Modern day medicine is quite an amazing thing. Think of the drastic changes in the last fifty years, most notably, in the field of transplant surgery. A life saving procedure which is aided by major advances in anti-rejection medications, transplants have given hope to patients where none existed before. In 2011, the number of patients on the waiting list for transplants is trending higher than last year while the number on the donor list remains flat (UNOS.org). According to the U. S. Department of Health and Human Services, an average of 75 people receive organ transplants each day. Unfortunately, however, an average of 20 people die each day while waiting for transplants that do not happen because of the shortage of donated organs. Every 11 minutes, someone is added to the organ donation waiting list.
Modern medicine and technology (e.g. dialysis, left ventricular assist devices) can keep patients alive longer than was possible fifty years ago, but at what cost? Do these options prolong the hope of a transplant, or accentuate the need for other alternatives?
Organ donations are encouraged in a variety of forms. You can now check a box off on the back of your license plate indicating your willingness to donate your organs should you die in an accident. Living wills allow an individual to direct what organ(s) one would like to donate should you be in a vegetative or non-resuscitable state. Why then, are donations not meeting the current need? Perhaps it is fear of the unknown – there are urban myths, (some heard from patients) – who are concerned that if they have registered as a donor and come to be in a vegetative state, it may hasten a decision leading to their demise. More grass root efforts should be made to raise awareness of organ donation. How many times while in your neighborhood have you seen flyers in a store, for example, asking individuals to get tested as a possible donor for a child or adult who needs a rare bone marrow match or organ transplant? We have the science and technology to perform these complex surgeries, yet thousands die each year in wait. These flyers are a cry for better alternatives, a silent prayer for solutions to unmet needs.
The near-future landscape is ripe to solve this dilemma – an organ created from your own adult stem cells would obviate the need for a donor. It may seem that I am getting ahead of myself, but this scenario is not that far-off. Consider Dr. Anthony Atala, Director of Regenerative Medicine at Wake Forest University, North Carolina. He has already grown human bladders from stem cells taken from the patient and transplanted. All of the recipients are doing well five years later. In addition, he and his team are also “growing” heart valves, muscle, and fingers for future transplantation. He is one of many scientists/clinicians around the world dedicated to tissue engineering using adult stem cells. Those of us who keep tabs on Regenerative Medicine are acutely aware of how close this is, that the finish line is in sight. More studies need to be performed on larger scales, yes, but adult stem cells are providing hope. While not the panacea for all transplant needs, adult stem cells can certainly increase the number of survivors on the waiting list. Even if it is by one, it is a victory against death.
Currently, autologous adult stem cell treatments are being investigated and are showing great promise in many applications; in the very near future one can theoretically heal oneself. There are also early clinical trials showing that adipose derived stem cells may be used for allogeneic transplants. While these are a little further off, they are still plausible. Adult stem cells can now be banked for future therapies as well as current applications should the need arise. This limbo that exists, this game of chance, may have resolution before the end of the decade.
So, for now, we are in a holding pattern – waiting, hoping, anticipating a time when we can tell our patients that the cure for their ailment lies within them.
Angela M. Miele, DPM
Medical Science Liaison