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21 t m c » p u l s e | m ay 2 0 1 9 heart. "Now, doctors say different things, but they will say about 10 to 12 years for survival." Changing expectations There is no particular, built-in time that a donated organ should stop working, said R. Patrick Wood, M.D., executive vice president and chief med- ical officer of LifeGift, the not-for-profit organ procurement organization that recovers organs and tissue for individuals needing transplants in Texas and beyond. The long-term survival rate, he added, varies from organ to organ. "When I started in 1984, our expectation was that very few people [receiving donor organs] would survive," Wood said. "That has completely changed and now the expectation is when a patient is transplanted, they will not only sur- vive, but they will survive long-term and have an excellent quality of life. That is because of improvements in the surgery, but also because of improvements in the medication that prevents rejection." Still, there is a long way to go in terms of increasing the longevity of transplanted organs beyond 10, 20 and 30 years. "This is one of the main reasons why we need more research in transplantation," Gaber said. "In my opinion, the organ that we transplant is in a very unusual, hostile environment." Organs are typically harvested from people who have died from brain death—individuals who have fallen or been involved in car accidents. The organs are harvested from the donor's body, put in a cooler, transferred by car or plane and then transplanted into a patient who is already compromised by their original disease. Once the organ is transplanted, the recipient's immune system must cope with this foreign entity. "The organ goes through a whole cycle of injury from the minute something happens to the donor to the end of the organ's life in the recipient," Gaber said. "It is not unusual, but it is actually a miracle that we get so much survival with these organs." Physicians discuss transplanted organs in terms of half-lives, meaning the point at which half of the transplanted organs have failed but the other half are still going strong. Calculating the life of a transplanted organ is a challenge because multiple factors contribute to how long a patient can live with a transplanted organ. "We are not able to calculate the half-life of a liver. It lasts longer than all of the other organs because liver cells regenerate," Gaber said. "The half-life of a lung is shorter because it has many different elements and it is constantly exposed to the elements. It is in the vicinity of seven years. And the heart is in the teens—12 or so years." Doctors have found the best transplant results with living kidney donations. "The half-life of a living donor transplant kid- ney is 21 years," Gaber said. "If you take the same age donor and everything else from a cadaver kidney, the half-life is nine years." Behavior and adherence to a treatment plan also help determine how long a patient can live with a transplanted organ. "It is important for the patient to understand that as soon as they get the transplant, they are getting a new disease," Wood said. "If there was a disease that led them to getting a transplant, they now have a new disease and that is the transplanted organ. That organ requires mon- itoring basically indefinitely. The frequency of the monitoring decreases over time, but ongoing monitoring of the organ is imperative for long- term success." ➟ Randy Creech, walking a hallway at Memorial Hermann-Texas Medical Center, has been living with a donor heart for nearly three decades.