What is it about?

Effective November 24th 2017, the Organ Procurement and Transplantation Network (OPTN),under a directive from the U.S. Department of Health and Human Services(HHS) changed its lung allocation policy.   The lungs used to be allocated to the transplant center within the same Organ Procurement Organization (OPO) territory.  Since OPO territory are arbitrarily established, a sicker recipient who lives much closer to a donor but outside of the OPO territory might have lower priority than a less sick patient who lives in the donor’s OPO territory.  OPOs everywhere in the US have predetermined territory.

Why were those sicker patients not prioritized??

 It is because they were not in the same OPO.  With the new rules, the priority goes to any recipients for which their transplant center is located within 250 nautical miles of the donor hospital regardless her their OPO territory.  The Lung Allocation Score (LAS) still drives the ranking of those patients making the first cut.  Basically, lungs are now being offered to the sickest candidates (highest need) in a 250 nautical miles radius from the donor hospital.  Any transplant center within that 250 miles radius will have their lung patients on the initial match list offer regardless of OPO and state location.

What will the impact be?

The impact of this change will not be known until at least next year when the OPTN will review the data.  We can assume the patients with the highest lung allocation score (LAS) will be transplanted faster than before the new rule.  Those will low score will most likely have to wait even longer.  States with only one lung transplant center and single OPO like Alabama and Oklahoma won’t automatically have priority at the top of the lung donor list of their in-state OPO.  If the donor is located within 250 nautical miles (287 miles) of an out of state transplant center, all those patients will also be at the top of the list.  This change in lung allocation will most likely promote an incentive in transplanting sicker patients which is what it should be.  

What about the other organs?

Liver allocation also has a similar policy but slightly different.  Kidneys and hearts are still allocated mostly based on OPO’s location.   Once all organs are allocated by distance instead of OPO location, it might interesting to watch some OPO realignment or merger as their arbitrary territory would become obsolete.  In the meantime if you have questions regarding the effect on how it affects you, please ask your transplant coordinator.  

source: https://optn.transplant.hrsa.gov/news/policy-modification-to-lung-distribution-sequence/

Let’s come back to Letermovir. It has also obtained the status of Orphan Drug in the European Union (EU). That status is reserved for drugs used to treat rare disease that affects a minority of the population. The drug company is given tax breaks and marketing exclusivity for 7 years in the US and 10 years in EU. This is an incentive that was created by the governments to incite drug companies to develop medicine against rare disease. CMV is known to affect less than 200,000 people in the US, most of them being organ transplant patients.

Valcyte has been on the market for 10 years and Letermovir seems to be the most serious alternative to date. With clinical trials underway we should know soon if this drug has a bright future in helping organ transplant recipients.

Thanks to a breakthrough in stem cells research, we are getting closer to have pigs be used to grow organs for human transplantation. According to the article in the Telegraph, researchers created rats’ organs in mice by injecting stem cells into their embryo. The same science would be used to grow human organs in pigs. Pigs have an anatomy somewhat close to the one of a human and they are mass produced. One of the major benefit of this new technique is it would potentially reduce the risk of rejection since the organ is created from stem cell from the recipient.

Human blood has already been made in pigs by using the same technique of injecting blood stem cells into pig fetuses. This technique has yet to be used to make organs though but has been successful between rats and mice. Professor Nakauchi, director of the center for stem cell biology and regenerative medicine at the University of Tokyo in Japan, states: “We are now rather confident in generating functional human organs using this approach”.

If this becomes reality one day, many years of research are still ahead, it would mostly benefit the patients waiting for kidney and pancreas transplant. These recipients have one luxury that lung, liver and heart patients don’t have; it is called time. It takes time to grow and organ in pigs, certainly a few months. Those sicker patients can’t wait and would still get the majority if not all the organs from deceased donors. But it would certainly help alleviate a big part of organ shortage since 80% of the 110,000 patients waiting need a new kidney. Let’s hope this becomes reality so more patients can be saved!
Source: Controversial British voice box transplant given go-ahead

Source:Pigs could grow human organs in stem cell breakthrough

Within the last several years we have seen major breakthrough in organ transplantation: multi-organ transplant, hair transplant, bone marrow transplant and even face and hand transplant.  Now a British surgeon wants to be the first in the world to successfully perform a uterine transplant from a mother to her daughter, the Telegraph reports. I said to successfully perform because it has been tried only once on a human before and it was in 2000 in Saudi Arabia. The uterus had to be removed 4 months later due to complications with blood supply.

What is Mayer Rokitansky Kuster Hauser Syndrome?

In this case it involves a British mother

of 53 years old and her 25 years old daughter. The daughter was born with a rare condition called Mayer Rokitansky Kuster Hauser syndrome. This genetic mishap has an occurrence in every 4,000 to 5,000 births, obviously in girls only.  In short it is the absence or malformation of a uterus. The subject will have normal ovaries and normal breast development but won’t be able to conceive children.

High-Risk Surgery

If everything goes according to the plan, the surgery is scheduled to take place next spring in Sweden. Dr Mats Brannstrom, who is leading the medical team, said a womb transplant remained one of the most complex operations known to medical science. The uterus has a very complex blood supply system and it is a procedure with a very high risk of hemorrhage. If the surgery is successful, which would be a first in the world, she could conceive by using her own eggs fertilized with her boyfriend’s sperm and then implanted in the transplanted uterus.

Pregnancy and Immunosuppressant Therapy

The major problem I see with that is the need of immunosuppressant drugs to avoid rejection with a pregnancy. They don’t mention anything in the article regarding the risk of a pregnancy after organ transplant. Obviously this would be a high-risk pregnancy and be the nightmare of most transplant physicians. If you were in the same situation, would you do the same thing?

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Source: World’s first womb transplant planned