Too few human organs for transplantation, too many in need...and the gap widens

Article Abstract:

The number of people waiting for organ transplants continues to grow (22,340 are on the waiting list, which is far from all-inclusive), and the number of donated organs has held steady, or even decreased, in recent years. For instance, 8,905 kidneys were transplanted in 1989, but more than 18,000 of the patients on the waiting list are waiting for kidneys. One-fourth of the elderly patients who receive dialysis die each year, and the rate of complications increases for all patients the longer they undergo this treatment. Hearts and livers for transplantation are also in short supply, and as many as one-third of the patients waiting for hearts will die before an organ is found. Although public opinion polls indicate that as many as 60 percent would donate their organs, in fact only 30 percent (at most) actually do so. Families often do not consent to the donation because they are not sure of the wishes of the deceased, or are never asked. In fact, the real shortage of donated organs is greater than the figures indicate, since many patients never apply due to their inability to afford the medical costs. Others decide that they do not want transplantation. The list would be increased still more if the approximately 30 percent of the 175,000 patients receiving dialysis who could benefit from transplantation were added. Even the most successful organ procurement programs enroll only between 30 and 35 people per million. One way of increasing these numbers, used in Europe, is to retrieve organs from brain-dead cadavers whose hearts are still beating, rather than from brain-dead cadavers whose hearts have stopped. According to this technique, a preservative solution is infused into the body while the families are being notified and are making their decisions. This allows more organs to be maintained in a condition suitable for transplantation. Ethical objections have focused on the rights of the deceased and the family, and the fact that the transplantation does not benefit the deceased, but only other people. Transplantation is now part of mainstream medicine, but it faces major obstacles in the form of resistance on the part of potential donors. Several other articles on issues related to this topic appear in the March 13, 1991 issue of The Journal of the American Medical Association. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Recruiting, Ethical aspects, Donation of organs, tissues, etc., Tissue donation, Organ donors, Tissue donors

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CDC plays cat-and-mouse with flu virus

Article Abstract:

The Centers for Disease Control (CDC) anticipates the coming year's influenza virus based on results of worldwide surveillance, and works hand-in-hand with pharmaceutical companies to develop vaccines against it. The CDC collaborates with the health services of other countries, especially China, where new flu strains commonly develop. The Pacific Basin collaboration, comprising 21 countries, helps characterize influenza viral samples. China and the countries in the southern hemisphere experience two flu seasons each year. Since 1988, the CDC has conducted 'aggressive' surveillance in China to detect new viral variants as soon as they develop. Samples are collected, freeze-dried, and sent to the CDC. The agency has conducted training in RNA-sequencing techniques, a method of further characterizing the flu virus's protein coat. Within the US, approximately 170 physicians report weekly rates of influenza-like illness among their patients. Some of these reporters also send samples from patients to the CDC for analysis. Information from state health departments and death certificates is also included in the CDC's anti-flu campaign. Physician reporting of influenza to health departments is encouraged. The drug amantadine can prevent influenza A infection in people who are unvaccinated, and can also treat the disease. It is currently the only drug approved for this use. Rimantadine, another antiviral agent, is under investigation. One problem in the race between prevention and the flu virus is the long lead time required by pharmaceutical firms to manufacture vaccines tailored to the specific viral strain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Research, Reports, International aspects, Prevention, Demographic aspects, Influenza vaccines, Influenza, Influenza viruses, United States. Centers for Disease Control and Prevention, Amantadine

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Rural health care faces reform too; providers sow seeds for better future

Article Abstract:

Health care reform needs to address the shortage of health care services in rural areas. Physicians discussed the provision of rural health care at a workshop sponsored by the University of South Alabama College of Medicine. The number of physicians in rural areas has decreased and many rural hospitals have closed since the 1980s. Almost one-fourth of rural physicians plan to leave their practices within five years. Special strategies need to be developed to offer universal health care to rural residents. These include using electronic communication to decrease isolation of rural physicians and providing support for rural hospitals. Many factors discourage physicians from practicing in rural areas. There are a large number of poor and elderly patients and higher malpractice insurance rates. One solution may be to develop rural medical teams that include an internist, a family practitioner and a general surgeon.

Management, Planning, Practice, Physicians, Medical professions, Health care reform, Rural health services

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