Mount Sinai - Living Donor Celebration - at the NY Academy of Medicine NYC

I was Almost Shocked by a Lot of What I Learned about Kidney & Liver Transplants

September 25, 2023 / Manhattan Neighborhoods NYC / Manhattan Healthcare NYC / Manhattan Buzz.

Nearly two weeks ago, on Wednesday, September 13th, I headed into the New York Academy of Medicine at 1215 5th Avenue on the Upper East Side to attend a ceremony - a celebration actually - honoring Living Donors of Mt. Sinai's kidney and liver transplant program. 

To be frank, when first approached to cover this event, I wasn't sure of what to expect.  But after mulling it over, and perhaps with a bit of deference to my Mother, who had signed away her organs on her driver's license [and likely elsewhere], I decided to go to see what I might learn.

New York Academy of Medicine on the UES

The ceremony was held at the New York Academy of Medicine, which is located along 5th Avenue at 103rd Street.  The NY Academy of Medicine was founded in 1847 by a number of NYC doctors, most notably the Presidents of the NYU School of Medicine, the Columbia University College of Physicians and Surgeons and the Medical Society of the City and County of New York.  The Academy has played an influential role in shaping public health policy in NYC, NYS and the U.S.

The building in which the New York Academy of Medicine is located, as well as the location of the Mt. Sinai Living Donor Ceremony, was built in 1926 and is also home to the NY Academy of Medicine's library of various aspects of medicine, which was first started in 1847, opened to the public in 1878, and continues to be accessible to the public to this day.  Generally it's dedicated to those wishing to do research and one has to make an appointment to use it.  For more information and to make an appointment see - https://www.nyam.org/library/connect/visit-library/

The Mt. Sinai Living Donor Ceremony event was held on the third floor of the building what seemed a library reading room turned into a theater.  The room had 20 foot high ceilings [possibly higher], nearly floor to ceiling windows overlooking Central Park, and I'm no expert, but I believe the bookcases in the front of the room were made of oak.  The Carnegie Foundation donated about one million to the NY Academy of Medicine to build this building back in the 1920's.

My point in telling you all of this, is to provide a feeling and sense of connection to the past, the early roots of scientific healthcare in this country, which I assume was part of the consideration in selecting this location for the event ... as well as its proximity to the Mt Sinai Hospital campus on the Upper East side, which is located along 5th Avenue between 98th Street and 103rd Street.

CLICK here to read the rest of our story about kidney and liver transplants by Mount Sinai at a presentation at the NY Academy of Medicine.

Mount Sinai Living Donors Ceremony 2023

The Mount Sinai Living Donors Ceremony went on hiatus from live events in 2020, in order to protect attendees from catching CoVid, after the pandemic outbreak.  This was the first time they held a Living Donors Ceremony since then. 

Drinks were served in the back of the room and about 200 folks mingled for a while prior to the start of the program, exchanging their own personal stories of life changing surgeries.  Music played in the background and there was a projection screen in the front of the room which had information about the program sponsored by the Zweig Family Center for Living Donation.  Around 6 pm the official segment of the program began, which included speeches by Mount Sinai personnel and people who were living donors. 

Human Organ Transplants at Mount Sinia Hospital NYC

The first speaker was Dianne LaPointe Rudow, NP Director of the Zweig Family Center for Living Donation at Mount Sinai Health System, who welcomed everyone to the event.  She noted that 103,000 people are awaiting the possibility of getting a transplant in the U.S. alone.  When one factors into the equation, that only 42,000 transplants are performed each year, it's not hard to see that about 61,000 people could die.  Currently there are 8,200 people in New York State waiting for either a liver or kidney transplant.

I found these numbers kind of shocking.  I had no idea how far and how fast transplant surgery had evolved in the approximately 70 years since its first successes with humans in the 1950's and 1960's. 

In the photo at right is Dianne LaPointe Rudow, NP Director of the Zweig Family Center for Living Donation at Mount Sinai Health System as she makes the opening remarks at the Mount Sinai Living Donor Ceremony.

A Brief History of Organ Transplants - Kidney, Liver & Heart

After the program I did a bit of research to learn more about transplants, in order to provide you [and me] with a bit more context with which to process some of the facts I'm about to share with you.

The first transplants were done on animals, with successes being recorded shortly after the turn of the 20th century [circa 1902] by Emerich Ullman.  The animals died within hours or days after the transplants, because their immune systems rejected the new organs.

In 1933 the first successful human to human kidney transplant was done by a Russian doctor Yu Yu Voronoy, but the recipient died shortly after the surgery, again for reasons having to do with the recipients' immune systems rejecting the new organ.

In 1954 Dr. Joseph Murray completed the first human to human kidney transplant, where the patient lived.  Murray's first two successful transplants extended the lives of the recipients by 8 and 50 years.

In 1967 both the first successful liver transplant and the first human heart transplant were performed.  The first liver patient lived more than a year after the surgery, while the heart transplant patient survived only 18 days after the surgery.  Today, over half of all heart transplant patients live more than ten years after the transplant.

The survival numbers for kidney and liver transplant patients are much higher.  About 97% of kidney transplant patients live at least a year, while the average survival rate of a kidney transplant patient is 20 - 25 years from a living donor and from a deceased donor the survival rate is 15 - 20 years.  For liver transplants the numbers are also pretty good, with 90% living more than a year, and 70% live more than five years, while many live more than 20 years after the surgery.

It's important to note that what once was a very risky, highly esoteric, life-threatening medical procedure back in the 1950's and 1960's, is now done an estimated 115 times per day in the U.S. [42,000 surgeries / 365 days].  So while a transplant is certainly a highly technical, very complicated procedure, one might say it's also an everyday occurrence based on the numbers.

The Evolution of Organ Transplants

From Super Science to a Daily Procedure Done 42,000 Times Per Year in the U.S.

The second speaker was Dr. Sander Florman, MD, Director of the Recanati / Miller Transplantation Institute, and Director of the Zweig Family Center for Living Donation at Mount Sinai Health System.  He told us that Mount Sinai had done about 10,000 kidney and liver transplants since inception of the program in 1988.  Of those, 4950 were liver transplants and 4950 were kidney transplant, of which 2523 of the transplants were done from living donors.

Here again I was somewhat shocked.  Over two and a half thousand living people donated their organs to someone else to save their lives.  And that is how the doctor framed the numbers - as actually saving someone else's life - which is a rare thing for any of us to be able to do.

When you donate a kidney, you have a second one to live on.  But since we have only one liver, I inquired how one could afford to donate that?  I was informed that you can donate up to 70% of your liver and most of it will grow back.  In the example of the woman who came to tell her story today, she donated 20% of her liver to save her son.  This woman's bravery and compassion for her child was quite moving, as you will see.

The photo above right shows Dr. Sander Florman, MD, Director of the Recanati / Miller Transplantation Institute, and Director of the Zweig Family Center for Living Donation at Mount Sinai Health System as he talks about the successes and challenges faced by the transplant industry.

First Live Donor Speaker - Jonathan Calixto who Donated a Kidney to Save his Father

The first donor to speak to us was Jonathan Calixto. He told us that six months ago his father's kidneys were failing, so he decided to make what is perhaps not the ultimate sacrifice, but about as close to it as one can get. Jonathan gave a part of himself, a kidney organ.

The young man said that he was LGBTQ and wasn't even sure he could donate blood when his father's health crisis arose. One of the key factors in making a successful transplant, is the compatibility of the donor organ with the recipient's body / system. The early failures of transplants were largely because the recipient's immune system rejected the transplanted organ, treating it much the same as an invading virus. This is why a number of living donors are related to the recipients - because their organs generally will be accepted by the related recipient. After learning about the procedure, Jonathan decided to make the donation to his father.

Jonathan's father has been recuperating, and was recently told he would not have to return for another medical monitoring appointment for about three months. Jonathan's father was also advised that he might soon be able to return to work. Jonathan's father wasn't in attendance at the event.

The photo above right shows Jonathan Calixto, who made a kidney donation to save his father's life.

Second Live Donor Speaker - Chasmine Booth who Donated Part of her Liver to Save her Son

About a year ago, Chasmine and her husband learned that their young son's liver was failing. It was determined that they could delay the procedure, but that ultimately their son would need a new liver in order to survive. They decided to wait and see how things progressed, but within three months, their 5 months old son started non-stop bleeding from a light scratch, so Chasmine took him to the hospital to have him checked out.

The doctors found what could only be described as alarming news. Chasmine's son's liver was failing, his spleen was gouged, and there was blood in her son's intestinal tract. One can live without a spleen as the liver can assume the spleen's functions, but one cannot live without a liver. The liver filters the blood in the body, breaking down and helping excrete poisonous substances such as alcohol and drugs, by producing bile which is a fluid that helps transport waste out of the body / system.

Chasmine decided to have the transplant done, and she became the donor. As a footnote, Chasmine told us that her brother had to have a kidney removed when he was ten years old, so she had some familiarity with transplants. The baby was also not in attendance, but was reportedly doing fine.

The photo above right shows Chasmine Booth, as she recounts her experience saving her son's life by making a liver donation.

The Rest of the Program was about Recognizing Contributors

To the Recanati / Miller Transplantation Institute at Mount Sinai

The rest of the program recognized the contributions of some of the extraordinary people who help make transplants work. One of them was Medical Assistant, Jellene Fernandez, who works at the Recanati / Miller Transplantation Institute (RMTI) Kidney Transplant Clinic. They honored her for her dedication to her work and the profession.

And the other Acknowledgement went to Christopher Smith, who is a living donor, and who mentors people coming into the program.

I looked up the Recanati / Miller Transplantation Institute at Mount Sinai to learn a bit more about them. In a nutshell, what I learned, was described on their website as follows,

" ... The Recanati/Miller Transplantation Institute (RMTI) at Mount Sinai is one of the largest and most comprehensive adult and pediatric abdominal transplantation centers in the world...".

For more information about them see - https://www.mountsinai.org/locations/recanati-miller-transplant/about

My Follow Up Questions included

Buyer Remorse, Transplant Costs & Insurance Coverage & Living Donor Longevity

Naturally, after leaving the event and thinking about things, I had a few follow up questions. One was related to the mentoring program, as it occurred to me that a recipient might feel guilty for accepting an organ from a relative or close friend, while the donor could experience what's called buyer's remorse - which is having second thoughts about a decision.

I was informed as follows,

" ... A comprehensive donor evaluation happens before clearance. They [donors] see nurses, doctors, surgeons, a social worker and in some cases a psychologist or psychiatrist. Donors are followed by that team for 2 years after donation to make sure they are cared for throughout the process..."

I also inquired as to the costs and insurance coverage. I was informed that insurance does cover transplants, including Medicare and Medicaid. They told me that,

"... The costs vary based on the type of surgery, length of stay, comorbidities, etc. Transplant recipients’ insurance including Medicaid and Medicare cover the transplant for the recipient and pay for all the donor medical expenses related to donor evaluation, surgery and follow up...".

And lastly, I inquired about the life expectancy of living donors after having made an organ donation to to save another human's life. Specifically I wondered if there were any studies that looked at this. They told me that,

" ... Unfortunately there are no randomized control studies with donors and non-donors. There are numerous studies of both living liver and kidney donors outcomes and all have positive long term results. There is a low incident of liver or kidney failure long term and risks are similar to people with the same risk profiles...".

My Follow Up Research on Transplant Costs & Insurance Coverage including Medicaid & Medicare

I did a bit of research on the web, to see if I might find some ball park [average] figures regarding kidney and liver organ transplants in the U.S. [not NYC]. What I found was that in 2020, according to the National Institute of Health, a kidney transplant cost about $442,000. According to Medical News Today, in 2020 a liver transplant cost about $878,000. These average costs are inclusive of the procurement of the organ, pretransplantation services which includes checking out the organ and the compatibility, the use of the hospital facilities and surgery, the post operative care and the follow up medications.

I looked into the insurance coverage and found that Medicare and Medicaid do include organ transplants in their coverage, as do most [or all?] other major health insurance policies. But, as with all insurance [and everything else], the devil is in the details. So if you ever find yourself in a transplant situation, go line by line through the details and process with your physician to confirm what's covered in your own unique situation and with your own health insurance.

Facilitating the Future of Transplants - H.R. 2544

Organ transplants have been in the news this year for a number of reasons. The primary obstacle in organ transplants is obtaining enough good organs to fill the demand.

One is that President Biden has been working with the Senate and House on passing a new bipartisan bill to break up the national monopoly on organ donations, by the Richmond, Virginia based United Network for Organ Sharing [aka UNOS]. According to the WhiteHouse.gov website,

" ... On Friday, September 22, 2023, the President signed into law H.R. 2544, the “Securing the U.S. Organ Procurement and Transplantation Network Act,” which allows for the award of multiple grants, contracts, or cooperative agreements to operate the Organ Procurement and Transplantation Network..."

In addition to providing more funding for infrastructure, to improve and expedite organ transplants, the bill also loosens the grip of UNOS, which reportedly has had a 40 year monopoly of organs used in transplants.

Facilitating the Future of Transplants - Buying Organs, 3D Printing &

Another option is to allow living donors to be compensated for their organs. But this effort is complicated by what could turn out to be the exploitation of the young and the poor in the acquisition / purchase of organs.

And, as always, scientists are pushing ahead on finding new ways to solve the immune system rejection of organs, by experimenting with building tissue to surround working organs, insulating them from the rest of the system. This approach would pave the path for the use of animal organs and possibly the use of 3D printing.

Lastly, this month [September 2023], the University of Maryland performed its second heart transplant using a pig's heart. They had also performed the first such surgery [pig heart to human body] a year ago, using the genetically modified pig heart. Unlike the other surgeries discussed above, this is very early experimental and only available to those facing a certain death. The first pig transplant patient died two months after the surgery and we'll see how well the second fares.

The Work on Facilitating Organ Transplants Continues

The Recanati / Miller Transplantation Institute at Mount Sinai is working on a new project, The Living Donor Collective, which together with the Scientific Registry of Transplant Recipients (SRTR), is creating a long-term registry to follow donors and donor controls.

One can see that transplants have come a long way since their inception 70 years ago. But based on the looks of things, they're not stopping. The good news is that tens of thousands of Americans and nearly ten thousand New Yorkers each year will be given a second chance at life.

Thanks for Mount Sinai and the Zweig Family Center for Living Donation for providing the opportunity to cover this event and learn more about the world of organ transplants.