The cruel irony of organ transplantation’s success
By Edmund O. Lawler

Seventy-one years ago, Dr. Richard Lawler led a team of surgeons and nurses in performing the world’s first solid organ transplant by grafting a kidney from a just-deceased patient into the abdomen of a 44-year-old Chicago woman. She lived nearly five more years. In the decades that followed that groundbreaking operation at Little Company of Mary Hospital in suburban Chicago, surgeons throughout the world have transplanted other internal organs: livers, hearts, lungs, pancreases and intestines.

Organ transplantation since 1950 has extended or saved the lives of hundreds of thousands of patients. Since 1988, when the first full year national transplant data was collected, more than 750,000 organ transplants of all stripes have been performed in the United States. The cruel irony of the clinical success of organ transplantation is that it has only increased the shortage of transplantable human organs by raising expectations and accelerating demand. Expectations have been raised by the hard, life-saving work of transplant surgeons like Richard Lawler—my great-uncle—and their teams. The shortage is only partially offset by the unmatched selflessness of live donors, as well as the generosity of deceased donors’ families who somehow look beyond their grief to see a different outcome to their loss for the benefit of a stranger.

The ever-growing disparity between the supply of available donor organs and the demand for organ transplantation is frustrating for the transplant community and devastating for the patients. It is estimated that out of the 20 people on the national organ transplant waiting list who die every day, 14 of them were waiting for a kidney. About 100,000 people are on the waiting list for a donor kidney. Kidney transplants sound miraculous, but they are not miracles. They are not even cures. They are treatments – certainly the best option for people with end – stage kidney failure. The alternative is dialysis and the drudgery and inconvenience of the three days per week, four hours per day treatment to remove wastes and extra fluid from the patient’s blood when the kidneys can longer do the job. Today, the average life expectancy on dialysis is 5 to 10 years. 

Transplant patients have longer life expectancies. Living-donor kidneys function on average from 12 to 20 years, deceased-donor kidneys from eight to 12 years. Patients must take an array of medications the rest of their lives to prevent their immune system from rejecting the kidney grafted into their abdomen. But they have regained their lives and can expect to live for many more years with diligent management of their health and lifestyle. The deadly gap between the supply of donor kidneys and the demand for a transplant has many causes. Too few people are willing to donate. The incidence of diabetes, obesity, hypertension and heart disease—which all damage kidneys—continues to grow. Too many organs viable for transplantation fail to reach patients, and, according to some critics, the U.S. organ procurement system is falling short of its potential.

Tragically, nearly one-fifth of the patients on the waiting list for a kidney either dies or is too sick to withstand a major surgery like a kidney transplant. Ideally, kidney disease will be cured by the middle of the twenty-first century, all but eliminating the need for kidney transplants. Or short of that, techniques that somehow condition a recipient’s natural immune response to tolerate a graft and regard it as if it is the same genetic identity as its own may be developed, ending the need for a lifetime of immunosuppressant drugs and their unpleasant side effects.

In the meantime, several advances may help allay the crisis. They include:

Xenotransplantation: The transplantation of cells, tissues and organs between individuals of different species – has been a goal of medical science since experiments began in the early twentieth century. Kidney xenografts may finally see clinical application at some point in the twenty-first century thanks to recent advances of CRISPR- Cas9 – based gene editing methodologies.

Bioengineered artificial kidneys: Scientists have been working for more than a decade to devise a means for blood to flow through experimental artificial kidneys without clotting. Recreating a synthetic version of a kidney is incredibly complex. A kidney contains more than a million intricately structured nephrons — filters that carry away waste products. Despite the complexity, scientists believe the day is coming when an artificial kidney can be surgically implanted into a patient’s body to continuously filter the blood through an array of silicon membranes.

Drone delivery of donor organs: Time is the enemy of a transplantable donor organ. Getting it from the deceased donor’s hospital to a transplant center can sometimes take an agonizingly long time, regardless if it is just across town or from another state or region of the country. Like any shipment, a transplantable organ in transit faces traffic delays, inclement weather and canceled flights. Human organs have even been lost by commercial airlines in transit. Drone test flights in Maryland and Nevada have demonstrated they can safely and expeditiously transport organs for transplant, potentially increasing the supply of viable organs.

The medical and technological advances of the twenty-first century would seem to be the stuff of science fiction to the first transplant team of 1950 that was fortunate enough to find the donor kidney from a just-deceased patient in the same hospital. “I just wanted to get itstarted,” Dr. Lawler said years after his trailblazing transplant. “I felt that many of the people who were dying of kidney disease each year could really benefit from even a small extension of their lives.”

But more than seven decades after the first human organ transplant, medicine still has miles to go before no patient is ever left waiting for a life-saving graft.

Edmund O. Lawler teaches journalism at DePaul University in Chicago. He is the author of “The Graft: The Pioneering Operation That Sparked he Modern Age of Organ Transplants,” published in 2021 by Anthem Press’s First Hill Books.