Oriented to Thoracic Transplant Recipients -- September 1997

The UPBEAT! Archive

SYNOPSIS OF THE REGISTRY OF THE I.S.H.L.T.
14TH OFFICIAL REPORT - 1997

David C. McGriffin, MD et al -J. Heart Lung Transplant 1997;16:713-22

Since the inception of this report in 1980, there are now 40,738 heart transplantations reported from 297 heart transplantation programs, 2186 heart-lung transplantations from 114 programs, and 3939 single lung and 2543 double lung transplantations reported from 145 lung transplant programs.

The number of heart transplant performed in recent years and the mean donor age is:



Year

No. Txed

Donor Age Yr's

1992

3893

28

1993

3872

27.9

1994

3967

29

1995

3986

28.9

1996

3865

29.2


The data for 1997 is not considered complete as of the time of the report.

It is clear that heart transplantation volume has plateaued, in spite of the practice of using older donors to "expand" the donor pool. Pediatric heart transplantations likewise have plateaued, and in the youngest populations (0 to 5 years), the number of procedures seems to be decreasing.

Again, as to indications for adult heart transplantation, coronary artery disease and cardiomyopathy represent approximately equal numbers and both together represent the vast majority of the cases. The percentage of cases for each of these two diagnoses has varied from year to year, with cardiomyopathy being the majority of cases in the early 1980s, supplanted by coronary artery disease in the late 1980s and early 1990s at a time when the age criteria for heart transplantation was being liberalized. During the past 3 years the percentage of patients with cardiomyopathy has again increased.

Congenital heart disease is the most common indication for transplantation in the pediatric population and has been since 1989. As anticipated, congenital heart disease makers up more than 75% of the transplantations in the less than 1 year age group, yet only 35% in the older aged children.

The overall 1-year survival rate for heart transplantation is 79%. The patient 1/2 life (time to 50% survival) is 8.6 years, and in those surviving the first year, the patient 1/2 life is 11.0 years. The fall off in survival is almost a straight line from year 1 through year 13, with a constant mortality rate of 4% per year. There has been a substantial increase in the 4-year actuarial survival in more recent patients, compared with those who underwent transplantation from 1980 to 1985. It is interesting to note, however, that no significant survival improvement has occurred from 1986 to the present time.

When one views actuarial survival rate by recipient age group, there is a statistically significant decrease in survival for each increase in decade of life, with a clinically significant decrease in those patients over age 65 years.

Retransplantation

As demonstrated in prior Registry reports, retransplantations done at the latest date from the primary transplantation have better outcomes, although the actuarial survival rate of even these retransplant recipients is still significantly lower than that of primary heart transplant candidates.

Risk Factors

As has been previously shown in prior Registry reports, the vast majority of risk factors known to affect 1-year mortality persist at the 5-year time point as a result of their profound latter time point. Furthermore at the 3-year mark, underlying diagnosis other than pulmonary fibrosis is a significant risk factor. As to causes of death: early after transplantation, nonspecific graft failure and hemorrhage account for s substantial majority of the deaths. In the intermediate time period, infection is the primary cause, and late after transplantation bronchiolitis obliterans is the principal cause of death. CAV does account for an important minority of deaths (9%)late after heart lung transplantation.

Lung Transplantation

Although lung transplantation had enjoyed continued growth through 1993, based on the past 3 years' data this growth seems to be plateauing, again with the use of increasingly older donors. Heart-lung transplantation seems to have been largely abandoned in the pediatric patient population, whereas pediatric lung transplantation continues to occur at low but steady rates.

The indications for adult single lung transplantation continue to be dominated principally by chronic obstructive pulmonary disease, whereas cystic fibrosis is the most common indication for double/bilateral lung transplantation. Idiopathic pulmonary fibrosis and primary pulmonary hypertension are also important indications for these procedures. In the pediatric group congenital heart disease, cystic fibrosis, and primary pulmonary hypertension are the principal indications for lung and heart-lung transplantation. Interestingly, retransplantation is used much more frequently in this age group than in adults.

There is no signification in the 6 year actuarial survival rate comparing single lung to bilateral/double lung transplantation, with patient half times of 3.7 years and 4.5 for single and double lung, respectively. For transplantation in adults there is a significant difference comparing lung transplantation performed from 1988 through 1990 compared with later years, but no improvement after 1991. Patients aged 55 and older had a significantly lower survival that younger recipients.

On the matter of survival according to the different indication for single and bilateral/double lung transplantation, respectively - patients with emphysema in both procedures fared well, whereas patients with interstitial pulmonary fibrosis and primary pulmonary hypertension had significantly worse survival. There are no differences in survival between single, bilateral/double lung and, in the case of primary pulmonary hypertension, heart-lung transplantation for each of these indications. The 1-, 2-, and 3 year actuarial survival rates for lung retransplantation are 44%, 37%, and 30%, respectively. For heart-lung retransplantation the outcomes are even worse, with rates of 30%, 27%, and 24% for 1-, 2-, and 3-year survival, respectively.

Several of the risk factors for 1-year survival, including preoperative ventilator support and patients with congenital heart disease or idiopathic pulmonary fibrosis, are no longer significant at 4 years. Other risk factors, including prior transplantation, donor race, and a recipient diagnosis of primary pulmonary hypertension, continue to predict worse long-term outcome. As with other organs, recipient age risk is a continuous variable. Of note is that in a marked contrast to both heart and heart-lung transplantation, donor age is not an independent risk factor for death lung transplantation.

For actuarial survival of pediatric lung, heart lung, and bilateral lung, transplantation, there are significant differences in outcomes, however, the numbers in all groups are small. Survival rates for all repeat pediatric thoracic transplantation are substantially reduced for all organs as compared with primary transplantation. The one-year mortality risk factors for pediatric lung and heart-lung transplantation include ventilator assistance before transplantation (a thirteenfold risk), ischemic time and recipient race.

In the case of lung transplantation, a slightly greater percentage of patients have some limitations compared with those after heart transplantation. Within the first two year period a significant percentage of patients (42.2%) continue to require repeat hospitalization after lung transplantation. The comorbid conditions of the first two years again include drug-treated hypertension, renal dysfunction, drug treated hyperlipidemia, drug-treated diabetes, and malignancy. In regard to maintenance immunosuppression, there is a larger proportion of patients receiving tacrolimus after lung transplantation compared with heart transplantation.

The most common causes of death after lung transplantation (both adult and pediatric) are: early after transplantation, nonspecific graft failure and infection; in the intermediate time interval, infection is the most common cause of death; and late after transplantation, infection continues to be strongly represented, but bronchiolitis obliterans results in most deaths after I year.

Abridged by Don Marshall, UpBeat
(Ed. Note - The specific numbers are available in large part on the web page for the International Society for Heart and Lung Transplantation. However, for complete detail the graphs, charts. and tables of the, original article should be consulted in the Journal of heart and Lung Transplantation as indicated at the top of the article.

And as recipients are reminded every time these actuarial statistics are reviewed - If you are reading the results. you are not part of them, so don't get over/y concerned. DM)

At Temple University Hospital, 16 Patients Cry, Laugh And Pray Their Way Through The Pain And The Fear. Some Will Live, Some Won't. The Unsteady Beat, Beat, Beat Of The Heart-Transplant Clock

By Stacey Burling - Inquirer Staff Writer

(6/2/96) A plastic party hat on his head and a noisemaker in his hand, Richard Mattingly hobbled from his hospital bed toward the New Year's Eve party.

His fellow heart transplant patients clogged the hallway outside his room at Temple University Hospital. They maneuvered their ever-present IV poles between two tables laden with low-cholesterol food.

They were feeling good. There had been a transplant that morning and reason to hope there would be more soon. It was New Year's Eve, a night when young people with healthy hearts get drunk, drive fast, and smash up their cars-- a promising night for people awaiting transplants.

The patients were blowing horns and joking about every ring of the phone. 'There's a heart," they'd announce. frowning in mock disappointment when it wasn't.

That night, 16 patients, ranging in age from 28 to 66, were waiting at Temple for heart transplants, a record for the North Philadelphia hospital.

Without a new heart, it was unlikely any would see another new year.

They would never again sit in their favorite chairs, sleep next to their husbands and wives in their own beds, see their kids play baseball or breathe the familiar scents of their own backyards.

They couldn't leave the hospital because they were being kept alive by the medicines dripping through their IV lines and the constant attention of the hospital staff.
Richard tried not to think of these things. He blew his noisemaker and made his way to a chair.

He knew time was running out for him. Two days before, his chest had tightened around him like a vise. It wasn't a good sign. His heart was dying.

'My wife wants champagne," boomed one of the patients before popping open a bottle. The drinks were a dispensation; the doctors were bending hospital rules.

At 9.35 p.m., Richard took a glass. Before the champagne even touched his tongue, the vise clamped down. It felt as if an elephant were standing on his ribs.

Pain bunched up in his chest, then shot out toward his shoulders and arms.

'I need to get back in the room," he said.

Richard Mattingly and the other patients on Temple' s seventh floor belong to a bizarre, hidden community created by this country's inability to meet the burgeoning demand for hearts.

In major medical centers across America, groups of patients such as this one wait for strangers to die and give them a second chance at life.

They wait in hospitals for weeks. and sometimes months. Many die waiting.
Tethered to IV poles or mechanical devices that keep their hearts pumping, they live in an antiseptic, high-tech purgatory. trapped between certain death and the possibility of renewed life.

It's a place where every emotion is mixed- fear with hope,joy with jealousy. grief with relief, revelation with regret.

At its best, the heart transplant ward is also an ever-changing small town, where friendships run deep and faith grows stronger. it's unlike anything else in modern medicine.

Waiting for any kind of transplant is agonizing, as the more than 45,000 people on waiting lists for all types of organs know. But most, at least, are able to wait at home.

That once was true for heart transplant patients, as well. But, with demand so high, the nation's organ procurement system has tried to direct hearts to the sickest patients, many of whom need continuous hospitalization.

Since 1988, the number of waiting patients has more than tripled nationally, while the number of hearts has increased by only 41 percent, partly because the families of many potential donors decline to donate. During the last three years, for every patient who got a transplant, two more joined the wait.

In the Philadelphia area alone last year, 44 people died before a heart could be found.

Last New Year' s Eve, 163 people were waiting for hearts here, either at home or in one of the region's four adult heart transplant hospitals--Temple, Hahnemann University Hospital, University of Pennsylvania Medical Center and Hershey Medical Center -- which combined did 156 heart transplants in 1995.

Nowhere does the plight of the waiting transplant patient play out more dramatically than at a hospital such as Temple, which does more adult heart transplants than any other center in the country.

As most of the 15 other patients continued partying, Richard was helped back to his room, where three nurses kept their eyes on the monitors above his bed.

'Can I have another nitroT' the 58-year old man asked.

Nurse Ted Fanelli dropped a pill into his mouth.

Nitroglycerin helps open blood vessels to the heart. As more blood carries oxygen to the heart, the pain usually subsides.

But it wasn't helping Richard. The nurses waited nervously for a doctor.

Richard said the pain was getting worse.

Fanelli put his hand on Richard' s shoulder and asked him to take a deep breath. Richard told him the pain was constant now.

'Oh, my God," he said, as another wave hit him.

A nurse ran for morphine.

Again and again, Richard doubled over. A nurse asked him to rate the pain on a scale of 1 to 10.

'It's 10," he said through clenched teeth. 'It's 10."

Doctors arrived. They gave him drugs to slow down his heart rate and lower his blood pressure. They gave him more nitroglycerin, more morphine. Still, the pain continued. He was dizzy and a little nauseated. He thought he was dying.

'Oh, God. Oh, God," he moaned.

It was now 10 p.m., 25 minutes since the attack began, and the pain still hadn't stopped.
'I'm sorry to cry," he told the nurses and doctors, 'but I'm scared s --less."

The doctors knew that Richard was getting sicker, making the need for a new heart more urgent.

It was only a matter of time before his heart, damaged by coronary artery disease, would grow so weak that it would be unable to pump enough blood to keep him alive. Doctors didn't know how long that would be. It was unlikely that his heart could last for more than a few months.

But Richard's deteriorating condition would not move his name higher on the waiting list. Hearts go to those in the hospital who have waited the longest.

Richard was a warm, open-faced man, the kind of guy who would grin and ask nurses for hugs and never have trouble getting them. He was an outdoorsman, proud of his American Indian heritage. He lived in Coilingdale and worked as a water-quality specialist for Philadelphia Suburban Water Co. He was proud, too, of his two daughters and three sons. His eyes filled with tears when he thought of how much he loved his wife, Nancy. All he wanted was 10 more years to spend with her -- not an unreasonable hope, given that 40 percent of transplant patients can now expect to live at least a decade.

Already, Richard had been waiting at Temple for 53 days. The average wait there was almost 96 days, 10 days longer than in 1994. Even when Richard reached the top of the recipient list, it wouldn't mean that he'd get the next heart.

The heart has to fit properly into a recipient's chest cavity. If it's too big, the surgeons can't close the rib cage. Too small, the heart isn't strong enough to support the body.

The heart also has to be the right blood type. Type A and Type B organs have to go to patients with the same blood type. Type O's are 'universal donors," which means that their organs can be given to anyone regardless of blood type, so competition is stiffer. Nationally, patients with Type O blood wait twice as long on average as people with Type A and Type B blood. Richard was a Type O.

All the patients on the seventh floor{~r knew the system. On first meeting, they would literally size each other up. Invariably, one of the first questions was: ~What's your blood type'?"

As the staff struggled to stabilize Rid~Richard, his fellow transplant patients continued to party though they were feeling far less festive. It was hard for them not to notice the activity going on in Richard's room and think about how fragile their existence was.

Richard wasn't the only one having problems. The nurses also had their eyes on several others. Like Richard, many of them had been waiting a long time and their hearts were getting weaker.

Over the weekend, Marge Freeman. 59. a small, quiet woman who did the books in her husband's store in the Lehigh Valley. had suffered a long spell of V Tach (ventricular tachycardia), in which the lower chamber of the heart beats so rapidly that it can't pump blood effectively.

The same thing happened to Pat Sailtoro, 60, a burly, tough-talking former brick mason and general fix-it man from Trenton. who had been waiting three months. The V Tach knocked him out while he was exercising.

Both Type B's, Pat and Marge were in a party mood this night.

The other waiting patients were:















Three other men, an A, a B and an O, were also waiting on the seventh floor. Three more, an O and two A' s, were in other parts of the hospital, recovering from surgery to implant left ventricular assist devices (VADs),which help hearts pump more effectively.

Although heart failure is the most common cause of hospitalization in this country, few people with this diagnosis become transplant candidates.

Even most of those referred to Temple for heart transplants end up getting less dramatic surgery or drugs, which are used much more effectively now. Only about 15 percent of patients referred to Temple for heart transplants are accepted for the program.

Most transplant patients have hearts damaged by viral infections, genetic disorders or clogged arteries. The organs are too weak to pump blood effectively.

The United Network for Organ Sharing, which determines how organs are allocated, gives top priority to patients who cannot live without intravenous drugs or mechanical heart assistance, patients such as those attending Temple's New Year's Eve party.

The selection committee at Temple is careful about whom it chooses.
Doctors are always walking a thin line with heart-failure patients. They don't want to put people on the transplant list until they're so sick that nothing else will keep them alive. But they don't want to wait until the patients are so sick that they won't survive surgery. They don't take people who have had cancer recently or have other medical problems that might compromise their ability to recover from surgery.

They also have to think about how patients will treat the heart after transplant. The doctors see themselves as guardians of a precious girl and they don't want to waste it on someone who won't take care of it. A heart transplant requires a lifetime of medications, exercise and prudent eating. Patients are told they can never drink or smoke again. It's hard to predict who will really follow the rules. Smokers are particularly prone to backsliding.

During meetings each Wednesday, the Temple doctors discuss the patients who already are waiting for hearts and they decide whom they will add to the list.

They talk about prospective patients' medical conditions, but they also discuss their health habits, their insurance and their family support systems. No one can get a transplant -- the surgery itself costs about $135,000 -- without insurance, but that is rarely a problem, hospital officials said. Most private plans cover the surgery, and people who have been disabled by heart disease usually qualify for public programs, which also cover it. The doctors look for family support and a good mental outlook because waiting for a transplant and doing all that it requires medically afterward can be so trying. But they rarely reject a patient who falls short in those areas.

During the first months of this year, however, the doctors did reject several patients who were too old -- the unofficial cutoff is 65 -- or sick. Others were tabled until they could prove they had stopped smoking and drinking.

Originally, Temple scattered its heart transplant patients throughout the seventh floor and made little effort to bring them together. But then the staff noticed patients comparing notes on the telephone, a sign of their deep need for contact with each other. Their situation is so unusual that it's hard for anyone, including their own families or the hospital staff, to give them adequate support.

Who else but other transplant patients can joke about how their golf game will be affected by the shakes they get from the drug cyclosporine, which prevents rejection of the new organ? And who else can talk about the very real possibility of dying soon, or talk as knowingly about death as Joe Urbanski did one day, when he said: 'I've died three times," only to have Rich Ford reply. 'I've only died once."

So four years ago, the Heart Failure Care Unit, which provides ICU-level treatment, was created as an ever-changing support group. Hahnemann has a similar unit. The University of Pennsylvania Medical Center doesn't have one, though it puts all transplant patients on the same floor.

Temple's heart unit is a friendly place, where all the patients are on a first-name basis and mingle in the hallways, public spaces and even their rooms.

Temple's heart transplant beds occupy one corner of the seventh floor. It has its own nurses' station, with monitors to constantly show each patient's heart rhythm. Some rooms also have video surveillance. It has a solarium for patients to lounge in and a small meeting room for family-style dinners on Thursday nights, video games, movie viewing and card games.

And like a spaceship equipped to keep its confined occupants in shape, it has a stationary bicycle, some small weights. a hand bike for upper-body strengthening and a treadmill. In the unit's hallway, groups of patients, most dressed in street clothes. march single file around the floor for exercise, their IV poles rolling beside them.

Because Temple's transplant program quickly outgrew the allotted space. some patients are grouped at the opposite end of the floor, a section the patients call the suburbs.

The staff does its best to make the wait fun. They organize parties for every possible holiday. They bring in videotapes and games. They put cots in patients' rooms so wives and children can sleep over. They help patients carve pumpkins for Halloween and give awards for the most festive Christmas decorations.

All of this has made a big difference, said Christopher Combs, the Temple psychologist who works with the transplant patients. He said the incidence of depression, anxiety and agitation has gone down considerably.

Finally, the morphine started to help Richard.

The pain had dropped to a 4, and he could begin to concentrate on what the young doctor was telling him.

They would be taking him to the coronary-care unit, an ICU on the second floor, where they could study his heart more carefully. They might have to give him a balloon pump, a mechanical device that is snaked through an artery in the leg until it reaches the aorta, the big artery leading from the heart.

Richard wasn't happy about this. The balloon pump was serious business. And if it didn't work, the next step was the VAD. Nobody wanted that. The VAD, or ventricular assist device, was a metal pump the size of a package of bologna implanted in the abdomen. It went only to people who were on the verge of death. Although it is a major reason that more patients aren't dying while waiting for hearts, it's no fun. It can be uncomfortable, and it makes patients more vulnerable to infections. A quarter of VAD patients die before transplant.

Richard didn't even want to move to another floor. He preferred the heart failure unit and being with his roommate. He wanted them to save his bed.

'This is not going to make you lose your parking space," the doctor assured him.

Nancy Marschall and her husband, Rick, came to see him off. Nancy, a religious woman who spent a lot of time reading the Bible, had been waiting for a heart and a kidney for 11 weeks.

'How ya doing, Richard?" she asked, poking her head into his room. Her Happy New Year hat was still on her head.

'Much better than I was," he answered. 'I was in pain you wouldn't believe."

'Do you want a prayer'?" she asked.

'Be happy to have a prayer if you'll say a prayer."

Rick held Richard's hand and spoke softly.

'Lord, you say, fear not.' ... There is so much to fear. The unknown. The pain. All sorts of worries that we have. In the middle, you tell us to fear not, but we don't understand why ....

'Dear Lord, in Richard's case this evening, bathe him in your peace."

Nancy, who before her hospitalization had been too shy even to pray in front of her family, spoke: 'Give him the new heart he needs so desperately. Let him resume the life you have planned for him."

'Dear God," Richard said. 'Just be with all of us. Thank you for being my partner tonight."

The Marschalls went back to the party. 'They gotta start getting more hearts," said Alice Lamont, a post-transplant patient who had joined the party.

'Short of going out and hunting them yourself," Nancy said, 'what are you gonna do?"

It wasn't your typical New Year' s party conversation, but this wasn't your typical New Year's party.

John Cathey and Alfie Powell were talking about death and fear. John liked Alfie. He felt sorry for her. She was so frail, so young and so far from home. So alone.

She said she'd feel bad if she got a heart before he did.

'Don't worry about how long I been here," he told her, his voice soft and breathy. 'If you get a heart, you take it and you don't worry about it."

Alfie, whose uncle had died during heart surgery, said she was scared she wouldn't live through her operation. John said he was afraid, too.

'All you gotta do is pray," he told her. It was the pain he feared, and with his VAD he'd endured so much of it. His chest and stomach were covered with surgical scars.

And now he felt Richard's pain, too. The patients on the seventh floor were constantly being reminded of how close death was.

Collins had seen his last roommate die one morning in November. The man had gotten up, stood on the scale as usual and dropped dead. Just like that. Another popular patient had died two weeks earlier, soon after her transplant.

One young man in his 20s had recently suffered a stroke while waiting. It left him so debilitated that he was taken off the transplant list. He was to be sent home to hospice care.

Eleven percent of prospective heart transplant patients die waiting, but Temple does better than this national average. Seven percent of its patients died last year before a heart could be found.

The statistics were not completely reassuring to the patients at the party.

Even with those odds, it meant at least one of them would probably die before transplant.

It was a quarter to midnight when Richard was rolled into the hall on a stretcher en route to the second floor.

The party was winding down, but some patients were still lingering in the hall. Some would go to their rooms to watch the New Year come in on TV. Another group would go to an empty corner room on the other side of the floor, where they would have a good view of the fireworks at Penn's Landing. No one would get a heart that night.

Richard was embarrassed to have everyone watching him like this.

His mind was racing. Would he need the balloon pump? Would he ever get a heart'? Would he die?

The other patients shook his hands as he rolled by.

'Take care, Bunkie," his roommate. Brian Collins, said gently.

His nurse, Pat Coverty, her face worried and reassuring at the same time, spoke for all of them.

'Happy New Year, Rich."

PVCS

errata: Tx Vern Meissner of Laguna Negele called to advise UpBeat provided a wrong number for the American Transplant Association. The correct number is 281-261-2682. Our apologies to Tx Ellen Woodall and her group.

Transplant Awareness Inc. run by Heart Tx Claude Brady has acquired and offers for sale the surplus copies of the 1996 International Transplant Directory published by Transplant News. When current, this 151 page book sold for $90. Claude is making them available for $6 (+$2 if Priority Mail shipping is desired). The book is just chock full of all the detailed information regarding transplantation: programs available and contacts both U.S. and foreign; government agencies; members of related Congressional Committees; national offices of Transplant Organizations; pharmaceutical companies; insurance and managed care companies with "centers of excellence" programs. Granted it's a fast moving field so some of the specific names of people in positions of authority may have changed, but the position and access point would remain accurate. Claude has performed a real service to the recipient community. If you don't think it's a bargain, or feel the need for the 1997 edition, it's available from Transplant News for $135.95. The 1996 directory may be ordered by contacting Transplant Awareness, Inc., P.O. Box 7634, Arlington, VA 22207 Phone 703534-8587, FAX 703-534-7759, or e-mail: tai01@ aol.corn. Credit cards are accepted. With your purchase you will also receive a catalog sheet showing the other organ ,an donation and transplantation products Claude's non-profit company offers.

Yours truly, UpBeat's erstwhile editor, has humbly accepted appointment to a term on the UNOS OPO Committee as per the announced goal of UNOS to broaden the perspective offered on the various operating committees to include more non-technical individuals concerned about the field of organ donation and transplantation. Of course, they automatically get a broader perspective here me as everything about me now is "XL".
Don Marshall

NAVY RESEARCHERS MAKE ORGAN TRANSPLANT BREAKTHROUGH

by Jan Davis, BUMED Public Affairs

WASHINGTON (NWSA) -- Navy medical researchers believe they have found a way to prevent "mismatched" transplanted organs from being rejected, thanks to new therapy that reeducates the immune system.

CAPT David M. Harlan and LCDR Allan D. Kirk, both doctors at the Navy Medical Research Institute, and other Navy researchers have developed a new medical therapy that re- educates the immune system so that it recognizes transplanted organs -- even transplanted organs that are completely mismatched -- as being the individual' s own. This "acceptance" of the organ prevents it from being rejected.

The researchers reached a significant milestone in their research when they transplanted very mismatched kidneys into two monkeys and treated them with the therapy. No other therapy, including the use of anti-rejection drugs, was administered. Six months later, the monkeys are robust and suffering virtually no side effects. The expected lifespan for monkeys with mismatched kidneys is about 21 days.

A summary of Harlan and Kirk's research is published in the Aug. 5 issue of the Proceedings of the National Academy of Science.

Harlan and Kirk's research stemmed from earlier Navy work that suggested that some immune responses could be turned "off" or "on" at will. Controlling this off or on response are T lymphocytes, or T cells, which play a key role in the immune system by fending off infectious agents. However, the T cells can also attack "invading" transplanted organs, which ultimately leads to organ rejection.

T cells are, in turn, controlled by chemicals known as co-stimulators and receptors. Harlan, Kirk and their fellow Navy researchers discovered a way to control the T cell co-stimulators and receptors to keep the immune response turned off against invaders so the T-cells won' t attack transplanted organs, no matter how mismatched.

"Our mission is to replace tissue that is damaged and provide a reliable way that a Sailor, as a result of combat, can have an organ replaced," said LCDR Kirk.

According to the United Network for Organ Sharing, which tracks organ transplant data,

almost 4,000 Americans died in 1996 as they waited for a compatible organ donor. Tens of thousands of other have decrease quality of life while they wait for an organ match or suffer from the side effects of anti-rejection drugs.

Harlan and Kirk believe that in addition to preventing organ transplant rejection, their research may provide help for immune system illnesses ranging from the relatively innocuous, such as hay fever, to severe and life-threatening, such as multiple sclerosis and lupus.

"We believe this product ... will save the lives of U.S. service men and women," said CAPT Harlan.

BRITISH DOCTORS FAVOR ANIMAL-TO-HUMAN TRANSPLANTS

London (Reuter 7/9/97) - Most British doctors think animal-to-human transplants 'should be allowed, a survey published Wednesday found..

Most also believe it is all right to genetically alter animals for the sake of medical science. The survey of 250 doctors for the British Medical Association's (BMA) News Review.

And despite fears, even among experts. about the ethics of using apes and monkeys for transplant research, the doctors surveyed thought it should be allowed. The British government has declared a moratorium on all animal-to-human transplants, known as xenotransplants. until the dangers and ethics have been examined.

Last year the Nuffield Council on Bioethics, a panel made up of scientists, lawyers and ethicists, said xenotransplants would probably be all right if health and animal welfare issues were watched out for. There are fears that animal viruses could pass to humans, becoming deadly or virulent or both. The BMA's survey found that 77 percent of its regular panel of 150 hospital doctors believed xenotransplants should be allowed. Sixty-five percent approved of genetically altering animals for science and 60 percent thought it all right to experiment on primates.
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