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The Nasty Side of Organ Transplanting.

Chapter 11

Futile transplants and flexible survival statistics

Kidney transplants rarely save lives in the sense that the patient is going to die immediately. They improve a person’s life by exchanging an unpleasant and dangerous dialysis and restricted eating regime for a more robust lifestyle that also includes anti-rejection drugs and, sooner or later, organ rejection and the need for another kidney. Hardly life-saving surgery though it is generally considered preferable to dialysis and extends the recipients' lives.

Kidneys are also removed and transplanted for financial reasons. Dialysis costs governments $50,000 per patient annually. A kidney transplant costs $70,000 with $10,000 each year for anti-rejection drugs. With luck, from the accountants’ point of view, the kidney recipient will die or the graft survives ten or twenty 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. 30% of Australian adults receiving liver transplants are drug injectors who have ruined their livers with Hepatitis C acquired from dirty needles.^[64]

With most illnesses a five-year survival rate after initial recovery is considered a permanent cure. This differs with organ recipients because the patient never fully recovers. 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 eventually defeat 95% of transplanted organs.

Fiona Coote and Professor Mario Deng

Every country performing transplanting has someone like Australia’s revered Fiona Coote. In 1984 at the age of fourteen doctors told her she needed heart surgery. She awoke from the anaesthetic with her heart replaced by a transplanted organ. Fiona was angry as doctors and her parents hadn’t said 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 in 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.^[65]

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

Professor Deng’s results showed that those with a high risk of death had a better survival rate than those of a similar illness level left on the waiting list, indicating the transplants 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 said in a British Broadcasting Corporation interview in 2000 that, “More than eighty percent of hearts in Germany are not allocated to those who can be expected to have a survival benefit from cardiac transplantation.”^[66]

Mario Deng’s study conclusion has rocked the heart transplant industry suggesting that waiting lists are crowded with those who could do better with other treatments.

Deng’s distressing results corroborated an earlier United Kingdom transplant audit that indicated the optimism surrounding heart transplanting was not based in fact.^[67]

But long before Deng’s study and the United Kingdom audit astute observers like David W Evans were observing in 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.^[68]It is notable that the transplant industry has been unable to produce a study disputing Deng’s study results. Anyone doubting the above might challenge an organ donation promoter to provide a statistical study that indicates those receiving heart transplants live longer than those of similar need who miss out. You'll be staggered by the obfuscation.

Why Not Restrict Hearts To Those Needing Them Most?

If the transplant industry restricted hearts to the very sickest patients then those who got the hearts would live longer than those of a similar illness level who missed out. However, statistically there would be a lower life expectancy for recipients generally and this would make heart transplanting appear pointless. Therefore the industry continues to transplant hearts into people who might do better without them.

Previous editions of this monograph contained survival statistics from sources like the United Network for Organ Sharing (UNOS) in the United States. However, I've limited statistics in this Third Edition because of the unreliability of the data.

UNOS provided data to me in 2006 and 2007 that didn't make sense. In 2004 UNOS said there were 2016 heart transplants in the United States then claimed a 79% patient survival rate while also claiming just 68 were left alive. With livers it claimed 6168 transplants performed with a two-year survival rate of 77.9% with just 139 still alive.

Their online data contains heart patient survival data broken down into age and gender specific rates but not the overall rates. The data appears designed to confuse and made difficult to interpret.

The Australian heart transplant data is equally misleading in that the Australia and New Zealand Cardiothoracic Organ Transplant Registry won't provide separate one-year patient survival percentages so one can compare each year. For me to present most of the data as factual would be pretense.

Kidney transplant promoters often promote their 90% one-year graft and patient survival data to show the success of vital organ transplant. What they don't say is that some patients are getting their third, fourth and fifth kidneys. These people live by obtaining vital organs from both heart-beating “brain dead” donors and from healthy people labelled “living” donors. Recipients tend to be much older than donors. It isn't a pretty industry with one doctor who promotes transplanting describing it thus: “Organ donation is fundamentally ugly – removing organs from bodies is distasteful no matter how you paint it…” ^[69]

Most of us have heard media stories where the right match of donor bone marrow can save a Leukemia sufferer. It’s a relatively benign though painful process for the donor: a needle removes a half litre of marrow from inside the hipbone. The marrow donor is under full anaesthetic and out of hospital in seven days.

But we don't hear how long the patient survived. One rare source says, “The actual one-year survival of the 141 patients was 40.0%.”^[70] Leukaemia is often a slow killer and most patients might live longer if they avoid a bone marrow transplant. At best it appears an experimental procedure and not a lifesaver.