We, transplant coordinators, sign up for this with one goal: make a difference in somebody’s life. As a lung transplant coordinator I have the opportunity to make a difference with patients who have a deadly disease that a lot of you are familiar with that is called pulmonary fibrosis. As a lone coordinator of a new lung transplant program I have had the opportunity to do it all. I was the one making initial contact with a sick patient referred to us, walk them through the whole process, brake the news they were approved for transplant, place them on the waitlist and then call them once a donor was available. There is not a better feeling than offering hope to someone who is short of breath by just talking on the phone. A lot of work needs to be done by the transplant coordinator and also the patients/caregivers to get there. The reward is the actual transplant but there is still a lot of work to be done after the surgery. I have seen patients go through ups and downs when recovering. The proudest moment for me as a lung transplant coordinator is when someone finally rings that bell at discharge time. The patient is finally going home with his new lungs and a second chance at life. The patient and family is forever grateful but we are also grateful towards the patient who at the end of the day is the one who trusted us with their life. The next big milestone after that is the one year anniversary. To see the patient looking like a “normal” person again is very rewarding.  All the pain, suffering, tears shedding that occurred following the transplant is now forgotten: it was all worth it.   The patient is enjoying life again and making plans for travel or whatever else they like about being alive.  

If I had to give you one advice it would be to seek out a medical opinion at a lung transplant center especially if your treating physician is not doing it for you. Only a lung transplant center would be qualified to tell you if you meet the criteria to be a lung transplant candidate.

           The National Organ Transplant Act (NOTA) was first signed into law in 1984 under President Reagan and underwent a few amendment in the following years.  What this law makes clear is that it is illegal to sale  human organs for transplant.  To this day it is still the law of the land.  There is, on average, about 120,000 people waiting for organ transplant in the US with the majority waiting for a kidney.  Last year was a record year with over 10,000 donors and almost 35,000 organ transplantations  in the US alone.  Roughly 20% (6,182 exactly in 2017) of those transplants were from living donors.

            It is not difficult to realize that not everybody will get a second chance at a better quality of life.  There is way more demand than offer.  The number of living donors has been pretty steady for the past 5 years according to UNOS data.  It is the number for deceased donor transplants that is expanding every year.  The increase in donors was credited to the opioids crisis who is unfortunately killing a lot of people.   Without any sort of financial rewards it would be difficult to imagine the number of living donors increasing from now on.  Any financial rewards is illegal at the moment in the US but we are kidding ourselves if we think brown envelops have never changed hands in the history of organ transplant.



              You need some very unselfish people to give a kidney to a relative and sometimes a stranger.  Unselfishness in this case is not enough to increase the number of living donors as we have seen over the past 5 years.  Money or some other form of financial incentives would most likely help.  At the moment everybody involved in transplant profits in one way or another with organ transplantation.  Transplant hospitals makes money off the actual transplant surgery and follow up care, physicians make a living out of those patients, drug companies make tons of money selling their medications and also let’s not forget about pharmacies who also profits from all that.  Organ procurement organizations (OPO)  also are able to stay in business by managing donors and maximizing donation.  Basically the only person not profiting from any of that is the actual donor or its family.    Should money (cash) be the only incentive???  Should only living donors get those benefits??  I don’t think so and will be covered in part 2 where we will cover the pros and cons of such system and different types of financial incentives. 

Young vs less young

Usually, for younger patients, it is almost automatic to be accepted by a transplant center unless there is a major problem anticipated with compliance after the surgery or some other contraindications. For older patients it is a little more difficult because they sometimes have other diseases like diabetes, heart disease (for non-heart transplant patient), kidney diseases, etc. The physicians draw fire sometimes for wanting to transplant older patients (read more than 70 and for some center even 65) and argue with each other because they all have different opinions . The physicians’ response in this cases is “the patient is the one that showed up asking for help so we are going to help him if we can”.  Some older patients do get transplanted and end up doing well.  Some are denied because their multiple medical problems make the transplant too risky.  A transplant surgery should always be treated as an elective surgery.  If we don’t think the transplant will do any good, it should not happen.

Competition always brings the best

Don’t get me wrong though, some transplant centers will not do patients above 70 and sometimes 65 years old. It is more about the philosophy of the center and their aggressiveness. Another important factor who plays a role in accepting older patients is competition around the transplant center.  Is this the only transplant center in town and they can afford to be more picky??  Is there a hospital across the street competing for the same thing therefore have to accept older patients so they can do more transplants??  Just like in any business, competition will bring more service so look around and do your homework. 

MRB: like your life depends on it

Every transplant candidates case go in front of a medical review board who reviews everything in depth. This group includes physicians, surgeons, social workers, nurses, financial specialists and any other experts needed. As a group, they decide if someone is a good candidate or not. So, if you need an organ transplant and you have been turned down at some hospital solely because of your age, keep looking because you may find a hospital willing to transplant you.  You may have to travel to another city or out of state but at least you may get a chance.  It is simply possible that you may just be too old too.  No transplant centers have an obligation to transplant you.  

Million dollar question

Now is time to answer the question about age. There is not any written rule about age limit for organ transplant. It is based on each transplant center policies and belief. If you are an older patient, I would suggest knocking on every door until you are out of option if you really want a chance at life. You may find a transplant center willing to give you a new life.

There are still a lot of myths about organ donation and that could explain why millions of people have not signed their state registry yet (in this blog I will mostly talk about deceased donors because living donor is much different). Education is the key solution to achieve higher success and it is just hard to reach everybody. The reason we are signing the registry is to become a deceased organ donor if we eventually become brain death. This condition, brain death, is used as a legal definition in many countries. It is irreversible and is usually caused by a lack of oxygen to the brain AKA brain anoxic injury. Before declaring someone brain dead, physicians will perform several tests so they can apply that diagnosis to the patient. They mainly look for reflexes like checking if a patient will breathe on his own after unplugging the breathing machine and will also look at pupils reactions (or lack of reaction) with light.

One of the main fears is that people are scared that their doctor will give up on them faster because there are potentially good organ donors. This is not true at all. If you knew how most physicians hate to lose patients, you would understand that they will do everything for you.  That could be true if they were receiving money for their patients organs but that is illegal in the US and hopefully would be unethical among all the physicians.  A transplant physician can’t be treating a potential donor as this will cause a major conflict of interest.




Once a patient is declared brain dead, the Organ Procurement Organization (OPO: regional organism mandated by the government to manage donors) come into play and will make contact with the family. If the potential donor has signed the registry, they don’t have to ask for permission to the family, the patient becomes automatically a donor. This is why it is important to talk to your loved ones about your intention regarding becoming an organ donor. SIGNING YOUR ORGAN DONATION CARD IS LEGALLY BINDING.

The coordinator from the OPO will have to interview the family or friends in order to get the most accurate social and medical history possible so transplant centers can make an informed decision about the quality of the organs for their recipients. The extent of the truth about a medical/social history for a donor is not known for the simple reason that who really knows you well enough to be able to tell everything to the coordinator. This is why blood tests are performed. It is to look for transmissible diseases like hepatitis B and HIV.  All the information collected by the OPO will be made available to the transplant centers.  Rest assure, nothing that could help identify a donor will be shared with the transplant recipient or its family.  Patient confidentiality is the main element of trust for the system to work.  Once a transplant center reviews a donor and is satisfied about the match, the transplant can proceed hopefully for a successful outcome.

In a different post I will tell you why I unsigned my donation card despite wanting to become a donor if I were to become brain dead.

The answer is YES!! if you don’t have health insurance or can’t fund raise a lot of money.  For everybody else with insurance you don’t, not even close.  A lot of people I talk to think you need to be at least in the middle class with private insurance to qualify for organ transplant. This is a myth. Over 80% of the transplant recipients have Medicare or Medicaid as a primary insurance and have no job and live with social security.  As a matter of fact, a transplant center that does not have a contract with Medicare for organ transplant has no chance of running a large program.  Medicare is where the money is for the hospitals that do transplants so yes government insurance is good enough.  Most of the patients I follow as a transplant coordinator are on some kind of patient’s assistance because they have limited income and can’t pay for everything, especially the most expensive drugs.  Some of this assistance is provided by drug companies themselves and some by charitable organizations.  If you ask your transplant or financial coordinator they should be able to assist.  Yourself, as a patient or caregiver can actually apply directly.