European Stars And Stripes (Newspaper) - March 12, 1986, Darmstadt, Hesse                                Availability of transplants brings More controversy or. Thomas Starzl is the guiding Force behind the University of Pittsburgh s transplant Prog Page 14 the stars and stripes a photo ram. By Marcia Dunn associated press doctors have been transplanting human organs for two decades or so but the practice has accelerated spectacularly in the mid-1980s, thanks largely to the introduction of a drug that stops rejection of organs. Concomitant with that growth however problems have Arisen that have More to do with human priorities than with medical techniques. First there has been a proliferation of transplant centers since the Federal food and drug administration approved for general use the potent immune suppressant drug cyclosporine in late 1983. With that came More transplants and a growing Competition for available organs livers kidneys hearts pancreas. That gave Rise to reports of questionable practices the favouring of those who could pay More being shoved ahead of others on the priority list. The Export of american organs to other countries while the waiting lists in the United states remained Long. Illegal traffic in organs gathered overseas from poor people willing to sacrifice one of their two kidneys for Money. How rampant those practices Are remains to be proved. But clearly in the eyes of some who have shepherded the transplant program from its pioneering Days there Are dangers ahead that need to be dealt with. One of those pioneers is or. Thomas e. Starzl who came from the University of Colorado to Start a transplant program at the University of Pittsburgh five years ago. From 1981 through 1985, Starzl and other surgeons at the University of Pittsburgh transplanted 634 livers 768 kidneys 198 hearts 32 heart lungs 16 pancreas and three single lungs. Thirty two times they transplanted a heart and lungs simultaneously three times a heart and liver. In 1985 alone 250 liver 176 kidney 82 heart 13 heart lungs seven pancreas two single lung anyone heart liver transplants were performed. Starzl became one of two . Surgeons authorized to use cyclosporine in 1979. He perfected the technique of using the experimental drug and brought that expertise and that authorization with him when he came to Pittsburgh from Denver. Pittsburgh became the Only place that had carte Blanche for cyclosporine for any Organ " Starzl said. But with the general release of the Swiss drug things have changed. In 1985, 35 other medical centers transplanted livers 70 centers were transplanting hearts 180 were transplanting kidneys and 20 were using pan creases. Most of these began after the drug became generally available in 1983. It s an amazing proliferation of a new Field Starzl explained during a recent interview. My feeling has been that the 80s will be remembered in medical history As the time when transplantation and All the dreams that people had about it will really come to fruition. Look at what s happened. My god Here in one place this place in 1985, we did 250 liver transplants. That s almost inconceivable. It took 10 years for the world to do that Many liver transplants before. The numbers Are  Brian Broznick Organ procurement coordinator for the Pittsburgh transplant foundation says it seems new transplant centers Are opening every Day even in places you would t  what s happening is we re having centers perform transplants in very few numbers with very Little experience in the Field said or. Oscar Salvatierra jr., president of the United network for Organ sharing. We May end up in a free for All scrambling for a Short Supply of  the nonprofit network links 180 transplant centers and laboratories which match tissue for transplantation. The number of organs is the same As it was five or six years ago said or. David Winter of Sandoz pharmaceuticals corp., the Swiss manufacturer of wednesday March 12, 1986so Mit 1m # a �. Kidney transplant recipients at Strong memorial Hospital in Rochester n. Y. New York times photo cyclosporine. Perhaps the desire to collect these organs has changed. Yet if you look closely the number of centers around the world has really  Twenty to 30 heart transplant centers easily could fill the nation s needs. Salvatierra said. That s about one third the existing number. Salvatierra suggests a better controlled system and designations of excellence for transplant centers demonstrating successful track records respectable work loads and a commitment to research. In Pittsburgh surgeons have won Hospital approval for precedent setting Multi Organ transplants. They re also studying ways to prolong the preservation of donor organs. Surgeons at other established transplant centers Are seeking an alternative to cyclosporine which patients must take every Day All their lives. The drug costs about $6,000 a year and has numerous Side effects including excessive hair growth facial puffiness and trembling. Patients should be Able to Tell where they re Likely to get the Best possible results Salvatierra said. With the proliferation of transplant centers the patient does t know that now. It s just another Hospital. It s like going in for an appendectomy or a Gall bladder  Salvatierra says Only designated transplant centers should receive insurance reimbursements for the operations which sometimes Cost hundreds of thousands of dollars. Such a move would shut out Many potential transplant centers and shut Down Many newcomers to the Field. Those kind of transplant centers take from the donor Pool and put nothing Back Broznick said. You can t keep up your skills if you re Only doing two or three heart transplants a  the Federal task Force on Organ transplantation apparently sharing those views approved a 13-Point checklist for transplant centers in january. Roger Evans a research scientist at the Battelle human affairs research centers in Seattle and a task Force member who drafted the checklist expects commercial insurers and eventually medicare and medicaid to use the task Force s criteria for making reimbursements. It s aimed at not Only getting some of them out of it but keeping others from getting in Evans said. It s very Clear that Given the number of donor organs available we Don t need a real Large number of centers to perform the  a major limiting Factor for transplantation in general has been an inadequate Supply of donor organs according to or. Anthony Monaco president of the american society of transplant surgeons and president elect of the International society. About 600 people currently Are awaiting livers hearts and kidneys at the University of California at los Angeles alone. Not All will survive the often lengthy wait. As Long As those situations exist and As Long As we know of a great number of deaths in the country in which organs do not get donated there s a lot of work _ to do said Barbara Schulman senior transplant coordinator for the regional Organ procurement Agency of Southern California. Indeed the answer May lie in finding More and better organs but that is More a problem of education and persuasion than it is medical. Starzl director of transplant surgery at presbyterian University Hospital of Pittsburgh has made transplants important news in the Pittsburgh area and local newspapers have keyed into the subject. The Pittsburgh press last Spring and summer criticized the program s distribution of organs to foreigners. Starzl considers some of the stories inaccurate and  the articles told of cases at presbyterian University Hospital in which foreigners offering higher surgical fees were pushed ahead of americans waiting for kidney transplants. The Hospital while admitting no wrongdoing quickly adopted a new policy setting quotas of 5 percent to 10 percent for transplanting suitable kidneys livers and hearts into foreign patients. A new governing Board also was formed for the Pittsburgh transplant foundation which guides procurement and distribution of hundreds of organs donated annually in Pennsylvania West Virginia and Ohio. Foundation director Donald Denny resigned in january however saying the new panel left the Hospital with too much control. In november the Pittsburgh press reported on overseas trafficking in kidneys from living unrelated donors a practice illegal in the United states. The newspaper interviewed numerous foreigners who admitted to Selling one of their kidneys As a Way out of poverty. The newspaper also told of at least 300 cases in which kidneys gathered in the United states were sent abroad even though More than 8,000 americans Are awaiting kidney transplants at any one time. Salvatierra acknowledges that not everything is perfect in transplantation. What we re dealing with is Complex therapy he said. There Are definitely problems we have to  the american society of transplant surgeons 500 to 600 members Are expected to ratify a proposed code of conduct at their annual meeting in May according to Monaco. The code proposes that All patients receive transplants regardless of financial status or belief and that the operations be performed Only at established centers. It also recommends that americans be Given preference for donor organs but that it is appropriate under certain circumstances to treat other human beings Monaco said. The proposed code sets a 5 percent limit for transplanting organs into foreigners. Salvatierra describes Starzl As having contributed More to the Field of transplantation than any other  Starzl an  surgeon who turns 60 in March performed the world s first successful liver transplant in 1967 at the University of Colorado. Since joining the University of Pittsburgh in february 1981, he has trained 121 surgeons from the United states and 28 other countries. Many of them have since taken Over much of his surgical work Load and he currently performs Only about one in every 10 liver transplants in Pittsburgh. However Starzl remains the Only surgeon in the world who has successfully performed a simultaneous heart liver transplant. He planned to transplant a liver stomach spleen pancreas and Small and Large intestines into a critically ill Indiana Man but the patient died last dec. 31 before suitable organs could be found. Such a transplant is still feasible although there Are no candidates at present Starzl says. Transplantation is an emerging technology it has a very Short history. So we have to Deal with some of these issues Salvatierra said. Today it May be transplantation. Tomorrow it May be some other  the stars and stripes Page 15