Organ transplantation

History Organs and tissues transplanted Types of transplant Types of donor Allocation of donated organs Reasons for donation and ethical issues Statistics and future of transplantation

By Peter

Egorov

Organs that can be transplanted are:

Heart

Kidneys LiverThymus

PancreasLungs Intestine

Tissues that can be transplanted are:

Bones Tendons Cornea

VeinHeart valves Skin of leg

Skin of face

•History

01/01/0300

Comos and Damian Allotransplantation

in humans was first conceived in the middle ages. In this account, the leg of the sacristan Deacon Justinian was amputated to treat a cancerous lesion. The leg of a recently slain Ethiopian Moor gladiator was retrieved from the battlefield and transplanted to the amputation site. Cosmos and Damian, twin Arab brothers who were converts to Christianity performed the operations.

First successful Bone Graft

First successful bone graft documented by Job Van Meeneren.

Job van Meekeren (1611 – 6 December 1666, Amsterdam) was a Dutch surgeon. Became a surgeon in Amsterdam in 1635. He showed a great interest in hand surgery, and interesting is a demonstration of flexor tendon repairs on corpses by one of his pupils. He wrote a book, which gives a good representation of the state of the art of surgery in the seventeenth century in Amsterdam.

01/01/1668

01/01/1878

First Sucessful Human to Human Bone Transplant

First successful human-to-human bone transplant. This operation, which used bone from a cadaver, remained unusual because there was no way to process and preserve human tissues.

09/07/1905

First successful cornea transplant by Eduard Zirm (18 March 1863 - 15 March 1944), was born in Vienna, Austria.

That day Zirm first met man blinded in both eyes called Glogar. At the same time, a boy was brought to his clinic after an accident that left metal pieces in his eyes. The attempts to save boy's eyes were unsuccessful. Zirm enucleated them and saved the corneas for transplantation into Glogar's eyes. Although complications affected one eye, the other remained clear allowing Glogar to return to work.[

The operation and healing were difficult at that time because without a microscope it was impossible to suture the cornea. Therefore, Zirm successfully used sutures from the outside. Although eye surgeons around the world had been unsuccessful in the operation in humans for over a hundred years, parallel advances in anaesthesia and asepsis have also been credited in Zirm's success.

Zirm 's method remains the basis for repairing corneal damage.

Eduard Konrad Zirm

December 1954

Firts Kidney transplantation

Pioneer medical team that received the 1961 Amory Prize of the American Academy of Arts and Sciences for bringing kidney transplantation to the world.

Left to right, Drs. Harrison, Merrill and Murray

Dr. Harrison, Joseph E. Murray, John P. Merrill ...Dr. HarrisonJoseph Edward

Murray

John Putnam Merrill

… and others achieved the first successful kidney transplant, between identical twins. Murray shared the Nobel Prize in Physiology or Medicine in 1990. In 1971, Dr. Harrison received the Purkinje Medal from Czechoslovakia. In May 1983, he was awarded the Keyes Medal from the American Assn.

Pioneer medical team

1966

The first pancreas transplantation

by Richard Lillehei and William Kelly (Minnesota, U.S.A.)

A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.

Vladimir Petrovich Demikhov

July

18,

1916

November

22,

1998Kulini Farm (Volgograd Oblast)

Moscow(Russian

Federation)

1947 - The first isolated lung transplantation1948 - The first liver transplantation1951 - The world's first orthotopic heart transplant without the use of cardiopulmonary bypass1952 - The world's first mammarno-coronary bypass surgery (1988 - State Prize) 1954 - The first transplant second head dog

First operations in the World made by Demichov:

1937 - The first artificial heart 1946 - The first Heterotopic heart transplantation 1946 - The first transfer complex heart-lung

1967

Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first successful human-to-human heart transplant. Following the first successful kidney transplant in 1953, in the United States, Barnard performed the first kidney transplant in South Africa in October 1967. Christian Barnard all his life considered Demikhov his teacher.

1979

First successful live-donor partial pancreas transplant by David E Sutherland.

First successful ovarian transplant by Dr P N Mhatre (wadia hospital mumbai,India)

2005

2008

First successful transplantation of near total area (80%) of face, (including palate, nose, cheeks, and eyelid by Maria Siemionow (Cleveland, USA)

• Types of transplant

Autograft Allograft and allotransplantation Isograft Xenograft and xenotransplantation Split transplants Domino transplants

Autotransplantation

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).

In a rotationplasty a distal joint is used to replace a more proximal one, typically a foot and ankle joint is used to replace a knee joint. The patient's foot is severed and reversed, the knee removed, and the tibia joined with the femur.

Allotransplantationand

AllograftAn 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. The Risk of transplant rejection can be estimated by measuring the Panel reactive antibody level.

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 do not trigger an immune response.

Xenograft and

xenotransplantation

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.

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 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.

In patients with cystic fibrosis (муковисцидоз), where both lungs need to be replaced, it is a technically easier operation with a higher rate of success to replace both the heart and lungs of the recipient with those of the donor. As the recipient's original heart is usually healthy, it can then be transplanted into a second recipient in need of a heart transplant.

•Types of donor• Living donor Deceased

donor Organ donors may be living, or brain dead. Brain dead means the donor must have received an injury to the part of the brain that controls heartbeat and breathing. 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. Tissue may be recovered from donors who are cardiac dead. That is, their breathing and heartbeat has ceased. They are referred to as cadaveric donors. The American Association of Tissue Banks estimates that more than one million tissue transplants take place in the United States each year.

Living 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, small bowel). Regenerative medicine may one day allow for laboratory-grown organs, using patient's own cells via stem cells, or healthy cells extracted from the failing organs.

Deceased donor

Deceased (formerly cadaveric) are donors who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation. Apart from brain-stem dead donors, who have formed the majority of deceased donors for the last twenty years, there is increasing use of Donation after Cardiac Death Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered.

•Statistics of donation

The Need for Organ Donors in the Greater New York Metropolitan Area

More than 8,200 people are waiting for organ transplants in the New York Organ Donor Network's service area.

Of these, more than 6,400 await kidneys; more than 1,400 need livers; and more than 250 need hearts.

Others also need pancreas (more than 100), lungs (around 40) and intestine (around 10). Some patients need both a kidney and a pancreas (more than 100).

Number of Deceased Organ Donors in the Greater New York Metropolitan Area, the

Region Served by the New York Organ Donor Network: 2004-2011

In 2011, there were 264 deceased organ donors in the Greater New York metropolitan area compared with 242 in 2010.

Economy Statistics of Donor

Top 10 countries: # 1 USA $23,530,000,000.00

# 2 UK $12,460,000,000.00

# 3 France $10,600,000,000.00

# 4 Germany $10,440,000,000.00

# 5 Japan $ 7,500,000,000.00

# 6 Netherlands $ 5,452,000,000.00

# 7 Sweden $ 3,955,000,000.00

# 8 Canada $ 3,900,000,000.00

# 9 Spain $ 3,814,000,000.00

#10 Italy $ 3,641,000,000.00

Here are some statistics and facts about organ donation for people over 50

Two thirds of the individuals waiting for an organ transplant in 2011 were 50 years old or older. That year 2,242 deceased donors were between 50–64 years of age. Five hundred and ninety-five deceased donors were 65 or older.

In 2011, 17,089 of the 28,535—or 59.9%—of the people transplanted were 50+.

According to the 2005 National Survey of Organ and Tissue Donation Attitudes and Behaviors, conducted by The Gallup Organization, 20.13% of people over 65 years of age mistakenly think they are too old to donate an organ while 11.73% believe they are too old to receive one.

As of April 13, 2012, according to OPTN, there are 51,718 people between 50 and 64 years old on the national waiting list and 21,172 people over 65 years old on the national waiting list.

Donation Problems

In USA over 78,000 men, women, and children waiting for organ transplants, and 14 of these people die every day while waiting to receive an organ transplant. There are more than five people waiting for every organ made available by donation.

An estimated two in three Americans have not indicated their wishes about donation. The United Network for Organ Sharing found slow growth in the number of organs from deceased donors.

In 1999, there were a total of 21,715 transplants performed in the United States, up 44 percent from 1990.

More and more people with HIV and/or hepatitis B and/or hepatitis C are going to need organ transplants, particularly liver transplants.

Problems of Transplantation

The number of donated organs hasstayed fairly constant over the last few years while the number of people needing organscontinues to increase.

Infection. You will be given fairly high doses of immunosuppressant medications that will make you more susceptible to infection. During the first few weeks the most common sites of possible infection are your chest.

CMV Infection. This is a viral infection which usually comes on about four weeks after transplant. It may cause fevers, aches and pains.

Problems of Transplantation

Other possible post operative problems. Include problems related to the flow of bile from your liver, either a possible bile leak or the development of a stricture (narrowing) in one of the bile ducts. There may be problems with flow with the blood vessels going into the liver.

Emotional changes to expect. Not only does transplantation involves many physical changes to the body, but it also means many emotional changes. It is a tense, anxious time for both patient and family while they live through the waiting period, the transplant itself and often a prolonged recovery period.The drugs given produce physical side effects that can be distressing to patients as they face changes in their body image and can also contribute to increased mood changes.

The future of organ transplantation

No challenge in medicine can be more urgent than the devising of new strategies for replacing organs. The need for organ replacement not only exceeds by far the supply of organs available for transplantation, the need is likely to increase dramatically. The induction of tolerance to spare transplanted organs and the use of animal organs, i.e. xenotransplantation, could help address this problem but neither appears close to application. Here discussed a strategy involving the sequential generation of pleuripotent stem cells, formation of human organs in an adoptive xenogeneic host, the harvesting of human cells, tissues or organs from that host and implantation into the individual from whom the stem cells were obtained as one potential way to generate histocompatible organs. The promise, limitations and uncertainties of these steps are discussed as well. This approach, while speculative and perhaps unlikely, may lead to development of further new technologies and insights, the pursuit of which could provide new approaches to replacing organ function.