  • Liver: 73.8%
  
  
  • Lung: 54.4%


• In 2008, 60% of living donors were women. The statistic is reversed for
  deceased donation.


• In 2008, 67% of all deceased donors were White, 16% were Black, 14% Hispanic
  and 2.5% Asian.


• As of November 2010, the national waiting list was made up of 45% White, 29%
  Black, 18% Hispanic, and 6% Asian.


• In 2007, (the most recent data) there were almost 2.5 million deaths in the
  U.S. Imagine if every one of those persons had donated.


• Currently, more than 86 million people in the U.S. are signed up to be a
  donor—sign up and join them.

> More
about organ donation among minorities
> Statistics & facts for people over 50


The Gap Continues to Widen
Right now, there are more than enough people waiting for an organ to fill a
large football stadium twice over.





Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual
Report.
** Data include deceased and living donors.


[ Graph
description of Gap Continues to Widen ]