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Solid-Organ Transplantation in the United States
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Although solid-organ transplantation began in 1954 with kidney transplantation in the United States, all other organs including liver, heart, and lung were not consistently and durably successful until about three decades ago. The first successful liver transplant was performed in 1967 and the first successful heart in 1968. It was not until after the introduction of cyclosporine which made it possible for the first successful lung transplantation procedure to occur in the form of combined heart-lung transplantation in 1981. The first successful single and double lung transplantation procedures occurred in 1983 and 1986, respectively.
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To better appreciate the scope of solid-organ transplantation in the United States, a brief overview of the governing body for transplantation is necessary. In 1984, the United States Congress under the National Organ Transplant Act created a unified transplant network for equitable organ allocation by enhancing the effectiveness and efficiency of organ sharing as well as making more donated organs available for transplantation through a unique public-private partnership of professionals comprising the Organ Procurement and Transplantation Network (OPTN). Today the OPTN keeps the only national patient waiting list which features the most comprehensive data available in any single field of medicine.1 Anyone can access this information and review the number of kidney, liver, pancreas, kidney-pancreas, heart, lung, heart-lung, and intestine transplants performed from 1988 to present. For example, on January 3, 2014, of nearly 600,000 solid-organ transplants performed in the United States, less than 40% were done in female patients of whom nearly 100,000 are of child-bearing age, see Table 34-1 and Figure 34-1.1 Other data gleaned from this website include total number of candidates on the waiting list, active candidates on the waiting list, number of transplants, and number of donors. For the sake of this chapter and because of its dependency on OPTN data, the Scientific Registry of Transplant Recipients (SRTR) and other datasets later mentioned over the course of this chapter, we will only refer to kidney, liver, heart, and lung transplantation. Because of the relatively small numbers of lung-transplantation procedures and few pregnancies after lung and heart-lung transplantation, we will combine heart-lung recipients with lung recipients in the lung transplantation cohort for simplicity. In view of so few reported pregnancies, there will be no mention of pregnancy after pancreas, intestinal, or other multiorgan transplant groups.
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