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The first ABO-incompatible transplant at Hopkins took
place one year later.
Generally, patients involved in the Hopkins ABO-incompatible
and positive crossmatch treatment programs are those
who have exhausted all the normal transplant options
and have come to Hopkins as a last resort. Usually,
patients either couldn't find an ABO-compatible donor,
or they were sensitized to a potential donor's antigens.
Sensitized patients include mothers who have been exposed
to their children's antigens during pregnancy and have
formed antibodies to them, and patients who have formed
antigens to the antibodies they received during blood
transfusions and previous organ transplants.
Hopkins has transplanted 53 kidney patients with positive
crossmatches, 12 with incompatible blood types and three
with both positive crossmatches and incompatible blood
types. The Hopkins patients' 95 percent one-year survival
rate is equivalent to the nationwide one-year survival
rate for patients who received kidneys from live donors,
but did not have to undergo plasmapheresis and IVIG,
according to Hopkins data.
The biggest obstacle, though, to organ transplants
is not enough donors-living or deceased. Although 82,404
patients in the United States awaited transplants as
of Aug. 1, only 10,450 transplants had been performed
this year from January to April, according to the Organ
Procurement and Transplantation Network. In that same
time period, only 5,831 organs had been recovered.
In recent years, only about 26 percent of kidney patients
nationwide who were on the waiting list received a transplant
from a cadaver, Holechek said.
Because the cadaveric donation rate has remained flat
for years, according to Holechek, the transplant nurses
at Hopkins spend considerable time trying to spread
awareness about the importance of living organ donation,
because patients who receive organs from living donors
have a greater chance of experiencing a successful outcome.
About 50 percent of kidney transplants come from living
donors, Holechek said.
The living donor pool doubled shortly after Hopkins
physicians Lloyd Ratner and Louis Kavoussi developed
the laproscopic donor nephrectomy procedure. The physicians
first used it at the hospital's Bayview campus in Baltimore
in February 1995.
The procedure involves making several half-inch incisions
around the abdomen and then going through the incisions
to cut the kidney free. This is much less invasive and
painful than open nephrectomy, which involves making
a 10- to 12-inch incision through major muscle groups
to remove the kidney.
It would take months before donors who underwent open
nephrectomy could return to work. With the laproscopic
procedure, however, most donors go home on the second
or third postoperative day and can return to work two
weeks after transplant, Holechek said.
So far, the only transplant patients for whom plasmapheresis
and IVIG have been used are kidney patients. However,
Denise Burrell-Diggs, RN, transplant nurse coordinator
at Hopkins, has witnessed the dawn of living donor liver
transplants, which, she said, have probably been the
biggest liver transplant advancement in the past 10
years. Living donor liver transplants are possible because
the donor's liver regenerates after part of it is given
to the recipient.
No major advances in lung transplants have occurred
in recent years, but survival rates have increased during
the past 15 years, Cook said, because of advances in
immunosuppressive medications. These advances are responsible
for nonrelatives being able to donate kidneys.
About 15 years ago, doctors considered only immediate
family members as donors, and would consider more distantly
related family members only if more closely related
individuals' blood types didn't match, said pre-transplant
coordinator Susan Turton-Weeks, RN, CNN, CCTC, of the
University of Arkansas for Medical Sciences in Little
Rock, Ark.
Holechek said that what she likes best about being
a transplant nurse is "to see people who've had
no real hope" of receiving a transplant "make
it" by achieving goals they weren't able to achieve
before, such as finishing college.
"To see people [being] able to get on with their
lives is one of the most rewarding things for us,"
she said.
Contact Rebecca Ray at rebeccar@nurseweek.com
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