May 21, 2024

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How Living Organ Transplants Work for Service Members, Vets and Their Donors > U.S. Department of Defense > Story

7 min read


Giving the gift of life to others through organ donation is one of the most selfless things a person can do. Many people think that’s something you do only after you die, but doctors encourage donors to do so while they’re still alive — and donations are badly needed.

According to the Organ Procurement and Transplantation Network, there were 46,632 organ transplants across the U.S. in 2023. Out of those, 6,953 came from living donors. Nearly 104,000 people are currently on the organ transplant waiting list. Statistics from OPTN show that kidneys are, by far, the most needed organ for transplant patients.

For service members, veterans and their families, transplant services are available at Walter Reed National Military Medical Center’s prestigious Organ Transplant Service. As the only certified transplant center within the Military Health System, the program is one of the oldest and most successful in the country, the program’s doctors said. In 2023, it performed 55 kidney transplants.

While Walter Reed’s program only transplants kidneys in-house, it takes care of patients who need other kinds of transplants as well, such as liver, pancreas, heart or lungs. Most service members and beneficiaries don’t know how to navigate the complex transplant process, so they call Walter Reed for help. The doctors will refer those patients with needs, other than a kidney, to centers in its network. Walter Reed’s team will either get them a transplant in the Washington, D.C., area or they’ll make calls and put in referrals to get the process going at another hospital.

“The reason why I tend to encourage [going through Walter Reed] is because it’s great for beneficiaries to keep all their care in the [military health] system,” said Army Lt. Col. (Dr.) Jamie Diaz Robinson, the chief of organ transplant services and hepatobiliary and pancreas surgery at Walter Reed. “I also think it’s great for … keeping us ready for training residents and the future doctors who are going to take care of veterans.”

Living Donations Last Longest, Work Best

The Walter Reed program aims to do about 30% of its transplants from living donors, Robinson said, because those donations are the most efficient and long-lasting. However, people are often afraid to donate and don’t think it’s worth it due to a common misconception — that an average kidney recipient will only survive for another 5-7 years.

“People need to understand … that living donation kidneys last the longest. They should last an average of 18 years. We have patients in at Walter Reed where they last 30 and 38 years,” Robinson said.

While some people need organs for years on end, others only need them for short period of time. “We use organs that may only last two or three [years]. Sometimes that’s all somebody needs,” Robinson said. “Somebody may not have another five years in them, but they don’t deserve to be on dialysis for the last of those five years.”

She said the first piece of advice they give to eligible recipients is to find a living donor, whether it’s a friend, family member or a stranger who read about your plight on social media.

“People can donate part of their liver or one of their kidneys and continue to have a normal, healthy life,” Robinson said. “You can go back to being full active duty, fully deployable, fully reach retirement and never have any kind of medical need.”

She said most studies found no decrease in long-term survival or progressive renal dysfunction in kidney donors. It’s also not a debilitating surgery — at Walter Reed, donors are able to go home the day after surgery, while transplant patients are sent home three days later.

Living donors can only donate a kidney, a piece of their liver or certain other tissues, but there are several other organs and tissues that come from deceased donors who have suffered brain or cardiac death. Patients sometimes receive donations from cadavers, too, but that only pertains to tissue, such as the corneas, skin and heart valves.

Can I Donate if I’m Not Military? And Does It Cost Me?

One thing Robinson wanted to emphasize was that anyone can be a living donor to a service member, veteran or other military beneficiary. It’s not strictly a military-to-military interaction, and it costs the donor nothing.

“The recipient’s insurance covers a lot of the testing to see if their donor’s a good candidate,” Robinson said. “We will pay to bring them here, to do the work-up to see if they’re an eligible donor and to do all the donation services. … Even if that donor gets ruled out at step 1 or step 17, that is a covered process of the recipient’s insurance.”

A fund is also available for Walter Reed recipients and donors that will pay for their housing at Fisher House, as well as their transportation and meals. Once the transplant is complete, donors will receive health coverage at Walter Reed for two years for any reason, even if they would not be able to be seen there otherwise.

“I have flown people in from other states to take their appendix out,” Robinson said. “We take it very seriously that if a donor gives a kidney and saves a life here … we always want to take care of them.”

The Complex Process

Robinson said the whole process — from evaluation to transplant — can take a long time for some recipients because it includes collecting every medical record they’ve ever had, doing a slew of tests and meeting everyone involved in the transplant process, including surgeons, dieticians, pharmacists and social workers. Those folks will determine if there are any social, financial or medical barriers to the patient getting a transplant and if they’re able to get through it safely. If there is a medical barrier — such as blood sugar that’s too high or an infection from a root canal — the team works to clear that up. Once the patient is deemed eligible, he or she is added to the donor database, and the wait to find a match begins.

Walter Reed’s transplant service works closely with the DOD’s Histocompatibility and Immunology Laboratory. Commonly referred to as the HLA lab, it runs virtual analyses to help predict whether a donor organ will be accepted or rejected by a potential recipient.

“They basically run bloodwork on patients in the community and our transplant recipients and anybody who thinks they want to be a donor. They keep pools and historical data of all that blood, and they look at the antibodies that patients have that would preclude them from getting a transplant from somebody,” Robinson said. “Some matches are just totally incompatible.”

Potential recipients have their blood tested monthly to ensure there have been no changes to their health.

A Stellar Record

Despite the complexity of the endeavor, Walter Reed’s transplant program has a 5-star ranking for having 100% of its living-donor kidneys survive more than a year.  In the most recent data evaluating the performance of the nation’s transplant system, Walter Reed exceeded expectations in several categories, including in observed rates of transplant — meaning the hospital is known for having shorter-than-average wait times for recipients, the program’s doctors said.

“With some of our most … medically complex health problems, we can get them ready and listed for transplant within weeks to a month or two,” Robinson said.

Walter Reed’s program is one of the fastest at getting patients from the evaluation stage to the actual transplant, and they use cutting-edge robotics to secure positive outcomes. Robinson said a lot of that success can be attributed to people who want to donate specifically to service members and veterans.

“That sometimes gets people pulled off our list a little bit faster than what their wait time would have been, and that’s a blessing,” she said, explaining that seeing patients get a new lease on life is “the most amazing experience ever.” She said donors often wake up immediately wanting to know if the transplant was a success.

“All they want to think about is, ‘Did it work? Did I do a good job?'” Robinson said. “Then you go look at the [recipient], and you’re like, ‘Guess what? You never have to do dialysis again.'”

Robinson said her team just recently transplanted a kidney into an active-duty spouse that was donated by another active-duty spouse she had never met. “Ten days later, they’re meeting in clinic, meeting each other for the first time, hugging and shaking hands,” Robinson said. “The husbands are in tears, and everybody’s like, ‘This is so emotional.'”

She said those cases are motivation for the days when they operate on donors who have passed away and the patients who will never get to meet them.

Consider Saving a Life

Robinson said healthy adults should consider becoming a donor — especially for a kidney. 

“We could really solve a national health care crisis by getting people to donate a kidney in this country,” she said, reminding people that there is funding and resources available.

Patients can self-refer or inquire about the process by calling 301-828-7313 or emailing the transplant team. If they are in the military healthcare system, their provider can put in a referral for transplant medicine.

If you want to sign up to be an organ donor, you can do so online through your state registry or at your local Department of Motor Vehicles.

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