CHAPTER I
Trends and Results for Organ Donation and Transplantation
in the United States, 2005

Introduction

This overview provides a summary of many aspects of solid organ transplantation in the United States, and is produced as part of the 2005 OPTN/SRTR Annual Report. The Annual Report is prepared by the Scientific Registry of Transplant Recipients (SRTR) in collaboration with the Organ Procurement and Transplantation Network (OPTN) under contract with the Health Resources and Services Administration (HRSA). The Annual Report is intended to provide valuable information to patients, the transplant community, the public, and the Federal Government by producing a single publication that contains a vast array of knowledge on activities related to solid organ transplantation.

Ten groups of authors, all experts in various areas of transplantation, have produced the 10 detailed articles in this report. Each article provides an in-depth look at the current state of specific aspects of transplantation, as well as trends over the last decade. The text and figures in these articles contain some new analyses but are based mainly on the wealth of information in the reference tables of the Annual Report, which have been prepared by the University Renal Research and Education Association (URREA), the contractor for the SRTR since October 2000. These 10 articles and reference tables are included in the Annual Report and are available online at www.ustransplant.org and www.optn.org.

Summary Statistic on Transplantation in the United States for 2003-2004

There were over 14,000 organ donors in the United States in 2004, an increase of 695 donors (7%) over 2003. During this time the number of living donors increased by 3% to 7,002, while the number of deceased donors grew by 11% to 7,152, the largest annual increase in deceased donors in the last 10 years. This increase in donors led to an additional 2,240 deceased donor organs recovered for transplantation from the previous year, an increase of 10% (Table I-1). Some of this increase can likely be attributed to efforts, such as the Organ Donation Breakthrough Collaborative that started in the fall of 2003, which focus on increasing the supply of organs for transplantation. The trends in organ donation are discussed in detail in an accompanying article, “Organ Donation and Utilization 1995-2004: Entering the Collaborative Era.”

Table I-1. Growth in Number of Decreased Donor Organs Recovered, 2003-2004

Organs	End of Year		Percent Change
	2003	2004
Total	22,997	25,237	9.7%
Kidney	11,437	12,575	10.0%
Pancreas	1.773	2,021	14.0%
Liver	5,773	6,405	10.9%
Intestine	122	167	36.9%
Heart	2,120	2,096	-1.1%
Lung	1,772	1,973	11.3%

The impact of the increase in the number of organs recovered is evident in the number of transplants performed in 2004. Just over 26,500 organs were transplanted in the Unided States during 2004, over 19,500 of them from deceased donors and almost 7,000 from living donors. These numbers represent an increase of 6% in total number of organs transplanted, a 3% increase in living donor transplants and a 7% increase in deceased donor transplants compared to 2003, as shown in Table I-2. There were just over 7,300 deaths reported for patients waiting for a transplant in 2004. This is an increase over the number reported in 2003 (7,091). However, since the size of the waiting list also increased during this time, the overall death rate showed a slight decrease.

Table I-2: Growth in Number of Transplanted Organs, 2003-2004

Organs	End of Year		Percent Change
	2003	2004
Total	25,083	26,539	5.8%
Decreased donor	18,272	19,549	7.0%
Living donor	6,811	6,990	2.6%
Kidney	14,856	15,671	5.5%
Deceased donor	8,388	9,025	7.6%
Living donor	6,468	6,646	2.8%
PTA	117	132	12.8%
PAK	343	418	21.9%
Kidney-pancreas	868	879	1.3%
Liver	5,364	5,780	7.8%
Deceased donor	5,043	5,457	8.2%
Living donor	321	323	0.6%
Intestine	52	52	0.0%
Heart	2,026	1,961	-3.2%
Lung	1,080	1,168	8.1%
Decreased donor	1,065	1,153	8.3%
Living donor	15	15	0.0%
Heart-lung	28	37	32.1%

Even with the increasing number of transplants being performed, the demand for transplantation far exceeds the supply of available organs. The increasing demand for transplantation is made apparent by the increasing number of candidates on the waiting list for a deceased donor organ. As seen in previous years, more patients are added to the waiting list than are removed due to transplantation, death, or on rare occasion, for recovery from organ failure. There were over 86,000 patients waiting for an organ at the end of 2004, over 4,000 more than at the end of 2003 (Table I-3). As seen in Table I-3, the number of patients waiting for a kidney, pancreas, or intestine transplant displayed the largest percent increases for 2004 compared to 2003; during the same time period, the number of patients waiting for a liver or a lung increased only slightly (~1%), and the number of candidates waiting for a heart or heart-lung actually decreased by about 7% and 10%, respectively. For the kidney, liver, and lung waiting lists (and in the total number of candidates awaiting any organ), the greatest growth has been among those aged 50-64 and 65 and older. Longer time trends and more detailed discussions of waiting list characteristics can be found in the three accompanying organ-specific articles of the report.

Table I-3: Growth in Number of Patients on the Waiting List, 2003-2004

Organs	End of Year		Percent Change
	2003	2004
Total	82,259	86,378	5.0%
Kidney	53,840	57,910	7.6%
PTA	454	504	11.0%
PAK	919	973	5.9%
Kidney-pancreas	2,370	2,403	1.4%
Liver	17,032	17,133	0.6%
Intestine	168	196	16.7%
Heart	3,475	3,237	-6.8%
Lung	3,812	3,851	1.0%
Heart-lung	189	171	-9.5%

Table I-3: Growth in Number of Patients on the Waiting List, 2003-2004

Key outcomes after transplantation include: 1) survival of transplant recipients, and 2) the function of transplanted grafts. Table I-4 displays one- and five-year unadjusted patient survival for all transplant recipients by organ, using the most recent cohort for which adequate follow up exists. The cohort used to compute one-year survival consists of recipients transplanted in 2002-2003, while the cohort for five-year survival is based on recipients transplanted in 1998-2003. One-year patient survival rates were highest for kidney and pancreas recipients, ranging from about 95% to 98%; corresponding survival for liver, intestine, and heart recipients was approximately 86% to 88%, about 83% for lung, and lowest for the small number of heart-lung recipients with around 58% surviving at one-year.

Table I-4: Unadjusted One- and Five-Year Patient Survival by Organ

Organ Transplanted	1-Year Survival	5-Year Survival
Kidney
Deceased donor	94.6%	81.1%
Living donor	97.9%	90.2%
Pancreas alone	96.2%	90.6%
Pancreas after kidney	95.5%	84.4%
Kidney-pancreas	95.3%	85.9%
Liver
Deceased donor	86.8%	73.1%
Living donor	87.7%	77.4%
Intestine	85.7%	53.5%
Heart	87.5%	72.8%
Lung	83.0%	49.3%
Heart-lung	57.9%	40.2%

Table I-5 shows the percentage of transplanted organs that are still functional (graft survival) one and five years after transplantation by type of organ. As for patient survival, graft survival was calculated based on the most recent cohort for which sufficient follow up was available. Graft survival rates are lower than corresponding patient survival rates due to the fact that patients may survive a graft failure by receiving a second transplant or with an alternative therapy, such as dialysis for kidney transplant recipients or insulin therapy for pancreas transplant recipients.

Table I-5: Unadjusted One- and Five-Year Graft Survival by Organ

Organ Transplanted	1-Year Survival	5-Year Survival
Kidney
Deceased donor	89.0%	66.7%
Living donor	95.1%	80.2%
Pancreas alone	76.9%	55.8%
Pancreas after kidney	77.6%	56.7%
Kidney-pancreas (kidney)	91.7%	76.5%
Kidney-pancreas (pancreas)	85.8%	71.0%
Liver
Deceased donor	82.2%	66.9%
Living donor	81.7%	69.7%
Intestine	73.8%	37.6%
Heart	86.8%	71.8%
Lung	81.4%	47.5%
Heart-lung	55.8%	37.6%