The Nasty Side of Organ Transplanting
                                         
Second Edition
                                               Norm Barber
                                              
Copyright

                                     Chapter 8
                 
Survival Statistics
                               Survival Prognosis


Transplant interests and organ donation agencies never tire of feeding the mainstream media stories like how a tragically killed teenage boy saved the lives of four or maybe five people by donating his organs.
The truth is usually different. Transplant coordinators or consultants face extreme pressure to obtain consent from relatives. Their careers and a million dollars worth of transplant surgery over the next twenty-four hours depend on the total unquestioning acquiescence from relatives.

The shocked parents are typically in sudden grief, often on sedation and haven’t eaten or slept for the previous 24 hours. They see their terminally injured son or daughter lying apparently healthy in a hospital bed. Transplant coordinators or intensive care unit staff face the difficult task of convincing these parents to allow surgeons to cut and saw open this warm body with its beating heart and remove multiple organs thus preventing the natural dying process of their child. They subject the shocked, confused parents to every psychological trick of guilt, hope and intimidation to gain acquiescence to what could easily be seen as a barbarous request. The key propaganda line they hit the parents with is that numerous lives can be saved from this tragic death.
The lives saved are an exaggeration. Kidney transplants rarely save lives. They may improve a person's life by exchanging an unpleasant and dangerous dialysis and restricted eating regime for a more robust lifestyle that includes anti-rejection drugs and, sooner or later, kidney rejection. It may also kill the recipient during surgery or from anti-rejection diseases. Hardly life-saving surgery.

Kidneys are removed and transplanted for financial reasons. Dialysis can cost governments $50,000 annually for thirty years. A kidney transplant costs $70,000 with $10,000 annually for anti-rejection drugs. With luck, from the accountants’ point of view, the patient will die or the kidney will last at least ten years. Kidney transplanting resembles a financial operation as much as a medical procedure.

Patients receiving livers from brain dead donors have a 20% death rate during the first year. Vital organ survival statistics beyond five years are suppressed because the death rate continues to increase.
With most illnesses a five-year survival rate after initial recovery is considered a permanent cure. There isn’t a permanent cure with organ transplanting because the patient never gets better. The immune system rarely relents and slowly kills the organ or the person dies from immune deficiency diseases caused by the anti-rejection drugs. These defeat 95% of transplants. So one can understand why the organ harvest promoters suppress long term survival statistics.

     Fiona Coote and Professor Mario Deng

Every transplant country has someone like Australia’s revered Fiona Coote. In 1984 at the age of fourteen doctors told her she needed heart surgery. She awoke with another person’s heart inside her chest. Fiona was angry as doctors and her parents hadn’t told her they were putting someone else’s heart into her. Later surgeons replaced it with yet another heart.

The personable and inspiring Fiona is regularly "expressing the gratitude" of fellow heart recipients. She expresses their gratitude because they can’t. Most are dead or too ill to either express or feel any gratitude. In fact half of all heart transplant recipients would have lived longer if they hadn't received the transplant in the first place.
In a landmark study, a team headed by associate Professor Mario C. Deng of Columbia University College of Physicians and Surgeons, New York, showed that many heart transplant recipients don't survive longer than those who were left on the waiting list. In the study, "Effect of receiving a heart transplant: Analysis of a national cohort entered on to a waiting list, stratified by heart failure severity," the survival outcomes for all 889 adult patients waiting for a first heart transplant in 1997, in Germany, were measured over a three year period. 40

Waiting patients were listed into three categories - those with a high, medium and low risk of dying while waiting for the procedure. Transplanted hearts go to patients with a high risk of dying while on the waiting list, but also to medium and low risk because these latter patients, with slightly less desperate heart problems, have a generally better chance of surviving the surgery and immune-suppressant diseases that follow.

          Heart Recipients Died Sooner Than
                   Those Who Missed Out

Associate Professor Deng's results showed that those with a high risk of death had a better survival rate than those left on the waiting list indicating the transplant extended their lives. But, surprisingly, those of medium and low risk who got transplanted hearts had a lower survival rate than those of a similar illness level who missed out on this supposedly lifesaving treatment. The conclusion of this study was that many patients lived longer with their bad hearts than those who got transplants.

Mario Deng’s study conclusion that, on average, only the sickest heart transplant recipients lived longer has prompted suggestions in the industry that less ill patients should be treated by other means. It also prompts the obvious conclusion that the waiting lists are crowded with those who won’t benefit from a heart transplant.

The results of Mario Deng’s study have rocked the transplant industry and allow commentators to reasonably speculate that half of those receiving heart transplants don’t experience an increased survival outcome over those of similar illness level who missed out. The waiting lists include many who won't benefit from a transplant.
Deng’s study results add more weight to the views of English cardiologist Dr David W. Evans, who observed as early as 1982, that patients requiring life-saving open heart surgery were being left to die at Papworth Hospital while heart transplant patients took up the intensive care beds. Dr Evans said they lost 14 patients in an eighteen-month period this way.41

            
So Why Not Restrict Heart Transplants To
          The Very Sickest Who Need Them The Most


The United Network for Organ Sharing (UNOS) in the United States sensed the problem before Mario Deng scientifically proved it to the world. In 1998 UNOS changed its policy by giving increased transplant priority to the sickest patients. This meant a lower general survival rate but an overall increased life expectancy for those receiving hearts compared to their life expectancy if they hadn’t got them. Maybe this explains the lower survival rate of American transplant recipients compared to Australia and Britain.

At first glance one could assume Australian transplanters were more skilled than the Americans. Anne Keogh of St Vincent’s Hospital in Sydney implies Australian survival statistics are higher because of better after care service. Bob Spieldenner of UNOS jokingly says it would be unthinkable to an American that Australians could do a better job of transplanting. He has a point because Americans developed most transplant technology and are more advanced in the body parts industry. Even Christiaan Barnard went to the United States to develop his surgical skills before returning to South Africa.

But the politics of who gets the organs, so as to manipulate survival statistics, can be seen in the differing survival rates of Australia and the United States.

Also, both countries statistics are slightly inflated because patients who leave their country, or withdraw from treatment, are still considered alive regardless of their actual survival.

                   Survival Statistics

In 1997, prior to the suppression of Australian transplant survival statistics (except for kidneys), the heart transplant patient survival rate as published by the government agency, ACCORD, was 90% for the first year and 77% for five years. The US statistics published by UNOS in 1999 show a lower patient survival at 85% for the first year and 69% for five years.

Similarly, US liver transplant survival rates are 79% for one year and 63% for five years while the Australian were 83% for one year and 73% for five years. The US pancreas patient survival rate is 96% for the first year and 82% for five years. In Australia it is 94% for one year and 87% for five years. The above is patient survival but the actual pancreas graft survival is another story. Graft survival is where the patient may survive but the transplanted organ fails or is rejected and must be cut out before it goes rotten. U.S. pancreas graft survival is 76% for one year and 35% for five years so you can understand why the Australians suppress graft survival figures. It doesn’t fit in with their "life-saving" transplant sales theme they throw at grieving relatives in the waiting room and at the public through mass advertising campaigns.

Pancreas graft failure means the patient is back on insulin and the whole thing was a waste of time with increased suffering, expense and risk of death from surgery and drugs. There doesn’t seem to be any proof that pancreas transplants increase life expectancy and, with the anti-rejection drugs and surgery, may actually reduce it.

The kidney statistics for 1999 from The Australia New Zealand Dialysis and Transplant Registry (ANZDATA), based in the Queen Elizabeth Hospital in Adelaide, indicate one-year kidney patient survival at 95% while the kidney or graft survival is 91%. Harvest promoters never fail to broadcast these encouragingly good figures. But these one-year figures are misleading in that they only include people receiving their first kidneys. Five year patient survival is 84% while 72% of kidneys kept functioning. 41a

It isn’t generally known, and harvest promoters visiting schools don’t mention it to the students, but a considerable portion of harvested kidneys go to sick old people who are getting their second, third, fourth and even fifth transplants. Each succeeding graft has a lower functioning life than the previous. Instead of being cured many older patients need a continuous supply of other people’s kidneys to avoid dialysis.

Like kidneys, corneal transplants don’t save lives. They improve or regain a patient’s eye sight and based on 1997 Australian figures have a 91% graft survival for one year and 74% for five years. Another interesting statistic kept suppressed is patient deaths and ill health from corneal transplants and immune-suppressant drugs.

                     
Bone Marrow Donors

The survival of bone marrow recipients is suppressed because their survival rate is so low and this is from a disease that has a very slow kill rate. A person can be sick for many years before dying while the transplant survival rates suggest it actually reduces their lives and is still an experimental procedure.


                      
The Surgical Procedure for
                  Bone Marrow Replacement

Millions of potential donors are waiting to become living bone marrow donors.  If chosen they are admitted to hospital for removal of approximately half a litre of bone marrow from their pelvic bones. It will entail staying in hospital a few days to recover and longer if infection develops from the needle pushing outer flesh into the bone itself.

The difficulty is finding a donor with the most identical marrow to the recipient who is usually suffering from leukaemia. Once a donor is found he or she signs on the dotted line agreeing to donate the marrow within one week. 

Doctors then inject poison drugs and use radiation to kill the bone marrow inside the recipient patient’s bones. The patient, now without living bone marrow, is doomed to death in one week unless the donor keeps his or her word. The donor now has the ability to become a murderer and get away with it. When the donor enters hospital the marrow is withdrawn and injected into the recipient. With the donor’s marrow the victim lives on though the survival rate is low.
The problem is that the poison and radiation rarely kill all the bone marrow cancer and the surviving cancer cells spread to the donor marrow and the patient is back to square one.