When a Massachusetts father appeared before the American Academy of Pediatricians six years ago in New York seeking help in finding a new liver for his 11-month-old daughter, his emotional plea aroused an outpouring of public sentiment.
In fact, after seeing the film of Charles Fiske's appearance on the television news a Utah couple decided to donate their son's liver to tiny Jamie Fiske, whose picture had been prominently featured in newspapers across the nation.The Utah boy's head had been crushed in a car-train accident. When doctors told the parents their son was brain-dead, they specifically requested that his liver be donated to Jamie.
The loving gesture set a precedent. In subsequent years, congressmen and celebrities joined the bandwagon, embracing the battle of dying children around the country.
While many Americans were touched by the emotional dramas unfolding daily, others were openly critical of what they considered the "unethical" way organ donations were being handled in the United States.
Their contention was that only through publicity and political pull could people obtain the life-saving organs.
That's all changed.
Today, through the computerized United Network for Organ Sharing program, organ procurement has entered a new era. The program was established by the federal government to manage the national organ transplant system. Some still maintain the system has quirks. But, most agree, it's more equitable.
Organ donations, coordinated locally through the Intermountain Organ Recovery System, are not determined by a person's age, social status or income.
"Locally, it is based on size (of organ), blood type and weight compatibility," said June Murray, director of procurement service. "If five possible recipients are the same degree of ill, the one who has been on the list longest will get the organ."
Someone added to the list yesterday could ace out a person who has waited for five months, however. The determination is based on which patient is best suited and who is the most sick.
That's why organ recovery programs can no longer accept organs given with any kind of a condition attached. Patients in high-risk categories for a transmittable diseases, such as AIDS, are excluded as donors in most cases even if their test results appear negative.
Organs recovered in the United States are used exclusively to transplant U.S. recipients, unless no suitable recipient can be found. In that case the organ might be transplanted into a non-U.S. citizen or sent outside the country for transplantation.
The sad fact is, there just aren't enough organs to go around. Some 15,000 to 20,000 people in this country would benefit from an organ transplant close to 10,000 are needy kidney recipients; close to 1,000 need heart transplants.
Murray said that in Utah alone 40 people are on the kidney transplant list at any given time; 25 on the heart list.
The prognosis is good for people who undergo heart transplantation in Utah.
UTAH Cardiac Transplant Program is believed to have the highest survival rate in the world.
Dr. John B. O'Connell, program medical director, said the group has done 143 heart transplants in 139 patients. Ten recipients have died over a three-year period, resulting in a 93 percent survival rate for one year; 91 percent at three years.
Most heart transplant programs are getting an 80 percent, one-year survival rate.
The local program has maintained an outstanding success rate, although UTAH Cardiac cardiologists and thoracic surgeons from the University of Utah Hospital, LDS Hospital and the Veterans Administration Medical Center have liberalized their criteria. They are now transplanting in patients over age 55 and diabetics who require insulin.
"In general, we are accepting patients with a more severe degree of debility with their heart disease patients who wouldn't have been accepted five years ago," O'Connell said. New, more effective immuno-supressive drugs are enabling the experienced transplant physicians to broaden the criteria without further endangering the recipients' lives.
O'Connell said the greatest threat to the program is the lack of donor organs.
"At one time our state led the nation in the number of organs donated," he said. "But we have had 12 people die waiting for a heart transplant. We have had more people die waiting for a donor than die after receiving one."
"The shortage of organs and tissues within the country is very serious," Murray said. "If your physician tells you that you need a heart or liver transplant, he's telling you that you have maybe a year to live. And 30 to 40 percent of those people die before the organ becomes available.
"No matter how many people we transplant, we put that many people on our list tomorrow."
But, an increasing number of people are willing, and are able, to donate. In fact, anyone can be an organ donor.
Murray said hearts are generally taken for transplant from newborns through the age of 55. Previously the cut-off age for donors was 40, but it was extended to increase the supply of donor organs, and because physicians are now transplanting an older population of patients including some 65 years old.
The age criteria for liver and pancreas donors is newborn to 55; kidney donors can be age 2 to 65. It's all contingent on how healthy the person has been during his lifetime.
Murray said tissue has an even broader criteria. Long bone can be taken up to the age of 65 and can be preserved and used in transplant procedures at a later date.
"Older people find it comforting to know that although they may be in their 70s or even 90s, they can still donate something to help someone else," Murray said. "I am tickled at the number of telephone calls we get from the older population who want to do something and actually make preparation for it in their wills."
Although organs cannot always be used for transplantation because of the age criteria, Murray said they can often be used with the consent of the family for research purposes.
"They may not be as helpful in terms of saving a life, but they are useful in providing information that can save future lives or help prevent the medical problems that are now requiring people to undergo organ transplants," she stressed. "With the shortage of organs and tissues, we can't transplant everyone.
"Our ultimate goal, therefore, is to try to prevent diseases."
With the research component, no organ or tissue is wasted. Intermountain Organ Recovery System shares organs locally with the three local transplant hospitals LDS, the U. and VA as well as working on a national scale to place organs that can't be used in this region.
But for the organ procurement team, it's either "feast or famine." They may get eight referrals one day, and not another one for months.
Many factors are involved, including the weather. In the winter when roads are icy, and in the summer when motorcyclists hit the trails, referrals go up. The holiday season brings an increase in the number of suicides and organ donations.
"The public is becoming more and more aware of the need, and most people have a willingness to share," Murray said. "I am a firm believer in the fact that there is some love for our fellow men."
In five years, Murray has seen an upswing in the number of organs recovered. But many families still continue to decline the invitation to donate.
"Some people just don't like it mostly because they have misconceptions about organ donations," Murray said. "They have the idea that it is very disfiguring, but it isn't."
She said a few people still have religious concerns about donating organs. But no major religion opposes it. People are also concerned about costs associated with donating an organ, but those costs are covered by the transplant program, she said.
"We have found that in most cases where the family has objections, those can be worked through because they are generally misconceptions," Murray said. "It also has a lot to do with who approaches the family, when they are approached and how the invitation to donate is handled.
"It's extremely important to convey to the family that whatever decision they make is O.K."
The federal government has mandated that every hospital participating in Medicare or Medicaid reimbursement programs must offer the option of organ and tissue donation to the family members of every person who dies in their health care facility.
"Be aware of your responsibility to tell the public it's their legal right to donate organs and tissues," is Murray's plea to health care professionals.
Her plea to the public: "Think about organ donation when you are healthy and well and make your family aware of your decision.
"Regardless of the fact that you have a little yellow circle on your driver's license, at the time of your death your family will still be asked to sign a consent form," she said. "Without that we will not take the organ, because in this country it is still a donation organs and tissues don't belong to the state."
And, she said, the family's decision as to whether or not to donate is often based on their own soul-searching query: "I wonder what Johnny would have wanted."