“Transplantation has been heralded as one of the major scientific accomplishments of the 21st century, but the success of transplantation has [also] been our undoing,” said Nancy L. Ascher, MD, PhD, FACS, professor of surgery, University of California, San Francisco, who presented the Charles G. Drake History of Surgery Lecture, Monday afternoon. “We have to look to the 21st century challenges to see where we have to put our next efforts.”
The lecture will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.
Dr. Ascher—the first woman to present the Drake Named Lecture—identified two specific challenges for the transplantation community: donor shortage and unethical practices.
According to Dr. Ascher, 135,860 solid organ transplants were performed globally in 2016, representing less than 10 percent of the global need. She underscored the reality that donor shortages are not just a global problem, but also a serious issue in the U.S. In 2018, 114,358 individuals were wait-listed for a lifesaving organ transplant; only 30,415 transplants were performed in the U.S. that year.
“The success and lifesaving nature of transplantation and the inadequate number of donors along with the lack of well-developed systems for transplantation in some countries has led some individuals to travel to other countries to buy deceased and live donor organs—so-called organ trafficking or transplant tourism,” Dr. Ascher said.
The Declaration of Istanbul, created in 2008, with input from representatives of more than 100 countries, clarified issues related to organ trafficking, transplant tourism, and commercialism and established ethical guidelines for organ donation and transplantation.
The practice of multiple listing (appearing on more than one waiting list in different parts of the U.S.), is another ethics-related issue Dr. Ascher identified. Data indicate most multi-listed patients are wealthy, well-educated, white men.
Dr. Ascher issued a “call to action” for transplant professionals to meet the challenges of the increasing burden of noncommunicable disease and organ failure, and to find ways to meet this need with both deceased and live organ transplants.
“We [also] need to be involved in public health initiatives that limit the reversible cause of end-stage organ disease…in the case of renal disease, that would be hypertension, diabetes, dehydration, and diet,” she said. “We need to develop plans for increased training of transplant professionals, and finally, we have to advocate for ethical transplant practices because that is why patients are willing to donate, which is based on their trust in our medical system.”