Organ transplant is the moving of an organ from one body to another (or from a donor site on the patient's own body), for the purpose of replacing the recipient's damaged or (previously referred to as cadaveric). The emerging field of Regenerative medicine may soon allow organs to be re-grown from the patient's own cells (stem cells, or cells extracted from the failing organs.)
Organs that can be transplanted are the heart , kidneys , liver , lungs , pancreas , intestine , and skin . Tissues include bones, tendons, cornea, heart valves, veins, and arms. Worldwide, the kidneys are the most commonly transplanted organs.
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 transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through serotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs.
In most countries there is a shortage of suitable organs for transplantation. Countries often have formal systems in place to manage the
Transplantation also raises a number of bioethical issues, including the definition of death, when and how consent should be given for an organ to be transplanted and payment for organs for transplantation.
United States
Acceptable organ donors can range in age from newborn to 65 years plus. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone, for total body donation. An estimated 10,000 to 14,000 people who die each year meet the criteria for an organ donation, but less than half of that number becomes actual organ donors. Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplatation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS), which is located in Richmond, Virginia. Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to some 261 transplant centers. All hospitals are required by law to have a "Required Referral" system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient's family to offer them the option of donating their loved one's organs and tissues. By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death. It is estimated that about 35 percent of potential donors never become donors because family members refuse to give consent.
United Kingdom
In the UK the number of people needing organ transplants is significantly greater than the number of organs available. To ensure that the patients awaiting transplants are treated fairly, there is a UK-wide organ allocation system run by a body called NHS Blood and Transplant (NHSBT), which is part of the UK’s National Health Service.
All patients who are waiting for transplants are registered on the UK Transplant National Transplant Database.
Allocation is carried out on the patient's need and the importance of achieving the closest possible match between donor and recipient. The rules for allocating organs are determined by the medical profession in consultation with other health professionals, the Department of Health and the specialist advisory groups of NHSBT.
The blood group, age and size of the donor and recipient are all taken into account to ensure the best possible match for each patient. For kidney transplant patients, tissue type match is also a consideration. NHSBT to identify the best matched patient, or alternatively, the transplant unit to which the organ is to be offered.
Types of transplants
Autograft
Transplant of tissue to the same person. Sometimes this is done with surplus tissue, or 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).
Allograft
An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same species. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's immune system will identify the organ as foreign and attempt to destroy it, causing transplant rejection. To prevent this, the organ recipient must take immunosuppressants. This dramatically affects the entire immune system, making the body vulnerable to pathogens.
Isograft
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 don't trigger an immune response.
Xenograft and xenotransplantation
Main article: XenotransplantationA transplant of organs or tissue from one species to another. An example are porcine heart valve transplants, which are 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.
Split 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.
Domino transplants
This operation is usually performed on patients with cystic fibrosis because both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs at the same time. As the recipient's native heart is usually healthy, it can be transplanted into someone else needing a heart transplant. That term is also used for a special form of liver transplant in which the recipient suffers from familial amyloidotic polyneuropathy, a disease where the liver slowly produces a protein that damages other organs. This patient's liver can be transplanted into an older patient who is likely to die from other causes before a problem arises.
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 blood-type or antibody barriers to transplantation. The "Good Samaritan" kidney is transplanted into one of the other recipients, whose donor in turn donates his or her kidney to an unrelated recipient. Depending on the patients on the waiting list, this has sometimes been repeated for up to six pairs, with the final donor donating to the patient at the top of the list. This method allows all organ recipients to get a transplant even if their living donor is not a match to them. This further benefits patients below any of these recipients on waiting lists, as they move closer to the top of the list for a deceased-donor organ. Johns Hopkins Medical Center in Baltimore and Northwestern University's Northwestern Memorial Hospital have received significant attention for pioneering transplants of this kind.
Major organs and tissues transplanted
Main article: Transplantable organs and tissuesThoracic organs
- Heart (Deceased-donor only)
- Lung (Deceased-donor and Living-Donor)
- Heart/Lung (Deceased-donor and Domino transplant)
Abdominal organs
- 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
Tissues, cells, fluids
- Hand (Deceased-donor only)
- Cornea (Deceased-donor only)
- Skin including Face replant (autograft) and Face transplant (extremely rare)
- Islets of Langerhans (Pancreas Islet Cells) (Deceased-donor and Living-Donor)
- Bone marrow/Adult stem cell (Living-Donor and Autograft)
- Blood transfusion/Blood Parts Transfusion (Living-Donor and Autograft)
- Blood vessels (Autograft and Deceased-
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