Have you ever been stuck in a line?
Like a really long line?
Maybe it’s the morning rush at starbucks, maybe you’re local DMV, or maybe you’re
camped out waiting for that new playstation 5.
Sorry X box.
But regardless of how bad you thought those lines may be there’s always a worse line.
I know, a line worse than the DMV, that’s almost unimaginable.
But the truth is, in the US today, there are more than 100,000 people waiting in line to
die, or at least they hope not.
As of October 2020 there were 109,000 people on transplant waitlists across the US.
Now at first glance this shouldn’t really seem like a problem.
More than 300 million people live in the US and nearly 1% die every year.
That’s almost 3 million bodies no longer using their organs, so why don’t use them.
Well out of those 3 million, only 8,400, less than a third of one percent, die in a way
that allows for organ donation.
It turns out, most people that die, weren’t very healthy.
Who would have thought right?
Obviously older people are more likely to die, but age actually isn’t a disqualifying
factor for organ donation.
In 2016 a 107 year old Woman from Scotland was even an organ donor.
But most organs end up being rejected for a wide variety of reasons like cancer or infection.
Organ donation starts with death.
From there it’s a race against the clock to find a suitable candidate and get the organ
transplanted.
That’s because you normally only have 24 hours to get the organ in a new body before
it becomes unusable, and delicate organs like hearts and lungs need to be transplanted within
6 hours.
Keep in mind that organ might have to jump on a plane and travel hundreds of miles to
reach their recipient.
This means there is a complex system in place to get organs to the people who need them.
Ever since the National Organ Transplant Act of 1984 it’s been illegal to buy and sell
organs.
That same year UNOS (or the United Network for Organ Sharing) was founded to decide who
gets organs.
Before that it was basically the wild west.
In the 70’s, organs were so scarce that hospitals would convene literary death panels
deciding who an organ should go to between a dozen people.
And they often used some pretty arbitrary standards, in at least one case, literally
flipping a coin to decide between two qualified candidates.
Today the process is a lot more standardized and starts with the donor.
How someone died is the number one factor in determining donation eligibility.
Most donors died from fatal head injuries like car accidents, strokes, or a brain aneurysm,
causes that kept the rest of their internal organs intact.
After a patient is officially pronounced dead a representative for UNOS or a partner organization
will evaluate the potential donor.
This is where 99.7% of organs are rejected.
Organs can be rejected for any of a handful or reasons.
If the person died from an infection or cancer, if they had a health condition like obesity,
or diabetes or if the organs were physically damaged by whatever killed the patient.
If the organs are approved, the transplant coordinator checks if the patient is an organ
donor.
If they are great, and if not they ask the legal next of kin for permission to harvest
organs.
This is where another quarter of potential organs don’t make it through.
A little more than half of americans are officially registered as organ donors (that little red
heart on your driver's license) but while 90 percent of U.S. adults say they would be
willing to become organ donors, half of the families end up refusing to consent.
If the coordinator can get permission to do the transplant they’ll try to preserve the
organs by putting the patient on a bypass machine to pump blood and breathe for the
patient.
From there UNOS’s real job begins, deciding who lives and who dies.
The organ coordinator will tell UNOS information about the donor like weight, blood type, and
geographical location.
From there a computer compiles a list of patients who would be a good match and then ranks them
based on distance, waiting time, and most importantly, how sick a person is.
To get a kidney transplant you better hope you score well on this equation.
Your EPTS score, or your estimated Post Transplant Survival Score, is one of the most important
factors in determining who gets a kidney.
It factors in things like age, and history of diabetes and dialysis, basically trying
to figure out if your body's healthy enough to accept the new organ because at the end
of the day, UNOS wants to give organs to the people they think will get the most use out
of them.
More than 90% of patients with a top EPTS score are still alive after 10 years, a mid
score and your chances are 70%, and having a bad score, and statistically you’re not
likely to see 8 years.
So it's a straight forward, even if rather morbid, calculation.
After crunching all the numbers, the candidates at the top of the list are the ones who have
the best chance of surviving the transplant and are the least likely to live long enough
to get a different organ.
But even with this standardized system, not everyone is equal.
If you live in the greater D.C metropolitan area and have blood type AB, the universal
recipient, good news your average wait time for a new kidney is two years, but if you
have blood type O or B, you’d be looking at a 5-6 year wait time.
And some factors have nothing to do with you.
The US’s 250 transplant centers are divided up into 11 regions, but not all these regions
are created equal.
Because time is such an important factor, donors are partially matched based on location
and wait times across the country, can vary by as much as 20-fold.
If you live in Mississippi, the average wait time for a kidney would only be a year, but
live in most of California, and you'd be looking at more than 3.
After the computer spits out it’s ranked list of candidates, UNOS calls the transplant
center that the top patient is registered at.
Ultimately, it’s the patient's doctor, not the actual patient, that makes the choice
on whether to accept the organ.
If the first doctor declines the organ for that patient, the organ coordinator goes to
the next person on the list.
And then the next, and then the next, and so on until someone accepts the organ.
Each year about 8,000 people die on the waitlist, and remember sicker people are offered organs
first, so if you pass on an organ your patient might never get another chance.
So you’d think doctors turning down organs was pretty rare right?
Well the truth is only a third [37%] of organs are accepted by the first patient in line.
Even worse, about 10% of organs are rejected by so many doctors that time runs out and
they’re unusable for transplant.
And remember these were the best of the best organs that made it to this point in the process
and have already been approved for transplant.
Doctors officially reject organs for a host of reasons like if they think it isn’t the
best size for their patient or they pass on it hoping to get a better offer, since their
patient is already at the top of the waitlist and is getting priority status.
But behind the scenes, hospitals also reject organs to protect their reputations and bottom
lines.
Every six months, all transplant centers in the country get ranked and their one-year
post-transplant survival rates are one of the most important metrics.
Poorly performing transplant centers get flagged, triggering an investigation into why thiers
numbers aren’t what they should be.
Consultants come in.
Medicare and Medicaid might refuse to pay for operations at low performing centers and
the hospital can lose federal funding.
Low ratings can cost a transplant centers millions and on rare occasions, get them shut
down.
As a result, some hospitals tend to avoid less than perfect matches or refuse to operate
on extremely sick patients, since if they don’t perform risky surgeries, it won’t
affect their survival rates.
Some transplant centers like the Ohio State accepted up to 58 percent of organs offered;
while others, like the Mayo Clinic, accept as few as 16 percent and turn down the rest,
which were then offered to the next person on the list.
A single person can donate up to 8 life saving organs, so this process continues for each
one until all of the organs have been matched with recipients.
The organ coordinator then arranges the operating rooms at all the various hospitals and transplant
teams are flown out to harvest the organs and head back to their base hospitals.
Most organs without a local donor are flown via commercial airlines stored in medical
containers and only about a tenth of a percent [.1%] are compromised due to transportation
issues like plane delays or traffic.
Once the organs are harvested time is limited.
Although recent advancements have allowed containers to keep pumping blood through organs
in transport, most are transported on ice so once their out of the body, the organ starts
breaking down,
By this point the recipient would have already been called in and begun their preparations
for surgery.
Since people can wait on transplant lists for years, but organs only last for hours,
they need to be ready at a moment's notice to drop everything and head to the hospital
to receive their organ.
The call could come in in the middle of the night, and if you miss it, they go onto the
next person on the list.
From here the biggest concerns are that the patient's body rejects the organ, but the
earlier matching process and immunosuppressant drugs are designed to minimise these risks.
Today, the 1-year survival rates for most types of transplants in the US are north of
90%.
Death can come at any time, but just because you’re gone, doesn’t mean you can’t
save a life.
I encourage everyone watching this video to sign up to be a donor (link in the description).
Who knows, your organs could go on to save half a dozen lives.
If you like this video be sure to check out some of our best uploads here and remember,
there is always more to learn.