Over 100,000 Americans are currently waiting for an organ transplant, and over 85% of those are in need of a kidney. As the demand for organ transplants continues to far outpace supply, increasing the number of organ donations remains an urgent priority. Most people are familiar with checking the box on their driver’s license, opting in to become an organ donor after death; but few realize that only three in 1,000 people pass away in circumstances that make organ donation possible.
This underscores the pressing need to encourage livingorgan donation in cases where it is viable, primarily for kidney and partial liver transplants. Over 340 million adults currently live in the U.S. If only one in 10,000 healthy adults chose to become a living kidney donor, the kidney transplant waiting list could disappear within just a few years. What’s more, living donation often has advantages for recipients beyond reducing wait times, including better outcomes and greater graft longevity. However, today, only about 15% of annual transplants in the U.S. come from living donors; with these statistics, the unfortunate truth is that thousands of Americans need to wait years to receive a suitable organ and often, patients become more ill or die while waiting.
Living Donation Reduces Wait Times and Improves Patient Outcomes
Kidneys are the most transplanted organ, and survival rates for kidneys received from living donors are approximately five to eight years longer than those received from deceased donor kidneys. Improved longevity associated with living donation is attributed to several factors, including better tissue matching opportunities, a shorter cold ischemia time (the amount of time an organ is without blood flow), favorable conditions associated with controlled and planned surgeries, and the organ generally being in a healthier condition at the time of transplant.
Relying on a deceased donor organ often creates a heightened sense of urgency, leaving limited time for high resolution human leukocyte antigen (HLA) matching, the critical process that determines how closely proteins of a donor and recipient align to reduce the risk of rejection. Living donation, on the other hand, allows for selecting and evaluating donor organs well in advance, often leading to better HLA compatibility, which subsequently improves the likelihood of more positive long-term outcomes.
Living donation offers what deceased donation cannot: time. In most cases, it can save lives faster by getting transplants to patients sooner, giving recipients a better chance of a healthier future. The process of becoming a living donor requires a physical exam, psychological evaluation, tests and screenings, as well as a deep dive into one’s medical history. This can take several weeks to a few months depending on how quickly appointments can be scheduled and evaluations are completed. However, it is still a fraction of the time compared to those on the national transplant waiting list, who wait three to five years on average for a kidney. Additionally, living donation simultaneously preserves a deceased donor organ for another recipient, creating a “double benefit” effect in reducing the waiting list.
Living donation also eases some of the emotional burden for patients by reducing the constant uncertainty and anxiety of waiting for an organ match to become available. Although there may still be some uncertainty concerning the timeline, the journey becomes clearer when the surgery can be scheduled in advance, reducing the stress of always being on guard for an urgent call with an offer.
By shortening wait times with living donations, patients may be able to receive preemptive transplants before dialysis becomes necessary, which can further improve outcomes and reduce complications from long waits. A trickle-down effect is felt across hospital systems as planned procedures optimize hospital resources. Of note, reduced post-transplant complications mean fewer medical resources are needed to support patients in the years after transplantation. Lower rejection rates from living donation also decrease the need for costly re-transplantation procedures.
The Future of Organ Transplantation: Alternatives Remain a Distant Solution
The scientific community is developing alternatives to address the supply and demand gap, such as xenotransplantation, which involves transplanting a genetically modified organ from an animal into a human. However, these alternatives are still largely experimental and could be many years away from becoming a large-scale solution to the organ shortage.
While recent breakthroughs have shown promise, including successful pig-to-human kidney and heart transplants in clinical trials, significant challenges remain before xenotransplantation can become a widely viable and available treatment option to alleviate the chronic shortage of organ donors. Medical and safety concerns include the risk of transmitting animal-borne viruses to humans, the potential for unknown pathogens to emerge and issues with physiological compatibility that can affect the long-term survival rate and functionality of xenotransplanted organs. To date, no xenotransplanted organ has lasted more than a few months.
Ethically, xenotransplantation raises concerns about animal welfare regarding gene modification and breeding for organs, implications of mixing human and animal tissues, and questions about informed consent and how to balance animal rights with human medical needs. Scientifically, the process requires extensive gene modification of donor animals to reduce rejection, complexity in maintaining organ viability, and managing long-term outcomes, which will require ongoing monitoring and the development of specialized immunosuppression protocols. There are also practical and logistical considerations, including high cost and scalability challenges, along with strict regulatory and safety protocols. Specialized facilities and expertise will be needed in addition to stringent monitoring to monitor for potential complications.
The field continues to evolve with ongoing research addressing these various concerns and xenotransplantation no doubt may play a role in the next generation of transplantation. However, xenotransplantation is still years away from being a viable option for closing the organ supply and demand gap, while living donation provides a practical lifesaving solution for many patients right now.
Harnessing the Power of Living Donation to Save More Lives, Sooner
Every year, about 6,500 living donation transplants take place, which showcases positive momentum, but it is still far from enough to meet the growing demand for organ transplants. Increasing living organ donation will require increased public awareness and education around the process and impact, improved access to donor evaluation and transplant centers, and stronger support systems for donors. It will take a collective effort from the clinical community, industry experts, advocacy groups, health insurance providers, employers and more. But the effort will be worth the rewards.
Ultimately, living donation benefits both the donor and the recipient, not to mention society as a whole. For recipients, a transplant from a living donor can improve long-term outcomes and increase their quality of life. And for the donor, it often comes with a renewed sense of purpose in helping to save or drastically improve the life of another human being. Living donation can offer the gift of life today and hope for a brighter tomorrow for many more patients in need.
About Tina Liedtky
Tina Liedtky has over 20 years of leadership experience in the medical device and diagnostics industry. As President, Transplant Diagnostics, Tina is responsible for the strategic direction and growth of Thermo Fisher Scientific’s transplant diagnostics portfolio across the patient care continuum. Previously, she served as President, Clinical Diagnostics, managing a broad portfolio of businesses within Thermo Fisher’s Specialty Diagnostics Group. Prior to joining Thermo Fisher, Tina led US and global commercial teams for the Diabetes Care and Rapid Diagnostics divisions of Abbott Laboratories, as well as sales and marketing leadership roles at Medtronic, Covidien, and Boston Scientific.
Tina serves on the Board of Directors for Neurovalens, a non-invasive neuromodulation company based in Belfast, Ireland, and is actively involved with Miracle Babies, a nonprofit organization focused on supporting families with babies in the NICU. She holds a bachelor’s degree in cognitive neuroscience from Princeton University and an MBA from Harvard Business School.
