July 23, 2013

Research: Some African American liver recipients fare better with organ from black donor


Special to The Advocate

July 23, 2013

Black patients with Hepatitis C who receive liver transplants fare better if they received the organ from black donors, new research from Tulane University and the University of California at San Francisco has found.

Dr. Nathan Shores, assistant professor of clinical medicine at Tulane School of Medicine, and other researchers followed 1,766 black patients with Hepatitis C who received liver transplants over a seven-year period. In a break from previous findings, the team found that transplants proved more successful if the donors were black as well.

The benefits were so significant that researchers found matching race in these particular cases mitigated the affect of age, allowing doctors more leeway in using organs from older donors. Both results could have significant ramifications for black liver patients and the organ donation community.

“This inverts a landmark 2006 study that said organs from African-Americans did less well in recipients than those from young Caucasians,” said Shores, whose study will soon be published in Hepatology. “This study shows that they do quite well in certain patients and sends a positive message to everyone. If people realize their organ donation can make a difference for their friends and neighbors, the people in their church and their community, they know they can make a real difference, especially in a place like New Orleans.”

According to Shores, black Americans have a 58 percent higher likelihood of contracting Hepatitis C than white Americans. Although those black Americans with chronic Hepatitis C have relatively better outcomes than patients from other races prior to needing a transplant – a fact that Shores said is not completely understood – they suffer higher rates of liver transplant failure than other racial and ethnic groups.

“Hep C is a huge problem in New Orleans,” said Shores, who also is medical director of liver transplantation at Tulane Medical Center. “More African-Americans suffer from it, as do those in (other) large Southern cities, so all those rates come together to make our rate higher than the national rate.”

While surgeons often prefer to use organs from younger donors, this study’s findings showed that black patients requiring a liver transplant will do better with an organ from a donor of the same race, up to age 60, Shores said.

The study therefore suggests that the current Donor Risk Index used to predict transplant failure be replaced in these cases by a model incorporating race and age, among other standard characteristics. Currently, race and ethnicity are not factors considered when matching organs, though certain blood types and tissue factors are recognized as being more common among certain groups.

“The liver is a big complex organ. It’s almost like an extension of bone marrow with lots of white cells and we don’t really understand it.” Shores said. “If we could figure out why this works, it could help us study the affect of medications and more. And I think this can help lead us on the path to more individualized care, which is the future of medicine.”

In Louisiana, African-Americans make up a disproportionate share of the people waiting for an organ, according to the Louisiana Organ Procurement Agency (LOPA), the agency designated by the federal government to maintain the Louisiana Donor Registry and recover organs and tissues for transplant. More than 1,000 African Americans in the state were waiting for an organ as of June 5.

Although people of most races and ethnic groups donate in proportion to their representation in the population nationwide, that isn’t the case in Louisiana. Twenty-five percent of African-Americans have registered with the Office Of Motor Vehicles to be organ donors while representing 32 percent of the population.

“Minority populations make up the majority of the Louisiana wait list,” said Kristen Heintz, LOPA public relations director. “There’s a great need for people to donate from those communities. That’s why it’s so important for people who wish to donate their organs to discuss it with their families and make their desires known.”

Sometimes misconceptions about organ donation hold people back from making the decision to donate.

“One of the most common myths we hear is that people think a health care provider won’t go all out to save someone’s life if they think that person is an organ donor,” Heintz said. “That’s simply not true. Health care providers take an oath to save lives and have no idea whether or not most patients have decided to be organ donors. The providers only call us when they have exhausted every option, and it’s then we look to see if the patient is in the registry.”

In addition, on a practical note, Heintz said a person who has not been given the proper care would be more likely to have organs that suffered during treatment, which then make those organs less viable for transplant.

While there are approximately 40,000 deaths a year in Louisiana, LOPA approaches less than 300 families a year about donating a loved one’s organs. “Last year about 160 people actually became donors. More families said ‘yes,’ but some people were too sick or too unstable and that prevented them from donating. It’s actually very rare, less than one percent on average, that someone can become an organ donor,” she said. “It really is an honor.”

Heintz also wants people to know that organ donation is not the quick process often portrayed on television. “Donation is usually a 24-to-36 hour process and, until the donation is complete, it can be taxing for families. They should know it takes a little bit of time,” she said.

Though organs often go to the sickest person on the list nationally, there is a limited time that an organ can go without oxygen and blood, creating restrictions on travel.

Therefore, Heintz says about 70 to 75 percent of organs donated in Louisiana stay here, helping fellow Louisiana patients.

To become an organ donor, sign your donor card on your Louisiana driver’s license. You can also become an organ donor online by completing the registry form at www.donatelifela.org or through LOPA at www.lopa.org. Be sure to discuss your decision to donate your organs and/or tissues with your friends and family beforehand so there will be no confusion at the time of death.


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