From the front left, Heidi Smith, Debbie Pinjuv, Annie Norris and Sandi Smith,
laugh together last month at Washoe Medical Center. All of these women
have come together through organ donations
(Candice Towell/ Reno Gazette-Journal)
Organ transplants:
Nevada on the waiting list
With the closest centers in Northern California, Northern
Nevadans find themselves at a disadvantage for organ
transplants.
By Jaclyn O'malley
November 6, 2005
From the front left, Heidi Smith, Debbie Pinjuv, Annie Norris and
Sandi Smith,
laugh together last month at Washoe Medical Center. All of these women
have come together through organ donations
(Candice Towell/ Reno Gazette-Journal)
Northern Nevadans waiting for an organ transplant, already battling difficult
odds due to organ shortages and high costs, face added obstacles because of
where they live, advocates say.
Nevada has just two transplant centers, Las Vegas hospitals that perform only kidney and pancreas transplants. That means most Nevada patients are put on the Northern/Central California waiting list, where the ratio of Californians to Nevadans is 80:1, said Sandi Smith, a registered nurse and regional supervisor for the nonprofit Sierra Eye and Tissue Donor Services in Reno.
"We really are at a disadvantage," said Smith, also the co-founder of The Transplant Network in Reno, a nonprofit educational and support organization for Northern Nevadans. "Patients have to go out of state for the transplant, and then because there is no support system here (for pre- and post-operative care), they have to relocate near the center. It's a real inconvenience and disruption for families."
In 2003, at least 7,000 patients died nationally waiting for transplants, according to the U.S. Department of Health and Human Services. Regional data was unavailable.
But the University of Pittsburgh Medical Center, a leader in organ transplants, is studying the possibility of founding a Las Vegas academic medical center that would provide organ transplants, said Ken Richardson, executive director of the Nevada Donor Network based in Las Vegas. Nevada Donor Network is a federally designated, nonprofit organization that procures organs, tissue and eyes for transplant operations.
According to the United Network for Organ Sharing, California has 27 transplant centers compared to the two in Nevada: Sunrise Hospital and Medical Center and University Medical Center of Southern Nevada.
"As close as we can tell, there are between 80 to 100 Northern Nevadans on the waiting list...the odds are not in our favor," Smith said, adding 300 Nevadans are on a waiting list for organs.
"Nevadans are concerned," she said. "They support organ donation and many organs end up going to Californians when we have folks here in need also."
Although a record 26,984 U.S. patients received transplanted organs last year, the number of people awaiting organs transplants (90,266) is greater than the number of donors who would match their requirements. On average, the Transplant Network said, 16 people die while awaiting an organ transplant.
Since 1988, 724 Nevadans donated organs, according to the United Network for Organ Sharing. The numbers have shown a steady increase every year since 1998. Last year, the state had a record 69 donors, with a low of 17 in 1989.
Advocates say public education about donation likely triggered the increases.
"Generally in the United States, there is a huge gap with patients who can benefit from transplants and the number of available organs," said Phyllis Weber, CEO of California Transplant Network, the procurement agency for Northern Nevada and Northern/Central California. "It's a national dilemma."
A proximity requirement
Another obstacle for Nevadans is that proximity to a transplant center is part of the criteria for patient selection since organs begin to deteriorate once they are removed. Most Northern Nevadans receive transplants in California, and a few travel to Oregon or Arizona, Smith said. Most organs recovered from Nevadans are sent to California.
Smith said the sickest patients get priority. The organ sharing network maintains the national waiting list. A series of laboratory tests are done on patients and a formula is used to determine the severity of a person's organ failure. The most critical patients are given a transplant if a matching organ is found and the person is physically able to have the transplant and is able to immediately travel to the center.
Debbie Pinjuv, co-founder of the Nevada Transplant Network with Smith, received a liver transplant six years ago at Stanford University. About four months before her transplant, the hospital said they had an organ for her and she traveled to Stanford University for the operation. But transplant officials then decided a Californian in poorer health would get the liver instead.
"There are no transplant centers in Nevada because there aren't enough people here to support one," Pinjuv said. "We get discriminated against."
To try to even the playing field, a 1999 law allowed "directive donation" that let a friend or relative donate an organ directly to a Nevadan if the organs matched. But due to federal medical privacy laws, there is no way to know how many Nevadans benefited from this effort.
To further expand the pool of possible statewide donors, Nevada motorists in 2003 who register with the DMV can use that registration as first-person consent to donate upon their death, which eliminates the need for relatives' permission to donate. According to UNOS, as of June 2005 eight states do not proceed with donation unless consent is received from relatives: Alabama, Georgia, Massachusetts, Mississippi, New Hampshire, New York, Texas and Vermont. But legislation for first-person consent is underway in most of these states.
"People don't know how critical this issue is," Pinjuv said. "It's so important that people donate their organs, especially with the shortages in organs. No one is immune to death. It happens."
Task force created
Also in 1999, the Nevada Organ and Tissue Donation Task Force was created by the Legislature for the purpose of public education and awareness about the issue to increase the number of organ donors. Some of the task force's efforts have been billboard campaigns, ads shown at local movie theaters, pins and bracelets, and donor license plates. Task force members include current and former state politicians, representatives from the attorney general's office and transplant advocates.
But transplant candidates nationwide are already at a disadvantage because in addition to the lack of donors, only 1 percent of deaths each year even fit the criteria of a "medically eligible donor," Pinjuv said.
Donors usually are brain dead and on a ventilator to sustain the organs. The organs must be disease-free, although sometimes a damaged or diseased organ is harvested and put in another patient. Pinjuv said the shortage is so bad that some people stricken with hepatitis C receive livers afflicted with the same virus that ravaged their own.
"Just saying you want to be a donor doesn't mean you will die under the circumstances that would make you medically suitable," Richardson said. "We really need as many people to register as organ donors as possible."
Richardson said of the roughly 12,000 deaths per year in Las Vegas, only about 120 are suitable to donate their organs. Last year, 37 Las Vegas residents donated their organs, according to the Nevada Donor Network.
Nationwide, he said of the 2.5 million deaths, only 16,000 are medically suitable donors. Of those numbers, about 6,000 donated their organs while the families of the rest declined to donate because they didn't know their loved one's wishes, he said.
"We don't talk about our own death," Richardson said. "As a result, your loved ones may not know your wishes."