Human Tissue Transplants : The Demand, Organ and Tissue Donors

by Food and Drug Administration (FDA)

(Page 4 of 4)

In 2002, the AATB's member tissue banks provided nearly 12,000 square feet of skin for transplant. "There has never been a critical shortage of skin," says Rigney, adding that the AATB's networking system with its banks enables skin to be supplied quickly to treat burn victims. "When 9/11 happened, we mobilized our skin banks to be able to ship skin to New York and to Washington D.C. within eight hours. We had about 2,500 square feet of skin ready to be shipped."

According to the EBAA, eye banks are currently meeting the demand for corneal tissue in the United States. A corneal transplant cannot only restore sight, but can restore nearly perfect vision in many cases if the rest of the eye is healthy, says Edward Holland, M.D., professor of ophthalmology at the University of Cincinnati and director of cornea services at the Cincinnati Eye Institute.

Eye donors, who numbered more than 40,000 in 2003, supplied corneas for more than 32,000 transplants performed that year in the United States. Additional corneal tissue is used for research and training or is exported to other countries. According to the World Health Organization, corneal blindness is the second leading cause of blindness in the world, and there is a critical worldwide shortage of corneas. Even with U.S. exports of corneas, "We have not begun to make a dent in worldwide corneal blindness disease," says Holland.

Holland is also concerned about potential shortages of corneal tissue in the United States. As tissue banks screen for a growing number of diseases, more tissue is ruled out for transplant, he says. "We're finding more systemic infectious disease, and if we find something suspicious, we will not use the corneas for transplantation. We decline more and more tissue every year."

And the donor pool may be shrinking as LASIK, a surgery that uses a laser to improve vision by reshaping the cornea, continues to be popular. "We don't know the impact of refractive surgery on the health of the cornea after transplant," says Holland. "We do wonder about the 2 million to 3 million people each year we do LASIK on, when they get older and become 15 to 20 percent of the donor population."

Because of the uncertainty of long-term corneal health, Holland says LASIK corneas are not used for standard corneal transplants, which use the center two-thirds of the cornea. But he still encourages people who have had LASIK to become donors. LASIK does not affect the back layer of the cornea, he says, which is used in a new type of corneal transplant procedure to correct certain types of inherited eye defects and for corneal swelling after cataract surgery. And the white outer coat enclosing the eyeball (sclera), also not affected by LASIK, can be used to reinforce tissue in certain glaucoma procedures. Wearing glasses or contacts has no bearing on the suitability of corneas for transplant, adds Holland.

Rigney urges people to become tissue donors. Whether bone, skin, eye, heart-valve, or other tissue, he says, "the surgical demand for tissue increases as surgeons find more ways to use tissue to enhance or save lives."

Nikki Fix's knee and elbow transplants not only enhanced her life but made an impact on her whole family, says her mother, Lynn Fix. "It has made our family very aware of how donors can really help others." Because she has had leukemia, Nikki is ineligible to be a donor, but both of her parents are donors. "And when her sister turned 16 and got her driver's license, she signed up, too," says Lynn.

How to Become An Organ and Tissue Donor

HHS Secretary Mike Leavitt announced in March 2005 that 26,984 Americans received an organ transplant in 2004, setting a new national record. HHS began a national effort to encourage organ donation with its Gift of Life Donation Initiative in 2001.

Despite the increase in organ transplants, the waiting list in the United States for whole organs — kidneys, livers, hearts, lungs, intestines, and pancreases — on any given day, numbers more than 87,000 people, according to the United Network for Organ Sharing. Although there is no waiting list for tissues, some tissues, such as patellar tendons for knee surgeries, are in constant short supply, says P. Robert Rigney Jr., chief executive officer of the American Association of Tissue Banks. Continued donations are essential to meet the national need for eyes, skin, bone, tendons, heart valves, and other tissues.

"If you sign up to be a donor, it will generally include not only the organs but tissues and eyes," says Rigney. "But you do have the right to determine whether you want to donate all your organs and tissues or to specify only certain ones."

Trained personnel take great care and treat the donor's body with respect, says Rigney. Donated organs and tissues are removed surgically, and all incisions are closed after the surgery. An open casket funeral is almost always possible.

Neither age nor medical history should stop someone from becoming a donor. The transplant team decides at the time of transplantation if the organs or tissues can be transplanted.

You can sign up to be a donor in several ways:

• Indicate your wish on your driver's license or state ID when you apply for or renew it.
• Join the donor registry in your state. Check www.donatelife.net to see if your state has a registry.
• Complete a donor card available at www.donatelife.net and carry it with you.
• Include donation in your advance directives, will, and living will.

Once you have decided to become a donor and documented your decision, the most important step is telling your family, says the Coalition on Donation. They may be asked to give consent.

About the Author

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