World Library  
Flag as Inappropriate
Email this Article

Organ transplantation

Article Id: WHEBN0000167166
Reproduction Date:

Title: Organ transplantation  
Author: World Heritage Encyclopedia
Language: English
Subject:
Collection:
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Organ transplantation

Organ transplantation
Intervention
The first heart transplant, performed in South Africa in 1967.
ICD-10-PCS 0?Y
MeSH

Organ transplantation is the moving of an tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart. Cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.

Organ donors may be living,

  • Organ Transplant survival rates from the Scientific Registry of Transplant Recipients
  • Multi Organ Transplant
  • The Gift of a Lifetime – Online Educational Documentary
  • The short film A Science of Miracles (2009) is available for free download at the Internet Archive
  • "Overcoming the Rejection Factor: MUSC's First Organ Transplant" online exhibit at Waring Historical Library

External links

Further reading

  1. ^
  2. ^ See WHO Guiding Principles on human cell, tissue and organ transplantation, Annexed to World Health Organization, 2008.
  3. ^ Further sources in the Bibliography on Ethics of the WHO.
  4. ^ See Organ trafficking and transplantation pose new challenges.
  5. ^
  6. ^
  7. ^
  8. ^
  9. ^
  10. ^
  11. ^
  12. ^ a b c
  13. ^ a b
  14. ^
  15. ^
  16. ^ a b
  17. ^ a b c d
  18. ^
  19. ^
  20. ^ a b
  21. ^ https://news.uic.edu/robotic-surgery-levels-field-for-obese-patients-needing-kidney-transplants
  22. ^
  23. ^
  24. ^ (subscription required for full access)
  25. ^
  26. ^
  27. ^
  28. ^
  29. ^
  30. ^
  31. ^
  32. ^
  33. ^
  34. ^
  35. ^
  36. ^
  37. ^
  38. ^ Live donors to get financial support, RASHIDA YOSUFZAI, AAP, 7 April 2013
  39. ^
  40. ^
  41. ^ The Meat Market, The Wall Street Journal, 8 Jan. 2010.
  42. ^
  43. ^ a b
  44. ^ a b
  45. ^
  46. ^
  47. ^
  48. ^
  49. ^ a b
  50. ^
  51. ^
  52. ^
  53. ^
  54. ^
  55. ^
  56. ^
  57. ^
  58. ^
  59. ^
  60. ^
  61. ^
  62. ^ a b c d David Kilgour, David Matas (6 July 2006, revised 31 January 2007) An Independent Investigation into Allegations of Organ Harvesting of Falun Gong Practitioners in China (free in 22 languages) organharvestinvestigation.net
  63. ^
  64. ^ Ethan Gutmann (August 2014) The Slaughter: Mass Killings, Organ Harvesting and China’s Secret Solution to Its Dissident Problem "Average number of Falun Gong in Laogai System at any given time" Low estimate 450,000, High estimate 1,000,000 p 320. "Best estimate of Falun Gong harvested 2000 to 2008" 65,000 p 322. amazon.com
  65. ^ Hospitals ban Chinese surgeon training The Sydney Morning Herald. 5 December 2006
  66. ^ Market Wired (8 May 2008) China's Organ Harvesting Questioned Again by UN Special Rapporteurs: FalunHR Reports Retrieved 26 October 2014
  67. ^
  68. ^
  69. ^
  70. ^ a b
  71. ^
  72. ^
  73. ^
  74. ^ (I wasn't sure about this – but I'm pretty sure this already supports our claim. This link is "dead cold" - archive.is, WayBack, WebCite, etc.)
  75. ^
  76. ^
  77. ^
  78. ^
  79. ^
  80. ^
  81. ^
  82. ^
  83. ^
  84. ^
  85. ^
  86. ^
  87. ^
  88. ^
  89. ^ a b
  90. ^
  91. ^
  92. ^
  93. ^ New Drugs in Transplantation, EBMT Meeting, France, March 2007 C. Paillet, Pharmacist, Pharm D. C. Renzullo, Pharmacist, Pharm D. Edouard Herriot Hospital, Lyon, France
  94. ^
  95. ^
  96. ^
  97. ^
  98. ^
  99. ^
  100. ^
  101. ^
  102. ^
  103. ^
  104. ^
  105. ^
  106. ^
  107. ^
  108. ^ http://www.organovo.com/3d-human-tissues

References

[108] An early-stage medical laboratory and research company, called

Research

Surgeons in Sweden performed the first implantation of a synthetic trachea in July 2011, for a 36-year-old patient who was suffering from cancer. Stem cells taken from the patient's hip were treated with growth factors and incubated on a plastic replica of his natural trachea.[107]

Artificial organ transplantation

Even within developed countries there is concern that enthusiasm for increasing the supply of organs may trample on respect for the right to life. The question is made even more complicated by the fact that the "irreversibility" criterion for legal death cannot be adequately defined and can easily change with changing technology.[106]

The existence and distribution of organ transplantation procedures in Universal Declaration of Human Rights.

Ethical concerns

In an article appearing in the April 2004 issue of [49] economist Alex Tabarrok examined the impact of direct consent laws on transplant organ availability. Tabarrok found that social pressures resisting the use of transplant organs decreased over time as the opportunity of individual decisions increased. Tabarrok concluded his study suggesting that gradual elimination of organ donation restrictions and move to a free market in organ sales will increase supply of organs and encourage broader social acceptance of organ donation as a practice.

On 27 June 2008, Indonesian, Singapore dollars (7,600 USD) fine.[104][105]

Starting on 1 May 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime.[103]

Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens. Austria, triangular trade in 1934.

Transplant laws

In November 2007, the [102]

In the United States of America, tissue transplants are regulated by the U.S. Food and Drug Administration (FDA) which sets strict regulations on the safety of the transplants, primarily aimed at the prevention of the spread of communicable disease. Regulations include criteria for donor screening and testing as well as strict regulations on the processing and distribution of tissue grafts. Organ transplants are not regulated by the FDA.

Safety

In India, a kidney transplant operation runs for around as low as $5000.

[62] Although these prices are still unattainable to the poor, compared to the fees of the United States, where a kidney transplant may demand $100,000, a liver $250,000, and a heart $860,000, Chinese prices have made China a major provider of organs and transplantation surgeries to other countries.

One of the driving forces for illegal organ trafficking and for "transplantation tourism" is the price differences for organs and transplant surgeries in different areas of the world. According to the New England Journal of Medicine, a human kidney can be purchased in Manila for $1000–$2000, but in urban Latin America a kidney may cost more than $10,000. Kidneys in South Africa have sold for as high as $20,000. Price disparities based on donor race are a driving force of attractive organ sales in South Africa, as well as in other parts of the world.

Comparative costs

Society and culture

  • 2014: First neonatal organ transplant. (U.K.) [101]
  • 2014: First successful penis transplant. (South Africa) [100]
  • 2014: First successful uterine transplant resulting in live birth (Sweden)
  • 2013: First successful entire face transplantation as an urgent life-saving surgery at Maria Skłodowska-Curie Institute of Oncology branch in Gliwice, Poland.[99]
  • 2012: First Robotic Alloparathyroid transplant. University of Illinois Chicago
  • 2011: First double leg transplant by Dr. Cavadas and team (Valencia's Hospital, La Fe, Spain)
  • 2010: First full facial transplant by Dr. Joan Pere Barret and team (Hospital Universitari Vall d'Hebron on 26 July 2010, in Barcelona, Spain)
  • 2009: Worlds' first robotic kidney transplant in an obese patient University of Illinois Medical Center
  • 2008: First successful transplantation of near total area (80%) of face, (including palate, nose, cheeks, and eyelid) by Maria Siemionow (Cleveland Clinic, U.S.A.)
  • 2008: First transplant of a human windpipe using a patient's own stem cells, by Paolo Macchiarini (Barcelona, Spain)
  • 2008: First baby born from transplanted ovary. The transplant was carried out by Dr Sherman Silber at the Infertility Centre of St Louis in Missouri. The donor is her twin sister.[98]
  • 2008: First successful complete full double arm transplant by Edgar Biemer, Christoph Höhnke and Manfred Stangl (Technical University of Munich, Germany)
  • 2006: First successful human penis transplant (later reversed after 15 days due to 44-year-old recipient's wife's psychological rejection) (Guangzhou, China)[96][97]
  • 2006: First jaw transplant to combine donor jaw with bone marrow from the patient, by Eric M. Genden (Mount Sinai Hospital, New York City, U.S.A.)
  • 2006: Illinois' first paired donation for ABO incompatible kidney transplant University of Illinois Medical Center
  • 2005: First robotic hepatectomy in the United States University of Illinois Medical Center
  • 2005: First successful partial face transplant (France)
  • 2005: First successful ovarian transplant by Dr. P. N. Mhatre (Wadia Hospital, Mumbai, India)
  • 2004: First liver and small bowel transplants from same living donor into same recipient in the world University of Illinois Medical Center
  • 2000: First robotic donor nephrectomy for a living-donor kidney transplant in the world University of Illinois Medical Center
  • 1999: First successful tissue engineered bladder transplanted by Anthony Atala (Boston Children's Hospital, U.S.A.)
  • 1998: United States' first adult-to-adult living donor liver transplant University of Illinois Medical Center
  • 1998: First successful hand transplant by Dr. Jean-Michel Dubernard (Lyon, France)
  • 1998: First successful live-donor partial pancreas transplant by David Sutherland (Minnesota, U.S.A.)
  • 1997: Illinois' first living donor kidney-pancreas transplant and first robotic living donor pancreatectomy in the U.S.A. University of Illinois Medical Center
  • 1997: First successful allogeneic vascularized transplantation of a fresh and perfused human knee joint by Gunther O. Hofmann
  • 1995: First successful laparoscopic live-donor nephrectomy by Lloyd Ratner and Louis Kavoussi (Baltimore, U.S.A.)
  • 1986: First successful double-lung transplant (Ann Harrison) by Joel Cooper at the Toronto General Hospital (Toronto, Canada)
  • 1984: First successful double organ transplant by Thomas Starzl and Henry T. Bahnson (Pittsburgh, U.S.A.)
  • 1983: First successful lung lobe transplant by Joel Cooper at the Toronto General Hospital (Toronto, Canada)
  • 1981: First successful heart/lung transplant by Bruce Reitz (Stanford, U.S.A.)
  • 1967: First successful heart transplant by Christian Barnard (Cape Town, South Africa)
  • 1967: First successful liver transplant by Thomas Starzl (Denver, U.S.A.)
  • 1966: First successful pancreas transplant by Richard Lillehei and William Kelly (Minnesota, U.S.A.)
  • 1965: Australia's first successful (living) kidney transplant (Queen Elizabeth Hospital, SA, Australia)
  • 1962: First kidney transplant from a deceased donor (U.S.A.)
  • 1955: First heart valve allograft into descending aorta (Canada)
  • 1954: First living related kidney transplant (identical twins) (U.S.A.)[95]
  • 1950: First successful kidney transplant by Dr. Richard H. Lawler (Chicago, U.S.A.)[94]
  • 1933: First successful cadaveric AB-0 incompatible kidney transplant (donor was B(III) and the recipient has 0(I)) by Yuriu Yu. Voronoy (USSR)
  • 1908: First skin allograft-transplantation of skin from a donor to a recipient (Switzerland)
  • 1905: First successful cornea transplant by Eduard Zirm (Czech Republic)
  • ’s. Sushrutha. He grafted a small chunk of full thickness flesh from the inner thigh to the nose successfully, in a method very reminiscent of syphilis on a person. Bunger was repairing a person with a nose also destroyed by skin graft The emerging field of [93] Many other new drugs are under development for transplantation.

    Recently, researchers have been looking into means of reducing the general burden of immunosuppression. Common approaches include avoidance of steroids, reduced exposure to calcineurin inhibitors, and other means of weaning drugs based on patient outcome and function. While short-term outcomes appear promising, long-term outcomes are still unknown, and in general, reduced immunosuppression increases the risk of rejection and decreases the risk of infection.

    As the rising success rate of transplants and modern cell types have been conducted with promising results, such as using porcine islets of Langerhans to treat type 1 diabetes. However, there are still many problems that would need to be solved before they would be feasible options in people requiring transplants.

    It was the advent of Stanford University Hospital. The head surgeon, Bruce Reitz, credited the patient's recovery to cyclosporine-A.

    The heart was a major prize for transplant surgeons. But over and above rejection issues, the heart deteriorates within minutes of death, so any operation would have to be performed at great speed. The development of the heart-lung machine was also needed. Lung pioneer James Hardy attempted a human heart transplant in 1964, but when a premature failure of the recipient's heart caught Hardy with no human donor, he used a chimpanzee heart, which failed very quickly. The first success was achieved on 3 December 1967, by Christiaan Barnard in Cape Town, South Africa. Louis Washkansky, the recipient, survived for eighteen days amid what many saw as a distasteful publicity circus. The media interest prompted a spate of heart transplants. Over a hundred were performed in 1968–1969, but almost all the people died within 60 days. Barnard's second patient, Philip Blaiberg, lived for 19 months.

    Joseph Murray's success with the kidney led to attempts with other organs. There was a successful deceased-donor lung transplant into a lung cancer sufferer in June 1963 by James Hardy in Jackson, Mississippi. The person survived for eighteen days before dying of kidney failure. Thomas Starzl of Denver attempted a liver transplant in the same year, but he was not successful until 1967.

    In the late 1940s Peter Medawar, working for the National Institute for Medical Research, improved the understanding of rejection. Identifying the immune reactions in 1951, Medawar suggested that immunosuppressive drugs could be used. Cortisone had been recently discovered and the more effective azathioprine was identified in 1959, but it was not until the discovery of cyclosporine in 1970 that transplant surgery found a sufficiently powerful immunosuppressive.

    The first attempted human deceased-donor transplant was performed by the Ukrainian surgeon Yuri Voronoy in the 1930s;[91][92] but failed due to Ischemia. Joseph Murray and J. Hartwell Harrison performed the first successful transplant, a kidney transplant between identical twins, in 1954, because no immunosuppression was necessary for genetically identical individuals.

    Transplant of a single gonad (testis) from a living donor was carried out in early July 1926 in Zaječar, Serbia, by a Russian emigré surgeon Dr. Peter Vasil'evič Kolesnikov. The donor was a convicted murderer, one Ilija Krajan, whose death sentence was commuted to 20 years imprisonment, and he was led to believe that it was done because he had donated his testis to an elderly medical doctor. Both the donor and the receiver survived, but charges were brought in a court of law by the public prosecutor against Dr. Kolesnikov, not for performing the operation, but for lying to the donor.[90]

    Major steps in skin transplantation occurred during the First World War, notably in the work of Harold Gillies at Aldershot. Among his advances was the tubed pedicle graft, which maintained a flesh connection from the donor site until the graft established its own blood flow. Gillies' assistant, Archibald McIndoe, carried on the work into the Second World War as reconstructive surgery. In 1962, the first successful replantation surgery was performed – re-attaching a severed limb and restoring (limited) function and feeling.

    The first successful corneal allograft transplant was performed in 1837 in a WWI.[89]

    Alexis Carrel: 1912's Nobel Prize for his work on organ transplantation.

    The more likely accounts of early transplants deal with skin transplantation. The first reasonable account is of the Indian surgeon Sushruta in the 2nd century BC, who used autografted skin transplantation in nose reconstruction, a rhinoplasty. Success or failure of these procedures is not well documented. Centuries later, the Italian surgeon Gasparo Tagliacozzi performed successful skin autografts; he also failed consistently with allografts, offering the first suggestion of rejection centuries before that mechanism could possibly be understood. He attributed it to the "force and power of individuality" in his 1596 work De Curtorum Chirurgia per Insitionem.

    Several apocryphal accounts of transplants exist well prior to the scientific understanding and advancements that would be necessary for them to have actually occurred. The Chinese physician Pien Chi'ao reportedly exchanged hearts between a man of strong spirit but weak will with one of a man of weak spirit but strong will in an attempt to achieve balance in each man. Roman Catholic accounts report the 3rd-century saints Damian and Cosmas as replacing the gangrenous or cancerous leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian.[87][88] Most accounts have the saints performing the transplant in the 4th century, many decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure.

    Successful human allotransplants have a relatively long history of operative skills that were present long before the necessities for post-operative survival were discovered. Rejection and the side effects of preventing rejection (especially infection and nephropathy) were, are, and may always be the key problem.

    History

    Transplantation rates also differ based on race, sex, and income. A study done with people beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list.[86] For example, different groups express definite interest and complete pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on people currently on the transplantation waiting list.

    [85]

    In Latin America the donor rate is 40–100 per million per year, similar to that of developed countries. However, in Uruguay, Cuba, and Chile, 90% of organ transplants came from cadaveric donors. Cadaveric donors represent 35% of donors in Saudi Arabia. There is continuous effort to increase the utilization of cadaveric donors in Asia, however the popularity of living, single kidney donors in India yields India a cadaveric donor prevalence of less than 1 pmp.

    Traditionally, Muslims believe body desecration in life or death to be forbidden, and thus many reject organ transplant.[77] However most Muslim authorities nowadays accept the practice if another life will be saved.[78]

    In addition to the citizens waiting for organ transplants in the U.S. and other developed nations, there are long waiting lists in the rest of the world. More than 2 million people need organ transplants in China, 50,000 waiting in Latin America (90% of which are waiting for kidneys), as well as thousands more in the less documented continent of Africa. Donor bases vary in developing nations.

    [76] in 2006. In 2011, it was 35.3.[75] donors per million population in 2005 and 33.8[74][73] According to the

    Transplantation of organs in different regions in 2000[71][72]
    Kidney

    (pmp*)

    Liver

    (pmp)

    Heart

    (pmp)

    USA 52 19 8
    Europe 27 10 4
    Africa 11 3.5 1
    Asia 3 0.3 0.03
    Latin America 13 1.6 0.5
    *All numbers per million population

    Some estimates of the number of transplants performed in various regions of the world have been derived from the Global Burden of Disease Study.[70]

    Usage

    [69][68][67] People in other parts of the world are responding to this availability of organs, and a number of individuals (including U.S. and Japanese citizens) have elected to travel to China or India as

    In May 2008, two United Nations Special Rapporteurs reiterated their requests for "the Chinese government to fully explain the allegation of taking vital organs from Falun Gong practitioners and the source of organs for the sudden increase in organ transplants that has been going on in China since the year 2000".[66]

    In December 2006, after not getting assurances from the Chinese government about allegations relating to Chinese prisoners, the two major organ transplant hospitals in Queensland, Australia stopped transplant training for Chinese surgeons and banned joint research programs into organ transplantation with China.[65]

    [64][63] In July 2006, the

    According to the Chinese Deputy Minister of Health, Huang Jiefu,[61] approximately 95% of all organs used for transplantation are from executed prisoners. The lack of public organ donation program in China is used as a justification for this practice.

    There have been concerns that certain authorities are harvesting organs from people deem undesirable, such as prison populations. The World Medical Association stated that prisoners and other individuals in custody are not in a position to give consent freely, and therefore their organs must not be used for transplantation.[60]

    Forced donation

    In Cyprus in 2010 police closed a fertility clinic under charges of trafficking in human eggs. The Petra Clinic, as it was known locally, imported women from Ukraine and Russia for egg harvesting and sold the genetic material to foreign fertility tourists.[57] This sort of reproductive trafficking violates laws in the European Union. In 2010 Scott Carney reported for the Pulitzer Center on Crisis Reporting and the magazine Fast Company explored illicit fertility networks in Spain, the United States and Israel.[58][59]

    [56] Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, "I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work." Most kidney sellers say that selling their kidney was a mistake.[55] In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami on 26 December 2004. About 100 people, mostly women, sold their kidneys for 40,000–60,000 rupees ($900–$1,350).[54] In Pakistan, 40 percent to 50 percent of the residents of some villages have only one kidney because they have sold the other for a transplant into a wealthy person, probably from another country, said Dr. Farhat Moazam of Pakistan, at a

    Iran has had a legal market for kidneys since 1988.[50] The donor is paid approximately US$1200 by the government and also usually receives additional funds from either the recipient or local charities.[44][51] The Economist[52] and the Ayn Rand Institute[53] approve and advocate a legal market elsewhere. They argued that if 0.06% of Americans between 19 and 65 were to sell one kidney, the national waiting list would disappear (which, the Economist wrote, happened in Iran). The Economist argued that donating kidneys is no more risky than surrogate motherhood, which can be done legally for pay in most countries.

    Two books, Kidney for Sale By Owner by Mark Cherry (Georgetown University Press, 2005); and Stakes and Kidneys: Why markets in human body parts are morally imperative by James Stacey Taylor: (Ashgate Press, 2005); advocate using markets to increase the supply of organs available for transplantation. In a 2004 journal article Economist Alex Tabarrok argues that allowing organ sales, and elimination of organ donor lists will increase supply, lower costs and diminish social anxiety towards organ markets.[49]

    Recent development of web sites and personal advertisements for organs among listed candidates has raised the stakes when it comes to the selling of organs, and have also sparked significant ethical debates over directed donation, "good-Samaritan" donation, and the current U.S. organ allocation policy. Bioethicist Jacob M. Appel has argued that organ solicitation on billboards and the internet may actually increase the overall supply of organs.[48]

    In 2007, two major European conferences recommended against the sale of organs.[47]

    In the United States, Human Tissue Act 2004.

    An article by [46] said that a free market could help solve the problem of a scarcity in organ transplants. Their economic modeling was able to estimate the price tag for human kidneys ($15,000) and human livers ($32,000).

    In the illegal black market the donors may not get sufficient after-operation care,[41] the price of a kidney may be above $160,000,[42] middlemen take most of the money, the operation is more dangerous to both the donor and receiver, and the buyer often gets hepatitis or HIV.[43] In legal markets of Iran the price of a kidney is $2,000 to $4,000.[43][44][45]

    In compensated donation, donors get money or other compensation in exchange for their organs. This practice is common in some parts of the world, whether legal or not, and is one of the many factors driving medical tourism.[40]

    [39][38] Now monetary compensation for organ donors is being legalized in Australia and

    Financial compensation

    Good Samaritan or "altruistic" donation is giving a donation to someone not well-known to the donor. Some people choose to do this out of a need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them. Web sites are being developed that facilitate such donation. It has been featured in recent television journalism that over half of the members of the Jesus Christians, an Australian religious group, have donated kidneys in such a fashion.[37]

    Good Samaritan

    Paired-donor exchange, led by work in the New England Program for Kidney Exchange as well as at Johns Hopkins University and the Ohio OPOs may more efficiently allocate organs and lead to more transplants.

    [36] The first pair exchange transplant in the U.S. was in 2001 at

    Paired exchange programs were popularized in the New England Journal of Medicine article "Ethics of a paired-kidney-exchange program" in 1997 by L.F. Ross.[27] It was also proposed by Felix T. Rapport[28] in 1986 as part of his initial proposals for live-donor transplants "The case for a living emotionally related international kidney donor exchange registry" in Transplant Proceedings.[29] A paired exchange is the simplest case of a much larger exchange registry program where willing donors are matched with any number of compatible recipients.[30] Transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program."[31]

    A "paired-exchange" is a technique of matching willing living donors to compatible recipients using serotyping. For example, a spouse may be willing to donate a kidney to their partner but cannot since there is not a biological match. The willing spouse's kidney is donated to a matching recipient who also has an incompatible but willing spouse. The second donor must match the first recipient to complete the pair exchange. Typically the surgeries are scheduled simultaneously in case one of the donors decides to back out and the couples are kept anonymous from each other until after the transplant.

    Diagram of an exchange between otherwise incompatible pairs

    Paired exchange

    Living related donors donate to family members or friends in whom they have an emotional investment. The risk of surgery is offset by the psychological benefit of not losing someone related to them, or not seeing them suffer the ill effects of waiting on a list.

    Living related donors

    Reasons for donation and ethical issues

    Access to organ transplantation is one reason for the growth of medical tourism.

    One of the more publicized cases of this type was the 1994 Chester and Patti Szuber transplant. This was the first time that a parent had received a heart donated by one of their own children. Although the decision to accept the heart from his recently killed child was not an easy decision, the Szuber family agreed that giving Patti's heart to her father would have been something that she would have wanted.[25][26]

    Experiencing somewhat increased popularity, but still very rare, is directed or targeted donation, in which the family of a deceased donor (often honoring the wishes of the deceased) requests an organ be given to a specific person. If medically suitable, the allocation system is subverted, and the organ is given to that person. In the United States, there are various lengths of waiting times due to the different availabilities of organs in different UNOS regions. In other countries such as the UK, only medical factors and the position on the waiting list can affect who receives the organ.

    The overwhelming majority of deceased-donor organs in the United States are allocated by federal contract to the organ procurement organizations (OPOs), all members of the OPTN, are responsible for the identification of suitable donors and collection of the donated organs. UNOS then allocates organs based on the method considered most fair by the scientific leadership in the field. The allocation methodology varies somewhat by organ, and changes periodically. For example, liver allocation is based partially on MELD score (Model of End-Stage Liver Disease), an empirical score based on lab values indicative of the sickness of the person from liver disease. In 1984, the National Organ Transplant Act (NOTA) was passed which gave way to the Organ Procurement and Transplantation Network that maintains the organ registry and ensures equitable allocation of organs. The Scientific Registry of Transplant Recipients was also established to conduct ongoing studies into the evaluation and clinical status of organ transplants. In 2000 the Children’s Health Act passed and required NOTA to consider special issues around pediatric patients and organ allocation (Services).

    In most countries there is a shortage of suitable organs for transplantation. Countries often have formal systems in place to manage the process of determining who is an organ donor and in what order organ recipients receive available organs.

    Allocation of organs

    however, given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered. [24] Deceased donors (formerly cadaveric) are people who have been declared brain-dead and whose organs are kept viable by

    Deceased donor

    In living donors, the donor remains alive and donates a renewable tissue, cell, or fluid (e.g., blood, skin), or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, lung lobe, small bowel). Regenerative medicine may one day allow for laboratory-grown organs, using person's own cells via stem cells, or healthy cells extracted from the failing organs.

    Living donor

    Tissue may be recovered from donors who die of either brain or circulatory death. In general, tissues may be recovered from donors up to 24 hours past the cessation of heartbeat. In contrast to organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked." Also, more than 60 grafts may be obtained from a single tissue donor. Because of these three factors—the ability to recover from a non-heart beating donor, the ability to bank tissue, and the number of grafts available from each donor—tissue transplants are much more common than organ transplants. The American Association of Tissue Banks estimates that more than one million tissue transplants take place in the United States each year.

    Organ donation is possible after cardiac death in some situations, primarily when the person is severely brain injured and not expected to survive without artificial breathing and mechanical support. Independent of any decision to donate, a person's next-of-kin may decide to end artificial support. If the person is expected to expire within a short period of time after support is withdrawn, arrangements can be made to withdraw that support in an operating room to allow quick recovery of the organs after circulatory death has occurred.

    Organ donors may be living or may have died of brain death or circulatory death. Most deceased donors are those who have been pronounced brain dead. Brain dead means the cessation of brain function, typically after receiving an injury (either traumatic or pathological) to the brain, or otherwise cutting off blood circulation to the brain (drowning, suffocation, etc.). Breathing is maintained via artificial sources, which, in turn, maintains heartbeat. Once brain death has been declared the person can be considered for organ donation. Criteria for brain death vary. Because less than 3% of all deaths in the U.S. are the result of brain death, the overwhelming majority of deaths are ineligible for organ donation, resulting in severe shortages.

    Types of donor

    Tissues, cells and fluids

    • Kidney (deceased-donor and living-donor)
    • Liver (deceased-donor and living-donor)
    • Pancreas (deceased-donor only)
    • Intestine (deceased-donor and living-donor)
    • Stomach (deceased-donor only)
    • Testis[23] (deceased-donor and living-donor)

    Abdomen

    • Heart (deceased-donor only)
    • Lung (deceased-donor and living-related lung transplantation)
    • Heart/Lung (deceased-donor and domino transplant)

    Chest

    Organs and tissues transplanted

    Until recently, people labeled as obese were not considered appropriate candidates for renal transplantation. In 2009, the physicians at the University of Illinois Medical Center performed the first robotic kidney transplantation in an obese recipient and have continued to transplant people with Body Mass Index (BMI)’s over 35 using robotic surgery. As of January 2014, over 100 people that would otherwise be turned down because of their weight have successfully been transplanted.[21] [22]

    Transplantation in obese individuals

    Limited success has been achieved in ABO-incompatible heart transplants in adults,[20] though this requires that the adult recipients have low levels of anti-A or anti-B antibodies.[20] Kidney transplantation is more successful, with similar long-term graft survival rates to ABOc transplants.[17]

    [17][12] The most important factors are that the recipient not have produced

    Because very young children (generally under 12 months, but often as old as 24 months,[12]) do not have a well-developed immune system,[13] it is possible for them to receive organs from otherwise incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. Graft survival and peoples mortality is approximately the same between ABOi and ABO-compatible (ABOc) recipients.[14] While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.[12]

    ABO-incompatible transplants

    In February 2012, the last link in a record 60-person domino chain of 30 kidney transplants was completed.[10][11]

    This term also refers to a series of living donor transplants in which one donor donates to the highest recipient on the waiting list and the transplant center utilizes that donation to facilitate multiple transplants. These other transplants are otherwise impossible due to Johns Hopkins Medical Center in Baltimore and Northwestern University's Northwestern Memorial Hospital have received significant attention for pioneering transplants of this kind.[8][9]

    [7] In people with

    Domino transplants

    Sometimes a deceased-donor organ, usually a liver, may be divided between two recipients, especially an adult and a child. This is not usually a preferred option because the transplantation of a whole organ is more successful.

    Split transplants

    A transplant of organs or tissue from one species to another. An example is porcine heart valve transplant, which is quite common and successful. Another example is attempted piscine-primate (fish to non-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study was intended to pave the way for potential human use if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue.

    Xenograft and xenotransplantation

    A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin). Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they do not trigger an immune response.

    Isograft

    An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same Panel reactive antibody level.

    Allograft and allotransplantation

    Autografts are the transplant of tissue to the same person. Sometimes this is done with surplus tissue, tissue that can regenerate, or tissues more desperately needed elsewhere (examples include skin grafts, vein extraction for CABG, etc.). Sometimes an autograft is done to remove the tissue and then treat it or the person before returning it (examples include stem cell autograft and storing blood in advance of surgery). In a rotationplasty, a distal joint is used to replace a more proximal one; typically a foot or ankle joint is used to replace a knee joint. The person's foot is severed and reversed, the knee removed, and the tibia joined with the femur.

    Autograft

    Types of transplant

    Contents

    • Types of transplant 1
      • Autograft 1.1
      • Allograft and allotransplantation 1.2
        • Isograft 1.2.1
      • Xenograft and xenotransplantation 1.3
      • Split transplants 1.4
      • Domino transplants 1.5
      • ABO-incompatible transplants 1.6
      • Transplantation in obese individuals 1.7
    • Organs and tissues transplanted 2
      • Chest 2.1
      • Abdomen 2.2
      • Tissues, cells and fluids 2.3
    • Types of donor 3
      • Living donor 3.1
      • Deceased donor 3.2
    • Allocation of organs 4
    • Reasons for donation and ethical issues 5
      • Living related donors 5.1
        • Paired exchange 5.1.1
      • Good Samaritan 5.2
      • Financial compensation 5.3
      • Forced donation 5.4
    • Usage 6
    • History 7
      • Timeline of successful transplants 7.1
    • Society and culture 8
      • Comparative costs 8.1
      • Safety 8.2
      • Transplant laws 8.3
      • Ethical concerns 8.4
      • Artificial organ transplantation 8.5
    • Research 9
    • References 10
    • Further reading 11
    • External links 12

    Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of serotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs.[5]

    Some organs, such as the brain, cannot be transplanted. [4]

    This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
     
    Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
     
    By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
     



    Copyright © World Library Foundation. All rights reserved. eBooks from Hawaii eBook Library are sponsored by the World Library Foundation,
    a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.