Newswise — Forty years ago, teenager Janice Ottenbacher lay in the hospital, dying of a kidney infection. But thanks to a kidney donated by her identical twin sister Joan, and the skill and daring of a team of University of Michigan doctors, Janice is alive and well today.
She was the first person to receive an organ transplant at the U-M, the first in the state of Michigan, and one of the earliest kidney recipients in the nation. And in the 40 years since, more than 5,920 children and adults have received the same "gift of life" in kidney, liver, heart, lung and pancreas transplants at the U-M Health System.
On Saturday, Nov. 6, Janice and Joan will return to Ann Arbor, where they'll join more than 800 other transplant recipients, living donors, transplant team members and others to celebrate the 40th Anniversary of Organ Transplantation at the U-M. The celebration will run from 9 a.m. to noon at the Michigan League.
At the event, Janice and Joan will reunite with one of the surgeons who took part in their transplant: Jeremiah Turcotte, M.D., who in 1964 was in his first year on the faculty of the U-M Medical School, and performed Janice's operation together with former U-M surgery chair C. Gardner Child, M.D.
An early leader in transplant research, Turcotte served for many years as director of the abdominal organ transplant program at U-M, and as director of the U-M Transplant Center. He is now an emeritus professor of surgery, as well as a past president of the American Society of Transplant Surgeons and the United Network for Organ Sharing, which manages the nation's transplant system.
" This anniversary offers a chance to look back on our long history, and an opportunity to show how today's research will allow Organ Transplantation to save even more lives in the future," says Jeffrey Punch, M.D., director of the U-M Transplant Center and associate professor of surgery. "We're celebrating the tremendous gift given by those who donated their organs when they died, and by the living donors who gave a part of themselves so that someone else could live. We're also saluting the courage of our recipients, and the dedication of everyone involved in their care."
In the last 40 years, transplants have gone from rare and risky to routine. And in that same time, the U-M has grown into one of the nation's largest, busiest and most research-driven transplant centers. Today, more than 350 patients receive new organs at the U-M's University Hospital and C.S. Mott Children's Hospital each year.
Since 1964, when C. Gardner Child organized the multidisciplinary transplant program, U-M teams have performed 575 heart transplants, 310 lung transplants, 13 heart/lung transplants, one heart/kidney transplant, 1,244 liver transplants, 27 liver/kidney transplants, 3,511 kidney transplants, 159 kidney/pancreas transplants, and 72 pancreas transplants.
Hope through research
Dozens of transplant-related research studies are under way at the U-M, from trials of new anti-rejection drugs to studies of devices that can keep patients alive until transplant. And a clinical trial of pancreatic islet cell transplants for patients with Type 1 (juvenile) diabetes will begin next year.
U-M faculty also lead the nation's registry of organ transplant data, the Scientific Registry of Transplant Recipients, which is used to evaluate the performance of transplant centers. It also allows U-M researchers and others to study the factors that influence long-term transplant results, and the benefits and risks of new transplant techniques.
Since the early 1960s and continuing today, U-M scientists have worked to unravel the mysteries of transplant biology, including the factors that can lead to rejection of a transplanted organ, and ways to fool the body into accepting a new organ.
Turcotte notes that in the four decades since that first U-M transplant, research has made a great difference in the long-term survival of transplanted organs. "In 1964, we had two anti-rejection drugs, and without those we would have had no success. But at that point, if 50 percent of the organs were functioning after one year that was a good result," he says. Later, Turcotte helped develop and demonstrate the usefulness of an antibody called ALG that was a standard anti-rejection drug for years. Today, with the help of newer drugs and drug combinations, as well as sophisticated rapid tissue typing, 92 percent of the organs transplanted at U-M are still working after one year. And many of the organ recipients coming to the Nov. 6 event have lived far longer. Punch notes that U-M played an important role in the testing of CellCept, a powerful modern anti-rejection drug, and others.
Making the most of the organ supply
Despite advances in transplantation science, the too-low supply of donor organs remains a major challenge. More than 87,150 Americans, including 1,170 U-M patients, are waiting for an organ. Last year, 6,280 Americans died while on an organ transplant waiting list.
The U-M Transplant Center is a leader in making the most of the nation's supply of organs from deceased donors, and increasing donation registration and awareness.
Decades ago, U-M led the way in organizing one of the first and largest regional transplant donor organ sharing systems. The system created a network of Michigan hospitals that allowed organs from a deceased donor to be shared statewide. It grew into what is now the statewide organ-procurement organization called Gift of Life Michigan, and served as a model for the organ procurement agencies in other states.
This year, the center was saluted by federal health officials for having one of the highest donor-conversion rates in the country: 91 percent of eligible registered organ donors who die at U-M hospitals are able to donate their organs, thanks to better outreach to families of potential donors and technology that can keep the organs of deceased donors viable longer.
At the same time, living donation of kidneys and partial livers among relatives, friends, co-workers and even strangers have grown tremendously. In the past decade, the number of kidneys from living donors transplanted into U-M patients has exceeded the number from deceased donors.
U-M surgeons were also among the first to use minimally invasive laparoscopic techniques to remove the living donor's kidney through a small incision, speeding their recovery.
It's a far cry from Joan's living donation to Janice, which took place before doctors even dared to make an image of the donor's blood vessel structure before operating. Turcotte recalls being surprised that Joan had two arteries leading to her kidney, making the operation more difficult.
The U-M also has Michigan's only liver transplant program for children, one of a handful in the world. It transplants partial livers donated by living adults, as well as livers from deceased donors.
Meanwhile, U-M doctors are leaders in new techniques that enable more patients to receive organs from donors who aren't a "perfect match" like Joan was for her identical twin Janice. For example, a new study now under way at the U-M uses a pre-transplant drug therapy regimen called immune globulin, or IGIV-C, to help a recipient's body de-sensitize itself to the antibodies on the donor's organ. If successful, the study may allow many more transplants that once would have never been possible because of what transplant experts call a "positive crossmatch."
And the pediatric heart transplant team at the C.S. Mott Children's Hospital was one of the first in the world to try a technique that allows babies to receive heart transplants from donors with incompatible blood types. This approach, which is possible because infants' immune systems aren't fully developed and can tolerate what's called "ABO incompatibility" , has already saved the lives of several infants transplanted at U-M, preventing scarce infant-donor hearts from being wasted.
A better "bridge" to transplant
For those patients who are still waiting for a suitable match, U-M offers a range of life-sustaining technologies. Among them: advanced kidney dialysis for adults and children, including peritoneal dialysis that can be performed at home, and a highly specialized pediatric dialysis team that's one of a few of its kind in the world.
To keep failing hearts pumping until they can be replaced, U-M offers one of the most experienced programs in the world for implanting and maintaining heart-assist devices. Almost 150 patients have received this mechanical "bridge" to transplant at U-M, including many who took part in clinical trials of a device that now has FDA approval. A few who have just received the next-generation experimental HeartMate II device. In all, six heart-assist devices are being used at U-M.
Many critically ill patients at U-M and around the world also receive life-sustaining heart and lung support from ECMO, or extracorporeal membrane oxygenation, a technology perfected at Michigan and often used as a "bridge" to transplant.
Looking back, looking forward
In all, says Punch, the 40th anniversary of organ transplantation at the U-M offers a chance to look at all that has been achieved — and to see what still needs to change. In fact, he says, transplant professionals would like to see fewer patients reach the point where they need a transplant.
"We need better systems for overall health care in this country, so we can prevent disease progression in people with hypertension, diabetes, hepatitis, and heart disease. There's a special need to prevent kidney failure in African-Americans, which is a growing problem that's compounded by the low rates of donation in that community," he says.
"But there will always be a need for transplantation," he adds. "And as we get better at preserving organ function over time, transplants will remain an effective way to address advanced disease."
For more information on the U-M Transplant Center, visit http://www.med.umich.edu/trans
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