Wanted: More organ
donors in Hawaii
A new federal policy offersBy Helen Altonn
hope, but island patients
A new policy governing donated livers and Hawaii's shift to a different organ-sharing region offer more hope to island patients waiting for liver transplants, officials say.
Yet, a big obstacle remains:
"There simply are not enough organ donors to go around," said Dr. Linda Wong, transplant surgeon at St. Francis Medical Center.
"If we had enough organs, we wouldn't have so much of a problem trying to decide who gets what organ in what order."
Under a new policy of the United Network for Organ Sharing, donated livers will go first to the sickest patients in a region rather than to less critical patients in the area where the organs were donated.
That sparked some concern among local transplant and organ donor officials, since Hawaii was part of the network's Western region, which has large population areas and transplant needs. Region 5 includes California, Nevada, Utah, New Mexico and Arizona.
But the Organ Donor Center of Hawaii and the Transplant Institute at St. Francis learned yesterday their request to shift to the Pacific Northwest region has been approved.Region 6 includes Washington, Oregon, Idaho, Alaska and Montana.
Cause for celebrationRobyn Kaufman, executive director of the Organ Donor Center of Hawaii, said the change was requested so the state could be with a more compatible population base, and among smaller transplant centers with similar philosophies.
"We're celebrating," said Donna Pacheco, a liver transplant coordinator at the Transplant Institute. "This is incredible news for Hawaii."
The Western region has 40 million people and 20 percent of all transplants in the country, Pacheco pointed out. With a mandate for regional sharing of livers, she said, "The smaller centers and areas just statistically are going to be hurt."
"They're wonderful people, they do wonderful care, in Region 5," she added.
"We work with them all the time. It's just because of their populations and huge lists, it's kind of a black hole of transplant. Everything goes in and nothing ever comes out."
Pacheco said Wong started working toward the change last November and the proposal by the Transplant Institute and Organ Donor Center went through regional, and then national, network boards.
As of Thursday, Pacheco said, Hawaii had 18 patients waiting at home for liver transplants. Only one was done here this year, she said.
Kaufman said about 200 people are on the waiting list for various organ transplants.
A total of 48 families have consented to donate this year, she said. Of those, nine donated organs and others donated bones, corneas, tissue and heart valves.
With the change in policy regarding livers, the most critical (Status 1) patients in the local area will have first chance at an organ. If no one qualifies, it will be offered to a Status 1 patient in the region.
Better access to organsThe advantage, Wong said, is the sickest patients -- those with acute liver failure -- will have a much better chance of getting a liver without having to fly to the mainland.
"They will have greater access to organs from the mainland," she said.
"With the shortage of donors in Hawaii, patients have had to be air-ambulanced to the mainland for a reasonable chance."
The disadvantage, she said, is that a person with a chronic liver disease who isn't a Status 1 patient may have to wait longer for a transplant. But it may help to be in a region with smaller and fewer transplant programs and people waiting, she said.
Officials also are encouraged by a new law that provides for closer cooperation between hospitals and the donor center to identify potential donors.
It also allows the center to obtain drivers license information to see if a hospitalized person is listed as a donor, and gives car owners the opportunity to make $1 donations for organ-donor education when registering their vehicles.
"For our people in Hawaii, listed and waiting for transplants, especially liver transplants, it is what we have been praying for," Pacheco said.
A coalition was formed to work on organ-donor education. It includes volunteers, the Organ Donor Center, the Transplant Institute, the National Kidney Foundation, the Eye Bank and other organizations involved in donation.
The group backed the legislation, which it feels "will push donations ahead quite a bit in coming months," Kaufman said.
"The bottom line is there aren't enough organs ... It's like arranging the deck chairs on the Titanic."
By Dennis Oda, Star-Bulletin
Charline Terukina gives her husband a kiss as he lies in bed.
Haleiwa man awaits
While family, friends and communityBy Helen Altonn
members offer support, time runs short
for Kenneth Terukina
Fighting back tears, Kenneth Terukina explained why he named his new 28-foot fishing boat "Millennium 2000 Y2K."
"I was hoping I could last to the year 2000," he said.
That may not be possible if the 59-year-old Haleiwa resident doesn't receive a liver transplant.
He was listed last November as Status 2-B, meaning he's not critical enough to be in intensive care in the hospital.
"But he's very, very sick," said Donna Pacheco, liver transplant coordinator at the Transplant Institute at St. Francis Medical Center. "He's close but he's not there yet."
Pacheco said Terukina's diseased liver resulted from a hepatitis C infection traced to a blood transfusion in 1969. "A lot of our patients have that. They didn't screen for that until the early 1990s," she said.
Terukina's wife, Charline, said the transfusion followed a serious motorcycle accident.
Terukina was uncomfortable but didn't learn until 1994 that he was suffering from hepatitis C, she said.
It was discovered in September 1998, after he suffered bouts of pain, that he had cancer of the liver, she said. "We felt like it was a death sentence."
But they had some hope after his doctor referred him to transplant surgeon Linda Wong, Charline said.
He went through a barrage of tests and passed all of them, she said. "The transplant people are marvelous to us, very upbeat, hanging in there and pulling for us," she said. "So, here we have this hand given to us. ... We're just waiting for one more. He needs a liver."
Meanwhile, she's watching her husband deteriorate.
For several months, he had been puttering and sitting in a lounge chair in the yard, looking at the harbor and visiting with the many friends stopping by, she said.
In the past week, he hasn't left the house because malfunctioning of his liver has caused his stomach to swell like a five- or six-month pregnancy, she said.
He used to have it drained every 10 days, but the time span has narrowed, she said. "He did it Tuesday, and Wednesday he was full again (with backed-up fluids).
"It's agonizing for him and for the doctor. Myself, I'm secondary, but the pain of me watching him -- it can just break your heart."
Charline said her husband designed his boat two years ago for deep-sea fishing, trolling and crabbing.
"That was his plan, when he stopped working. He loved fishing."
But when it was completed last Sunday, she said, "He could not even go to the christening, to the virgin launching of his boat. Everybody was just crying."
She said her husband entered the boat in the North Shore Hanapaa fishing tournament with the Kauai crew, and the first day they caught three ahi -- one a 170-pounder -- an ono and a sailfish.
The overall weight pushed them ahead for the tournament, and her husband "was just beside himself," she said.
Although Terukina was in bed yesterday, the last of the three-day tournament, he seemed happy to report, "They are still No. 1 on the board yet."
"The shame of it is, he couldn't come out to see that because of his condition," his wife said. "My husband is a strong person, in mind as well as body ... and not to have him come out of the house for this occasion, I have no more words for it.
"He is just dwindling. His liver is failing. We were hoping for that phone call. I have a pager. We keep hoping, 'We have a liver for you.' Is it ever going to come?"
The Terukinas have six children: 13-year-old Alana at home and five older children here and on the mainland.
"They're a wonderful family," Pacheco said. And they're part of the fabric of Haleiwa, where they've lived all their lives.
Terukina owned Ken's Backhoe Service until he became ill. "He was all over the community with his little backhoe," said Charline, a library technician at Waialua Public Library.
"His business was booming. He was working seven days a week, 10 to 12 hours a day."
Since he became sick, she said, "Our philosophy is, you look for the silver lining in your traumatic experience.
"Ours is, No. 1, how many people have come forward. Kenneth doesn't know how much impact he's had in this community. Big burly men with tears in the eyes say, 'My gosh, Kenneth, what can I do for you?' "
North Shore Christian Fellowship children serenade the ailing man every Sunday, and the Catholic Church group and many others are saying prayers, she said.
Although he's "skin and bones" and in pain, Terukina is thinking of others.
"I tell my kids, please, all of them, no matter what, be (organ) donors because you never know. A lot of people don't realize until something like this happens.
"Everybody I talk to, I tell them it's a good feeling to be a donor, because a lot of people don't think about it until they get sick. It's being selfish, but sooner or later we learn."
For more information about organ donations, call the Organ Donor Center of Hawaii at 599-7630.