December 7, 2018/Transplant

Pushing the Limits of Organ Transplant

Transplant Center makes more organs available to more patients

16-TRC-1010-Transplant-CQD-650×450

By Charles M. Miller, MD

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

At this moment, more than 114,000 people are waiting for a lifesaving organ transplant. And the longer they wait, the sicker they get. As we strive to be a global leader in saving and restoring lives through transplantation, our goal at Cleveland Clinic is to evaluate patients in need of an organ with efficiency and compassion, and get them on and off that waiting list as quickly as possible.

Putting patients first means figuring out a way to get them the right treatment at the right time – and getting them an organ is absolutely paramount to that.

An enterprise-wide commitment to maximally using every donated organ possible is a piece of what’s driving our success in this endeavor. We are aggressive. We are creative. We are willing to take calculated risks. And we don’t say no easily.

We have been able to cut patients’ wait times by expanding the organ donor pool and making use of less-than-perfect organs. If there is an organ available, we try to find a way to make it work for a patient.

Higher-risk HCV organs

A notable new source of organs is hepatitis C (HCV)-infected livers, kidneys and hearts. Over the course of one year, Cleveland Clinic developed a careful protocol that enables us to offer select transplant candidates who have not been exposed to the virus the option of receiving an HCV-infected organ, which previously would have been undesirable. The availability of highly effective multiple direct-acting antivirals (DAA) that all but cure HCV have made this a reasonable proposition.

Post-transplant, patients are treated with DAA regimens, which appear to have no adverse interactions with anti-rejection medications. The patients clear the HCV and are left with a healthy organ that they wouldn’t have gotten otherwise.

Protecting living donors

We are also continuing to improve the safety of transplants for living kidney and liver donors. We’ve pioneered techniques that allow us to transplant the smaller left lobe of the liver from a living donor, rather than the larger right lobe. In carefully selected transplants, this minimizes the risk of complications for the donor while producing comparable outcomes for the recipient.

Next in the innovation pipeline is a laparoscopic liver donation technique that we are developing with the potential to cut recovery time, pain and risk for donors. With better safety for living donors, we hope to continue to increase transplant opportunities for healthier patients who are further down the waiting list.

Advertisement

Salvaging rejected organs

Work is also continuing on an ex vivo organ perfusion device that pumps oxygenated warm blood, nutrients and medication through a donor organ. It can keep a liver alive and functional outside of the body for up to 86 hours and holds the promise of reviving organs that would be rejected for transplant. The perfusion device can also help us assess the function of a donor organ and predict its viability before it’s transplanted. The device is currently in clinical trials.

In many ways, this quest to get the most organs to the most patients is about an attitude. In the intricate world of organ transplant, if you’re always looking for a reason to say no, you will find one for sure. We make a point to not forgo any opportunities we have to say yes – and in return, create more lifesaving chances for patients.

Dr. Miller is Enterprise Director of Transplantation at Cleveland Clinic’s Transplant Center.

Advertisement

Related Articles

23-URL-3973558 CQD 650×450-B
July 11, 2023/Transplant
Moving Closer Toward Narcotic-Free Kidney Transplantation

Smaller incision may lead to reduced postoperative pain for some patients

Masked Medical Appointment
March 21, 2022/Transplant
Pilot Study to Create Automated Referral Process for Kidney Transplants

The process could improve access and equity for patients with end-stage kidney disease

22-URL-2682158 – CQD 650×450
February 3, 2022/Transplant
A Closer Look at Single-Port Robotic Kidney Transplant: Venous and Arterial Anastomosis (Video)

Video offers glimpse into technically challenging portion of the procedure

650×450-Covid-and-Kidneys
September 7, 2021/Transplant
Early Successes in Kidney Transplantation From Deceased Donors With COVID-19

Infectious disease and kidney transplant specialists share key insights

650×450-Dialysis-Safety-Wong
September 2, 2021/Transplant
Many High-Priority Patients Not Placed on Kidney Transplant Waitlist

Demographic and social factors found to influence preemptive listing

650×450-Kidney-Transplant-Access
March 26, 2021/Transplant
Access to Kidney Transplantation Unchanged Over 20 Years

New interventions and policies haven’t increased wait-listing

650×450-SPSurgery
November 5, 2019/Transplant
First Kidney Transplant Performed in the World Using Single-Port Robot

Cleveland Clinic surgeons use single-incision robotic surgery to perform kidney transplant

Ad