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[MUSIC PLAYING] DAN OLSON: Welcome to Voices. This is the first of what we intend to be a regular series of interviews with people from all walks of life in our region. I'm Dan Olson.

Dr. John Najarian is not granting interviews these days about his problems with the University of Minnesota and with federal authorities. However, the world famous transplant surgeon is willing to talk about his work.

Najarian resigned his university faculty position when confronted with evidence of double billing for travel expenses. And Najarian awaits the outcome of a federal investigation looking at his financial involvement with the manufacture and sale of an unapproved anti-rejection drug. Najarian agreed to an interview if there were no questions about his legal difficulties. We agreed to the ground rules for several reasons.

Najarian is President of the International Society of Transplantation Surgeons. He's a pioneer in the transplantation of kidneys and livers. And at 67 years of age, he's still an active transplant surgeon with a broad knowledge of what is happening in the area of organ and tissue transplantation.

The FM news station's Bob Potter talked with Najarian early in March at Najarian's University of Minnesota office. Najarian says organ donation has plateaued.

JOHN NAJARIAN: What we're doing is we're using virtually every organ around. Yet over the last four or five years, there have been very little increase in the number of donors available for cadaver donation. It ranges around 5,000 to 6,000, which means we can get about 10,000 kidneys, two to per patient.

We can get something less than 5,000 livers and 5,000 hearts. And our waiting list for livers, hearts, kidneys continues to grow as we're almost at a plateau as the number of organs we can put in.

BOB POTTER: Why do you suppose the donation rate is remained at a steady level?

JOHN NAJARIAN: Well, I think what we did was we reached the maximum we'd ever get from a cadaver point of view. In other words, what we do is by alerting people and educating individuals that this is something worth doing. We did increase our numbers for the prior 15 years before that every year, and then I think we really got to a saturation point.

Those people that would either get to a hospital because they were in an accident and in good enough condition to be salvaged long enough so that organs could be removed, or that their families could be found to give us permission to remove them, or they were in a hospital and had a brain hemorrhage or something of this nature which made them a candidate.

And our ability to alert the medical personnel in the field and at other hospitals to be on the alert for possible donors, to take the responsibility of caring for their donors, calling us to help them come and care for those donors. I think we've come pretty close to what we can achieve. We may gain some more, but I doubt it.

So we've taken another turn, Bob. What we've done now is something that I've been pushing all along. We really stress the importance of living related transplants because the success is so good.

But in addition to that, within the last five to seven years, we've been pushing for living unrelated transplants from friends, from a spouse, from individuals who are distantly related to us, or maybe nothing more than a roommate. And you'd be surprised how these individuals come through.

And what they do is they provide us with an excellent organ. And as a result of this, we are getting better results with those organs than we are with cadaver organs, even though, like a cadaver organ, they're not related to us.

But we get a fresh kidney or a fresh organ that we can work with right there, and that organ works better. So that's been where we've been able to expand our donor pool to some degree.

BOB POTTER: And this works just on an individual by individual basis then. It's not some big macro kind of thing.

JOHN NAJARIAN: No, they come in. And when they exhaust the possibility of family, we suggest the possibility of a spouse. Interestingly enough, we've done at least a half a dozen spouses that were divorced.

BOB POTTER: Oh, Is that right?

JOHN NAJARIAN: And it always amazed me. And I would ask them, I would ask the wife or the husband, I say, why are you doing this? And he says, well, we're still friends. We just can't live together. That's all. And it's really a wonderful human thing, philanthropic thing to do.

BOB POTTER: What's your advice to people who are squeamish about the idea of becoming a donor?

JOHN NAJARIAN: Well, we've done living donors now well over 2,000 in the 5,000 kidneys that we-- or 5,000 transplants we've done. We've done over 4,000 kidneys.

We've never had a fatality and we've never had a serious complication. That doesn't happen by accident. It happens because we have all the stresses placed on the safety for the donor, and we do that at every turn.

We will not accept a donor if there is any flaws whatsoever. They must be in perfect health and all of our emphasis is placed on the donor. And as a result, we can achieve that kind of statistic.

So if they're squeamish, we tell them that. But if they're really squeamish and they don't want to go through, we never press it. We think it's terribly important that they make that decision. It's totally voluntary decision on their own. And we give them the facts, and they deal with it from there.

BOB POTTER: What do you think about the prospect of compensating people for organ transplant donations?

JOHN NAJARIAN: I like it for the cadavers, but not for living related. Living related would get into or living unrelated into bartering, something that we do not support and have been very much against, both from the society of which I'm president, the Transplantation Society, international transplantation society, as well as the local transplantation societies.

We think that's wrong. It's a traffic in organs. It's done in India. We're doing everything in our power to stop this sort of thing. And I think we're doing a pretty good job of it.

But when somebody dies-- and under those circumstances, if you could where it was appropriate offer them money to help with the funeral expenses, maybe 1,000 $2,000, wouldn't that make sense? Don't put it up as a reward for doing it, but rather to come through with compensation.

And I think, number one, that would give me a very good feeling about it. But number two, I think it would increase our donor pool much more than anything we've done in the past.

There are a lot of ethicists. One of them you know very well, Dr. Caplan and others, who feel that this is wrong. You don't sell and buy organs. And in a way, he feels that this is rewarded giving, which in a way is an oxymoron, I suppose. But it really makes sense to me, and it is I think a decent thing to do.

BOB POTTER: Is everybody at any age a potential donor, or after a certain age, can the organs no longer be used?

JOHN NAJARIAN: Well, we have extended that in our organ pool. We used to take them 45 and below, and then we went to 55, 65. We now take organs up to about 70, 75 years of age. The kidneys seem like they are the ones that suffer the most. You seem to lose kidney function with time, but they're still good organs.

What we do there is if we have a particularly older patient that we're using, say, 70, 75 years of age, we might preferentially put that organ into an older recipient. And as a result, if you feel there's a limited period of time and you wouldn't have used the organ anyway, it makes sense to do it that way.

As far as organs are concerned, in general, the liver, we go up to about 60, 65, hearts not much past 60 because the heart begins to take damage before that. Kidneys, as I say, up to 75, corneas for any age up to 100. The pancreas is they begin to peter out around 60, 65. So we have a tendency to cut those off at that point.

BOB POTTER: Do you think that some donations are wasted in a way because the transplant procedures are being done at hospitals where the success rate is not as high as it should be?

JOHN NAJARIAN: That's a controversial issue, Bob, but one that I feel very strongly about. There's what's called a center effect. And that you get a better result in a center that's larger, not always, but that's a quality center versus a smaller center that's occasionally doing a heart or a liver or a kidney.

And as a result of that, with a shortage of organs, that I think there ought to be designated areas in which there are regions in which certain number of hospitals would be identified as hospitals that would do kidney transplants, liver transplants, heart transplants. That would make a lot of sense.

Unfortunately, in the democracy that we live in, you cannot restrict people from saying you can't do a kidney transplant because your results aren't as good as the results in hospital A.

And so it hasn't come about. But I think eventually with the shortage of organs, that the emphasis on finding ways to improve this problem will focus on that particular issue of the center effect.

BOB POTTER: Couldn't there be federal legislation that would require that? There seems to be federal laws for everything else.

JOHN NAJARIAN: That might. If you can get that passed, it probably would. You can't pass a balanced budget amendment. Maybe you could pass something like that.

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DAN OLSON: This is Voices on the FM news station. You're listening to transplant surgeon John Najarian talking with Bob Potter.

BOB POTTER: Tell us a little about the UNOS system, United network for Organ Sharing. What is that?

JOHN NAJARIAN: Well, what happened was that all of us kind of used the organs within our own region. And then we used all the ones that we got, and then we shared those with other people in our region when we couldn't use them.

The United States government, through a bill, then enacted the law that there should be a national system in which everybody could be registered throughout.

And how that changed things was when we get an organ, we use it. If it's a kidney, we get two kidneys, we use one, give one. The give one usually goes within our region here in Minnesota, would go to the Hennepin County or down to Mayo Clinic, or someone else in our region.

If it couldn't be used in our region, and what I say is by couldn't be used, it's a blood type or the tissue type is such that it doesn't really match anybody waiting, then prior to that it might have been wasted.

Whereas now with UNOS, then it goes to the national list where there's certainly somebody in the country who could use it. So that our retrieval of organs now and the utilitarian fact that it can be used by this larger pool I think has made a great deal of difference in the number of organs that we don't throw away anymore.

BOB POTTER: Who determines the priority for recipients?

JOHN NAJARIAN: What we do there is we try to keep that on a very good medical basis. We have a point system in which it depends on the length of time that you've been on the waiting list, you get credit for that, depends on whether you have high PRAs, which means you have a lot of antibodies and therefore are difficult to transplant, and your age.

If you're a child, a small child who doesn't do well on dialysis or artificial treatment, you get so many points. And putting all the points together puts individuals in a priority system, which is based on medical need.

And I think that's a fair system and that's a system which UNOS subscribes to. And they keep changing it, altering it in ways so it becomes more, I think, fair with time.

BOB POTTER: Is everybody involved in this UNOS program or are there some centers that don't bother with it?

JOHN NAJARIAN: They have to be.

BOB POTTER: They have to be.

JOHN NAJARIAN: That's by mandate. If they are not, then they don't get paid for their transplants, which, for the majority, 98% comes from, as you know, Social Security Administration.

BOB POTTER: What's happening with the donor situation in other countries around the world?

JOHN NAJARIAN: Well, we're one of the few countries that use a lot of donors from living related. The donor situation, they've tried a lot of techniques. They've tried a technique of, in France and some of the Scandinavian countries, presumed consent.

What that means is that the individual comes into an emergency room and is dying and the organs could be used. You can't find a family member to give you permission. You can presume that if they were here, they'd give permission. And in some countries, that did help get more organ donors.

It has a two-sided coin, though. On the other side of the coin is the fact that some of these individuals then found out about this and were very leery about allowing their next of kin's organs to be used because of this. We think there's more bad press from presumed consent than there is good. So a lot of techniques have been tried.

For the most part, for a variety of reasons, Japan's a classic example. There's no cadaver transplant. They all must come from living related. That's true in some of the Muslim countries as well. There's a certain sanctity to the body and you shouldn't destroy it once death has occurred.

BOB POTTER: Is there any kind of black market for organs?

JOHN NAJARIAN: Yes, there is. It's unfortunate. And it's not as big as some of the tabloids would like to make it, but it does occur. It occurs primarily in the Middle East, India in particular, some other countries in that area where kidneys are bought.

If you're an individual with a lot of money, you can buy a kidney. You go to the right place and somebody donates, and they get 7 or 8 or $10,000 for giving up one of their kidneys.

BOB POTTER: What do you think the prospects are of being able to use animal organs in humans? I know at the university there were working on pigs at one point. Did that ever go anywhere?

JOHN NAJARIAN: Yeah, we still are. That is an area of research that continues. Since I've been here for 28 years, I've been involved in that. I was doing it in San Francisco when I was there. I think that's the eventual solution. The trouble is that it's so difficult to overcome that gap.

When I first started 28 years ago, when we could extend an organ between two different species by minutes and get it to hours, we thought we were being very successful. 28 years later, now we're down to days, so we got a long way to go. I think it eventually will be successful, but it's going to take time.

There are problems with the physiology of the organ more than just its closeness to the recipient, because, obviously, the liver of the pig is different than your liver. It makes many of the same proteins but not all. And so there are things that need to be worked out. I think it will happen sometime within the next 10 or 15 years, but it's not immediately around the corner.

BOB POTTER: What about the prospect of being able to transplant instead of a whole liver or a whole kidney, part of one?

JOHN NAJARIAN: Well, we do that already.

BOB POTTER: You do?

JOHN NAJARIAN: Liver, not kidneys, but livers. One of the biggest problems we had with children was that we had to have a child donor for a child recipient because there had has to be a fit in size. The liver is a very large organ. Therefore, it must be of comparable size. So as a result, children were dying because you didn't have that many children donors.

The one we got from Jamie Fisk came from a family who had heard a plea by Jamie Fisk father on the television. And when their child was killed in an automobile accident train, automobile accident in Utah, they offered the child's liver.

But then there were a lot of children who were waiting, and they'd wait so long and then they'd eventually die, unfortunately. And then we began doing split livers, taking a liver, an adult liver and splitting it in half, or taking off a third of it and transplanting that. And that began about now eight years ago. And that's pretty much used all over. And what that did was it cleaned up our pediatric liver list.

So we are doing that. And in some instances, as you know, they've been in Chicago, the University of Chicago, some in San Francisco, in Germany, and in Japan are taking a segment of the liver from a living donor and removing a segment and transplanting it.

We have not done that. We think it's putting the donor at an undue risk. And in addition, we don't have a large group of children waiting for livers at the present time. If that were the case, we'd start doing it as well.

BOB POTTER: The supply of donors is the biggest problem. It sounds like you've got some other things that are being worked out. Where do you think the next big step is going to come in this whole field?

JOHN NAJARIAN: Hard to say. I would guess that if we can begin to find ways of creating tolerance. That means where the donor now organ is tolerated by the recipient without drugs. All transplants require drug therapy.

BOB POTTER: There is, of course, a ever increasing concern about the cost of medical care in this country. We have cost containment of one sort or another third-party payers, employers negotiating with insurance companies, pushing, putting pressure on hospitals and so on. Do you think we're reaching the point here where the science is going to get ahead of the body politics willingness to pay?

JOHN NAJARIAN: To a degree, that's true. And it's a difficult situation to handle. The one thing that I can say is practically every organ we transplant today is cheaper than the alternative, unless the alternative is death.

And what I mean by that is, if I do a kidney transplant tomorrow, that takes somebody off dialysis machine, which costs approximately 30 to $35,000 a year, and it costs $35,000 for me to put in a kidney. So I paid for it in the first year. So it's cheaper.

Same thing is true of heart. If you have someone who you put in a heart and that individual is going to go through the agonal phases of heart failure, is going to be hospitalized in intensive care units over and over again until they finally die, then it's a lot cheaper to put in a heart.

Same thing is true of a liver. These patients with liver disease come in and they're in the hospital and in intensive care units, which now cost 2 and $3,000 a day just to be there, let alone the medications and other things that they receive.

And so as a result, it makes sense from a cost-effective point of view to transplant. How long can we keep it up? Hard to say. If you can make people well by giving them a new organ and make them a viable working, tax-paying citizen again, you'll get back in return what you placed in the first place.

DAN OLSON: Transplant surgeon John Najarian talking with the FM news station's Bob Potter on March 3. This is Voices from Minnesota Public Radio. Technical direction, Michael Osborne, Kevin Middleton, and Jeff Conrad. I'm Dan Olson.

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