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Chapter 2 : Coming to Terms with Reality: Why Xenotransplantation Is a Necessity

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Abstract:

Transplantation is considered to be established therapy for a variety of end-stage diseases. Despite some obvious parallels, transplantation stands in stark contrast to many other health care services. First, while cost is an extremely critical issue, donor organ supply has always been the foremost concern. Second, the gap between need and demand is narrowing. Third, this situation has been the source of highly controversial disputes. Finally, it is conceivable that if we were to resolve the supply issue, the financial one would become even more significant than it is today. Too often, naive analysts and misleading analyses give the impression that the future will be unlike the past, since both xenotransplantation and mechanical devices will enable to overcome the supply constraint. This chapter focuses on actual and potential cadaveric donors and donor organs. It presents data in tables to enable to put xenotransplantation into an appropriate perspective. Despite the data reported here, futile health policy efforts will be directed toward eliminating the disparity between the need for solid organ transplantation and the supply of human donor organs. The pace of progress may be exceedingly slow, as nonclinical issues take center stage as resource constraints become as apparent as they are real.

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2

Key Concept Ranking

Liver
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Pancreas
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Xenotransplantation
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Lead
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Precursors
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Figure 1

The concepts of need and demand in organ transplantation.

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Figure 2

What happened to potential organ donors (January-March 1996)? (Data provided by Susan Gunderson, LifeSource, Inc., Minneapolis, Minn.)

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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References

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Tables

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Table 1

Definitions of concepts

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 2

Age criteria for various organ transplants

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 3

Total need for transplantation, 1979-97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 4

Year-end waiting list for transplantation, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 5

Reported deaths on the waiting list, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 6

Number of cadaveric organ transplants by year, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 7

The total demand for cadaveric transplantation, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
Generic image for table
Table 8

Estimates of the unrecognized need for transplantation, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 9

Estimates of the unmet demand for transplantation, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
Generic image for table
Table 10

Estimates of the unmet need for transplantation, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 11

Estimates of potential donor supply in the United States

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 12

Number of cadaveric organ donors, 1980-97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
Generic image for table
Table 13

Number of cadaveric organ donors by year, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 14

Number of organs recovered from cadaveric donors, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 15

Estimated number of potential cadaveric organ donors by year, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 16

Potential supply of cadaveric organ donors

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
Generic image for table
Table 17

Potential supply of cadaveric donor organs

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 18

Potential supply of cadaveric organ donors by donor type, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 19

Percentage of potential cadaveric organ donors from which organs were procured, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 20

Potential supply of cadaveric donor organs by donor type, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
Generic image for table
Table 21

Percentage of potential cadaveric donor organs procured, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 22

Cadaveric kidney transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 23

Cadaveric liver transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 24

Cadaveric pancreas transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 25

Cadaveric heart transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 26

Cadaveric lung transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 27

Cadaveric heart-lung transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 28

Cadaveric transplantation: need, demand, and supply, 1988–97

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 29

Cadaveric transplantation: percentage change in estimates from 1988 to 1997

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2
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Table 30

Discrepancy between the need for cadaveric transplantation and the supply of cadaveric donor organs, 1997

Citation: Evans R. 2001. Coming to Terms with Reality: Why Xenotransplantation Is a Necessity, p 29-51. In Platt J (ed), Xenotransplantation. ASM Press, Washington, DC. doi: 10.1128/9781555818043.ch2

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