Whelan says the jury is still out on the equity of the new system and its impact on those on the waiting list over the long term. But, he says, "I think it's doing the right thing... It gives me a lot of hope to offer patients without other options."
What about individuals in less dire circumstances? Does the new allocation system leave them out in the cold?
Not at the University, says Marshall Hertz, M.D., director of the Medical School's Center for Lung Science and Health, which provides access to a broad range of innovative nontransplant approaches to enhancing lung function. Some treatments help patients stay healthier while they wait for a lung. Others, such as surgical intervention for emphysema and medication for primary pulmonary hypertension, may make transplantation unnecessary for some patients. Many patients have the opportunity to participate in clinical trials that offer access to the newest approaches to combating loss of lung function caused by pulmonary fibrosis, chronic obstructive pulmonary disease, pulmonary hypertension, or cystic fibrosis.
"We really try to structure our lung disease program so we can care for more of these patients and prevent them from needing a transplant," says Hertz, who is also a professor of medicine and medical director of the Transplant Center's lung transplant program.
Marshall Hertz, M.D., director of the Center for Lung Science and Health, offers patients innovative treatments that enhance their lung function while they're on the transplant list—or eliminate the need for a transplant altogether.
Barry Friedman, senior director of organ transplant services for the University of Minnesota Medical Center, Fairview, notes that this focus has brought a growing number of referrals from physicians who recognize the program is not a "transplant mill" but a comprehensive effort to promote lung health.
"When people are diagnosed with end-stage lung disease, the University of Minnesota is one of the only centers in the United States that can offer them multiple protocols," Friedman says.
"They may come here for a transplant, but we may decide that a medical or surgical procedure on the patient's own lung is a better option." Whenever possible, says Friedman, a team of physicians and nurses tries to restore the patient's health by improving lung function—without resorting to a transplant.
Demand and supply
Being at the top of the transplant list made a life-or-death difference for Gary Broberg—but only because a donor lung became available. The fact that one did is likely due to a second big change that has bolstered lung transplantation nationally: improvements in obtaining donor organs.
Gary Broberg received a new lung and a new life almost two years ago. Today he's back to the things he enjoys—golfing, traveling, and spending time with his family.
As with other types of solid organ transplants, nonprofit groups known as organ procurement organizations, or OPOs, are responsible for obtaining and distributing donated lungs. When a hospital becomes aware of a prospective donor, it contacts the regional OPO, which works with family members to determine whether organ donation is an option. If it is, the OPO serves as the bridge between donor and recipient, making sure organs are delivered where they're needed, when they're needed, and in good enough shape to last a lifetime.
In 2003, in an effort to boost the availability of organs for transplantation, the U.S. Department of Health and Human Services organized the Organ Donation Breakthrough Collaborative with the goal of identifying OPOs with the best track records and encouraging others to emulate them. LifeSource, the OPO that serves Minnesota and the Dakotas, had organ procurement rates to be proud of—for all organs except lungs. For lungs, it was in the bottom third.
"We were not satisfied with that position at all," says LifeSource CEO Susan Gunderson. In February 2005, after a discouraging year in which only 28 lungs were transplanted from the 147 donors in the region, LifeSource joined with the region's two lung transplant centers—the University of Minnesota Medical Center, Fairview, and Mayo Clinic—in a "lung summit" to brainstorm ways to boost lung procurement.
"The bad year was unfortunate," says Whelan, "but it made everybody perk up and want to pay attention."
"Our premise was that we as the donor program really have the responsibility to do everything we can to increase donations and maximize the gift of donations," Gunderson says. "If a family makes the gift of donation, we have to be stewards of that gift."