Organ Transplant: Finding More Ways to Save Lives

How our doctors are exploring new ways to help patients get the organs they need.

Using organs once thought to be unsuitable
A young man dies tragically in a motorcycle accident, but he leaves a big legacy: As an organ donor, he will save seven lives. But with 114,500 people waiting for organs, some doctors are pioneering new ways to use organs once considered unsuitable—sometimes because the donor is older or has used drugs. And they’ve made other changes to improve every aspect of the transplantation. “Thirty years ago, we were still improving anti-rejection medicines. Now we have excellent long-term survival,” says David Mulligan, director, Yale New Haven Transplant Center.
Giving a kidney even if you aren't compatible
You can provide a kidney to a loved one even if your blood types don’t match. In 2017, nine living kidney donors gave organs to nine recipients in a string of paired exchanges at Yale New Haven Hospital (YNHH). Patients traveled from as far as Florida to be part of a series of connected surgeries that gave each recipient the organ he or she needed. “Paired kidney transplants can be complex and beyond the level of risk taken by many transplant centers,” says David Mulligan, MD. Thanks to diligent planning, multiple patients walked out of YNHH with new kidneys.
Tapping the liver's power to regenerate
A liver can regenerate—a donation of just 25 percent of a liver will grow to a full-sized, fully functioning liver in a transplant recipient. Yale Medicine’s Sukru Emre, MD, was one of the first surgeons worldwide to do an in situ split liver transplant (dividing one liver donation between two people), and he performed the first living donor liver transplant in Connecticut. “This is a new era where we are learning how make the most of an organ—and boost survival after a transplant,” Dr. Emre says. Lately, transplant surgeons have been looking at ways to optimize liver regeneration (using machine perfusion technologies) to better ensure the success of surgery.
Building communities of living donors
When Jen Ragaini donated a lifesaving piece of her liver to her husband, Matt, she joined a special club: People who donate an organ while they are still living. Around the same time, Yale Medicine launched the first program in the country to create supportive communities around living donors, and (while problems are rare) provide donors with free, lifelong local monitoring for health issues related to their donation. “Our philosophy is that people should be as healthy after donating a kidney as before,” says Sanjay Kulkarni, MD, medical director, Center for Living Organ Donors.
Making organs better for transplant
Some donated organs are considered unsuitable for transplantation for a variety of reasons, ranging from poor organ quality to donor age, or even because the donor has a disease. But research suggests it could be better for a patient to receive one of these “marginal” organs than to stay on the waiting list. “There is plenty of data to support this,” says Gregory Tietjen, PhD, associate professor of transplantation and immunology at Yale. “But using marginal organs comes with increased risks post-transplant. We’re trying to find a way to eliminate that extra risk.” He and transplant surgeon Dani Haakinson, MD, work with transplant-declined human kidneys and livers, supporting them with machine perfusion (to pump blood), testing their function, and tailoring a repair that may make them suitable for transplantation. Their goal is to see the method used for transplants in the United States within a few years.
The future—growing organs in the lab
Will transplant change in the future? Here at Yale, Laura Niklason, MD, PhD, anesthesiologist and tissue engineer, is working on engineering new blood vessels and lung tissue. In fact, there are several ongoing clinical trials involving blood vessels engineered using Dr. Niklason’s technology. The idea is to use cells from a patient or donor to grow tissue that can function in a patient. “This may be decades away, but I hope one day engineered lungs may be able to help patients with severe lung disease,” Dr. Niklason says. Other Yale research is exploring generation of a new liver from a patient’s own cells, which would eliminate the need for anti-rejection drugs.
How you can become an organ donor
You can express your wish to become a donor when you receive or renew your driver’s license, or you can register online at Donate Life America. You can learn more about becoming a living kidney or liver donor by calling the Yale New Haven Transplantation Center at 203-785-2565.