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HOUSE CALL WITH DR. SANJAY GUPTA
House Call: 50th-Anniversary of Organ Transplantation
Aired July 10, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Welcome to HOUSE CALL.
Well, this year marks the 50-anniversary of the first successful kidney transplant. Since then, organ donation has become a life- saving option for thousands of people. But it's also raised some ethical questions and sometimes fear in the general public. We're going to talk about all of that this morning.
But first, let's start way look at the human face of organ donation.
CHRISTY FIRFER, CNN CORRESPONDENT (voice-over): Barbara Amster and Rodney Rodriquez would love to have children of their own, but first, she needs a kidney transplant. So far, she's been waiting three years.
BARBARA AMSTER, WAITING FOR KIDNEY: Because I'm on dialysis, it's a very risky pregnancy. I would have to pretty much be on dialysis every day.
FIRFER: She already gets three hours of dialysis every Monday, Wednesday and Friday after work. But her wait for a kidney could be long.
WALTER GRAHAM, UNITED NETWORK FOR ORGAN SHARING: Currently there are almost 85,000 people waiting in this country for vital organ transplants. The sad thing is that about 6,000 of those people will die this year because there are not enough organs donated.
FIRFER: Experts say everyone should sign up to be an organ donor.
GRAHAM: There have been organ recoveries and successful transplants done recently for persons as old as 90, 91 years old. And son, it all depends on the person's health. Therefore, let the professionals make that decision after you've died.
FIRFER: So when asked, do you want to be an organ donor? Barbara wants you to see it from her point of view.
AMSTER: You have the opportunity to save a life. Do you want to do it? FIRFER: In the meantime, her dream waits.
AMSTER: Hopefully one day, if I get a transplant, I'll have my little pitter-patters running around my house.
FIRFER: Christy Feig, CNN, Washington.
GUPTA: Thanks, Christy.
Organ donation is also called, "Giving The Gift Of Life." A single donor can help or save up to 50 lives. But as you've heard, thousands of people are still on the waiting lists.
Let's give you some facts. On average of 100 are added to those lists every day, that's about one every 13 minutes. In that same 24- hour period, 16 people will die waiting. Last year that equaled about 6,000 deaths. On the positive side, more than 25,000 organ transplants were done in 2003. That life-saving transplant can come in many forms: from kidneys and lungs, to your heart, liver pancreas and intestines. Beyond that, there's also various tissue, such as bone and corneas that can bring new life to a total stranger.
Here to help us answer all your organ donation questions, Dr. Kenneth Newell. He's a transplant surgeon. He's the director of the Living Donor Kidney Transplant Program at Emory University here are in Atlanta. He's also listed in "The Guide of America's Top Surgeons."
Thanks for joining us.
DR. KENNETH NEWELL, TRANSPLANT SURGEON: Thank you. It's a pleasure to be here.
GUPTA: Fifty years -- thank you. Fifty years since the first kidney transplant. Does that seem like a long time or not that long?
NEWELL: In the evolution of medicine, I think it's not. And so many changes have happened in transplantation just in the last decade or two, that I've been involved, that it's really I think, still a very young field.
GUPTA: And you yourself have performed around 700 transplants. Lots of questions coming in on this topic. You get these all the time. Let's get to one of them. First one from Sarah, this is in San Diego writes, "I have heard that physicians do not take as many life- saving measures for a patient that is an organ donor. How can I be sure that my donor status will not result in changes in the treatment that is rendered?"
Seems to be a big fear. We get lots of questions like Sarah's. I mean this was something that people talked about a few years ago. Do you do as much for a possible donor as in any other patient?
NEWELL: I've heard this question in various forms. That's a very good question. For a long time -- I think there are several safeguards here. First of all, we, as transplant physicians and surgeons, are not involved in taking care of any critically ill patients, prior to them being pronounced brain dead. In effect, the law prohibits that.
So there's a whole separate group of doctors whose entire purpose is to give you the best medical care, and to give you the best chance for recovery that they can. It's only after all of that's failed and they have spoken with your family that organ donation would even come up. So I think that that's really a myth that, you know...
GUPTA: Neurologists and neurosurgeons, often responsible for declaring someone brain dead, and then you get the call?
NEWELL: Yes. And point in fact; the transplant community has nothing to do, really, with a potential organ donor until such time as that their physicians have deemed, you know, that they can't do anymore. That they're brain dead.
GUPTA: It's one of the most emotionally charged situations, though, isn't it?
NEWELL: It is. It's particularly hard for the family. And I think that's one of the barriers to organ donation. In that, when you haven't thought about it in advance it's really hard, during such a time of stress, to consider these things.
GUPTA: Yes. Well, let's get to -- keep on that point here. Another common fear involves what happens after the surgery is done. Joe in Pennsylvania wanting to know, "What conditions is the body in after organ donation? Is it still possible to have an open-casket funeral?"
Again, many people fear that the body will be disfigured after donation. Is this something you hear about a lot?
NEWELL: I don't hear about that as much, but I know it is a concern. And I think it's really important to recognize that these people are treated with great respect. The surgery is done just as carefully, with just as much attention to detail, as if we were operating on a person, you know, to put a kidney in or something like -- akin to that. So I think that there's no disfiguration, you know, an open casket would not be a problem at all.
GUPTA: A judicious operation of trying to prevent that from hatching.
GUPTA: Lots of misconceptions. Hopefully we've cleared some of them up.
Coming up next...
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (voice-over): Can you be too old to donate? What about too young? When HOUSE CALL continues, we'll get to the bottom of who can be a donor.
And later, are all transplant patients treated the same? We'll get answers.
See if you can answer our "Daily Dose quiz." What's the most important step in becoming an organ donor? The answer, when we come back.
(END VIDEO CLIP)
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (voice-over): Checking the "Daily Dose" health quiz. We asked, what's the most important step in becoming an organ donor. The answer: inform loved ones of your wishes.
(END VIDEO CLIP)
GUPTA: A really important point. We're going to talk more about that.
Welcome back. We are talking about organ donation. If you want to become a donor, there are some simple steps you can take. First, make sure you're listed as an organ donor on your driver's license, and remember to carry an organ donor card as well. Also, you need to have named on your list of donor registry in your area. And as you saw in our quiz, letting family members know is critical, since many hospitals require them to sign consent forms before transplants. Still, they can refuse even if you have a donor card.
We're talking to Dr. Kenneth Newell. He's a transplant surgeon at Emory University Hospital.
Lots of e-mails coming in on this topic, ethical questions as well as specific ones. Let's go to Kim in North Carolina. She wants to know, "When you indicate that you are an organ donor, is there a way to indicate that preference of donation for either medical research versus donation for another life?"
There are very different donation procedures on this sort of thing. Is that right?
NEWELL: Well, and it's important to remember that you can do both. It's not either/or. So you can donate organs for both life- saving transplants, and organs or tissues for research. I think the important thing to keep in mind is you can indicate your preference, but the way it works practically, is your relatives will be approached. And it's what they say that really determines what happens.
GUPTA: Such a difficult conversation to have with your family. Isn't it?
NEWELL: Yes. And it's something that in the past we never thought about. Now, education is better. They're approaching this at the high school and junior high level. And that's when people think about it, when they don't need to.
NEWELL: You know, that's that the approach that will really change donation in the future, I believe.
GUPTA: Really requires someone to confront their mortality, oftentimes at very young age.
NEWELL: Well, it's easy to confront it as a youngster, I think, than when you're older.
NEWELL: And certainly easier than when, you know, some tragedy happens to a loved one.
Let's go to another e-mail question. Iris in Pennsylvania asking, "If you do decide to become a donor, can you choose which organs to donate, or at least be advised on what organs will be removed?"
And the answer in part, Iris, is yes. You can be specific. Take a look at this organ donor card. You can check the box that says "any needed" or specify what you'd like to donate. For example, if you only wanted to donate your kidneys and intestines, or you can do something else.
So let's clear something up, Doctor. If you want to have specific organs donated, will doctors remove anything else?
NEWELL: No. Absolute not. It's basically prohibited by law. It's very specific. And again, the card, you can list things. But the only way -- it's just like signing a consent for any operation. Your family, in effect, signs the consent for you once you're brain dead, and they list exactly what can be done. And we don't do anything beyond that.
GUPTA: So despite the driver's license, despite the organ donation card, if your family still says no, then nothing will be done? NEWELL: Yes. That is correct.
GUPTA: That's the way it works. Family has the final say in this sort of thing.
We sent our cameras out to try and get a few more questions. One of the questions came in from Atlanta.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: What is the maximum age at which, for example: eyes, corneas or livers or whatever, can be used for another person?
(END VIDEO CLIP)
GUPTA: Is there an age? I mean can someone be too old or too young?
NEWELL: No. Absolutely not. And we've learned that. We used to be much more restrictive, even when I started as far as the age that we would go to. And it's continually being pushed further and further out. And not only can these people donate, but the organs really work very well. So they're really helping someone.
GUPTA: And there's a lot of living-related donations now. Is that right? I mean a parent or a child donating to someone else?
NEWELL: I think one of the fastest growing aspects of transplantation, particularly in kidney transplantation, is living- related donation.
GUPTA: So a family member would actually donate to someone else?
NEWELL: That's typically how it was maybe a decade ago. Now one of the biggest trends is people who aren't even related donating. People who meet each other through church or work. And that's really a dramatically growing area.
GUPTA: And we're going to have some of those stories coming up as well.
Ethics and transplants. Is everyone treated the same? Coming up...
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (voice-over): Pat Summerall, Larry Hagman. Mickey Mantle. Are celebrities given special treatment?
More HOUSE CALL coming up. But first, a tip for staying healthy from our "Bod Squad."
UNIDENTIFIED FEMALE (voice-over): At first glance, this may look like just another step class, but this ramp-shaped platform is no step. You might say it's a whole new direction in fitness. The latest creation of fitness guru Gin Miller simulates the feeling of walking up a ramp, hence the name.
GIN RAMP, CREATOR, THE RAMP: Ramping is really more about the upper leg muscles, the higher leg muscles in the hips and glute muscles. Because those are the muscles that you do these little inclined walking or modified lunge movements with. So it is a little bit more about hips, legs and hamstrings.
With a constant interchange of acceleration and deceleration, ramping promises a high-calorie burn in a simplistic workout. So virtually everyone can do it. And after a decade of encouraging people to step in the name of fitness, Miller's take-home message is simple...
MILLER: Get yourself moving 30 minutes a day. If people could feel how much better they would feel in their head and in their heart from exercise, then they would do that. They would do exercise anyway. Losing weight is the perk. It's the icing on the cake.
(END VIDEO CLIP)
GUPTA: Welcome back.
We're talking about organ donation, from the controversy to the myths surrounding the process. One of those myths, is that if you're famous and in need of a transplant, you're going to get one sooner than the average tern. We're going to check in with our guest in a moment on that.
But first, let's talk about how someone gets picked for a transplant. First the blood, tissue type and size of the donor organ has to match. Your placement on the list is also a factor. How sick you are. How long you've been on the list. And lastly, location also important, both of the organ and of the person needing the transplant are taken into consideration.
We're talking with Dr. Kenneth Newell. He's a transplant surgeon at Emory University Hospital. He's an associate professor of surgery at the university medical school.
First, let's get this straight. Because a lot of people ask about this. Is there any priority given to celebrities or someone famous?
NEWELL: No, absolutely not. I think maybe we hear more about those cases because they are famous people. But they have no priority in the allocation of organs.
GUPTA: Is there a way to game the system, to fix it?
NEWELL: Not really. I think there's always issues about access to medical care, and that may be different. But once you're in to the system, there's really no way to take advantage of it.
GUPTA: All right.
We sent our cameras out to get another question from Atlanta.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Is there any central system for prioritizing people who need organs? Or is it just, I go to one hospital, I get on one list. Someone else goes somewhere else. And the lists are not at all related to each other.
(END VIDEO CLIP) GUPTA: It's a good question. A recent study in the Journal of the American Medical Association indicates the sickest people on waiting lists for livers, aren't necessarily the ones receiving the transplants.
Doctor, you've read the study as well. Do people need to be on multiple lists in order to get a transplant?
NEWELL: No. I don't really believe that that is a practical solution. I think that being on one list is perfectly adequate. There is a national list. Being on multiple lists allows you the chance to, perhaps, get an organ from outside your area. But practically speaking, if you were to look, people get transplanted at about the same rate. And in fact, you can't be on multiple lists in one region. So if you want to be on multiple lists, you have to be willing to be transplanted at a center a long distance from your house.
GUPTA: To have to move.
And another big topic, and we touched a little on this. But Larry Hagman, Pat Sommerall, various folks, Mickey Mantle. The question about alcoholic livers and transplantation. Should people who are alcoholics who, you know, in effect have damaged the livers on their own, be candidates for transplantation?
NEWELL: I'm not sure I'd answer should they be. That's a bit of an ethical issue. The way the medical community has decided to deal with it, there are many, as you know well, things that we do that contribute to our own illnesses. We look at things like alcohol use. If you're activity drinking, almost no center in the United States will transplant you, if it's caused alcoholic liver failure. However, you're not penalized if you're willing to stop, go through rehabilitation program, undergo evaluation and not drink anymore. Almost every center in the country will transplant you.
GUPTA: How many of those come back?
NEWELL: It's really been studied pretty carefully, and it's really quite rare. If you stop and you've gone through a careful program to evaluate you. And the center that does the transplant, you know, really adheres to detail and looking at that, it's quite rare to ever resume drinking.
GUPTA: I guess the liver transplant, probably a good wake-up call for the drinking.
GUPTA: And you know, another main point. We were talking mainly about donating after someone has died. But we also touched on the fact you can be a living donor as well. Your kidney, parts of your liver, lungs, pancreas can be used to help someone on a waiting list.
Betty from West Virginia writes, "I have a friend that needs a kidney transplant and I want to be tested to see if I am a match. I am 30 years old, single and have no children. My friends and family are worried that if I later marry and want to start a family, pregnancy would be too hard on me with only one kidney.
Am I putting my health at risk by donating to my friend? I don't want to see his quality of life deteriorate more. He is only 37 and I want to give him a second chance at life."
Now, living donors have outnumbered deceased donors for kidney transplants for the last few years. Can someone still have a healthy life? Betty's question: go on to marry, have a pregnancy, all that with one kidney?
NEWELL: Absolutely. And in point of fact, people who get a kidney transplant go on to have children. So you know it can be done. GUPTA: That's right. And we're not done with this. There is a lot of issues. Stay tuned now for more HOUSE CALL.
(BEGIN VIDEO CLIPS)
UNIDENTIFIED FEMALE (voice-over): When we come back, we'll give you web sites, where you can download organ donor cards and learn more about the organ matching process.
Plus, we'll share some success stories.
First, some of this week's medical headlines in today's edition of "The Pulse."
FIRFER (voice-over): A new study in the "Journal of Pediatrics" found over-the-counter cough medicines do not work any better than sugar water, to suppress nighttime coughing and help sick children sleep. The study followed 100 kids ages 2 to 18 with upper respiratory infections, and concluded the most common type of cough anti-present and ant histamine, found in many cough syrups, were no more effective than a placebo.
Also, a new study says drinking more milk may lower your risk of colorectal cancer. The report, published in the "Journal of the Cancer Institute," followed over 500,000 men and women, and found those with more calcium in their diets had a much lower chance of developing colorectal cancer. Drinking only two glasses of milk per day allowed study participants to reduce their risk of cancer by 12 percent.
Holly Firfer, CNN.
(END VIDEO CLIPS)
GUPTA: You can read more about organ transplants and keep up with the waiting list at www.unos.org, that's the United Network for Organ Sharing. Another option, www.optn.org.
Click on "Donation and Transplantation" and you'll find tons of fact sheets and more information on the ethics surrounding the whole process.
And if you want to become a donor, click on to www.organdonor.gov, and download an organ donor card to keep in your wallet.
Along with all the questions that we've been receiving today, you'll be happy to know we've received some inspirational stories as well, Doctor. We want to share a few of them with you.
The first is from Harry in Maryland who writes, "In early 1985, after the birth of our last child, my wife developed congestive heart failure. Doctors gave her six months to live unless she had a heart transplant. Because of the gift of life from a total stranger, my wife received her heart transplant in May of 1985. Next month will mark 19 years of survival."
Unfortunately, Doctor, there are many who don't get this opportunity. But obviously, in this case, a different life, a new life for her.
Nate from Pennsylvania also writing, "I had my first heart transplant at the age of 20. Eight years later, it failed. I had my second transplant at the age of 29 in 2002. My brother also had a heart transplant in 1997. Thanks to loving people who, in their time of grief, helped our family," They are both leading productive lives today.
Pretty impressive, you save lives, you change lives for sure what you do.
NEWELL: I think that it's really gratifying to see people with such debilitating, chronic medical problems get a new lease on life. And go back to enjoying it. And it benefits them and their families.
GUPTA: Yes. And along those lines, do you have a final thought that you would like to share with our viewers today?
NEWELL: I think the most important thing is to think about organ donation when you are healthy, when it's not a crisis for your family, to share your thoughts with them. At it helps them at the time when, you know, emotions are so distraught. And to make a decision that helps other people and honors your wishes.
GUPTA: Really important advice. You've helped us work through some very important, sometimes difficult information.
We are out of time for today. So I would like to thank the Dr. Kenneth Newell, first of all. Also like to thank all of you at home as well, for asking all of your questions. We hope we have inspired some folks to become donors today.
Thanks for all of your e-mails. Remember to e-mail your questions every week firstname.lastname@example.org.
And tune in next week when I'll be in Thailand for the International AIDS Conference. New research suggests young Americans and women are the new targets of this deadly disease. We'll talk with a doctor fighting this war at ground level. Plus take a look at the access other countries have to AIDS' drugs. Is it enough? And is pandemic of AIDS getting worse? That's next weekend at 8:30 Eastern.
Remember, this is the place where you can ask the experts all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned for more news on CNN.
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