Organ transplants are medical procedures in which organs are removed from one body and placed in the recipient's body, to replace damaged or missing organs. Donors and recipients may be in the same location, or the organ can be transported from the donor site to another location. The organs and/or tissues that are transplanted in the body of the same person are called autografts. A recent transplant between two subjects of the same species is called allografts. Allografts can come from sources of life or cadavers.
Organs that have been successfully transplanted include the heart, kidneys, liver, lungs, pancreas, intestines, and thymus. The tissues include bones, tendons (both referred to as musculoskeletal grafts), corneae, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the heart and then the heart. Corneae and musculoskeletal grafts are the most frequently transplanted tissue; this more organ transplants more than tenfold.
The donor organ may live, die brain, or die through circulatory death. Tissues can be found from donors who die from circulatory death, as well as brain death - up to 24 hours of passing the cessation of the heartbeat. Unlike organs, most tissues (except corneas) can be stored and stored for up to five years, meaning they can "bend". Transplantation raises a number of bioethics problems, including the definition of death, when and how consent should be provided for the organ to be transplanted, and payment for organs for transplantation. Other ethical issues include transplant tourism and a wider socio-economic context in which organ procurement or transplantation can occur. A special problem is organ trading.
Transplant treatment is one of the most challenging and complex areas of modern medicine. Some key areas for medical management are the issue of transplant rejection, in which the body has an immune response to transplanted organs, possibly leading to transplant failure and the need to immediately remove organs from the recipient. Where possible, transplant rejection can be reduced through serotyping to determine the most appropriate donor-receiver match and through immunosuppressant drug use.
Video Organ transplantation
Transplant type
Autograft
Autografts is a network transplant to the same person. Sometimes this is done with excess tissue, tissue that can regenerate, or a much needed tissue elsewhere (for example including skin grafts, vein extraction for CABG , etc. ). Sometimes the autograft is done to remove the tissue and then treat it or the person before returning it (for example including autograft stem cell and blood store before surgery). In rotationplasty, the distal joints are used to replace the more proximal ones; usually the foot or ank joint is used to replace the knee joint. The man's legs are disconnected and reversed, the knee is lifted, and the tibia joins the femur.
Allograft and allotransplantation
Allograft is an organ or tissue transplant between two genetically identical members of the same species. Most human tissue and transplant organs are allografts. Due to the genetic differences between the organs and receivers, the recipient's immune system will identify the organs as alien and attempt to destroy them, causing transplant rejection. The risk of transplant rejection can be estimated by measuring the level of reactive panel antibodies.
Isograft
Part of allografts in which organs or tissues are transplanted from donors to genetically identical recipients (such as identical twins). Isografts are distinguished from other types of transplants because while they are anatomically identical to allografts, they do not trigger an immune response.
Xenograft and xenotransplantation
Transplant organs or tissues from one species to another. An example is a porcine heart valve transplant, which is quite common and successful. Another example is the attempt of primate transplantation (fish to non-human primates) from islet tissues (ie pancreatic tissue or insular tissue). Recent research studies are intended to pave the way for potential human use if successful. However, xenotransplantion is often a very dangerous type of transplant because of the increased risk of nonconformity, rejection, and disease carried in tissues. In the opposite twist, CEO of the Ganogen Research Institute Eugene Gu is studying how to transplant human and human fetal heart to animal for future transplant to human patients to overcome the shortage of donor organs.
Domino transplants
In people with cystic fibrosis (CF), where both lungs need to be replaced, this is a technically easier operation with a higher success rate to replace the recipient's heart and lungs with the donor. Since the original heart of the recipient is usually healthy, it can then be transplanted into a second recipient requiring a heart transplant, thus making the person with a live heart donor CF. In the 2016 case at Stanford Medical Center, a woman who needs a heart-lung transplant has cystic fibrosis that causes one lung to develop and the other shrinks so that it displaces its heart. The second patient who in turn receives her heart is a woman with right ventricular dysplasia that has caused an abnormally dangerous rhythm. Double surgery actually requires three surgical teams including one to remove the heart and lungs from the initial donor who just died. Both live recipients were successful and even had a chance to meet six weeks after their simultaneous operation.
Another example of this situation occurs with a special form of liver transplant in which the recipient suffers from familial amyloidosis polyneuropathy, a disease in which the liver slowly produces a protein that damages other organs. The recipient's heart can then be transplanted to an older person for whom the effect of the disease may not necessarily contribute significantly to death.
The term also refers to a series of live donor transplants in which one donor donates the highest recipient to the waiting list and the transplant center utilizes the donation to facilitate multiple transplants. This other transplant is not possible due to blood group or antibody resistance to transplantation. The "Good Samaritan" kidneys are transplanted to one of the other recipients, to which donors in turn donate their kidneys to unrelated recipients. Depending on the person on the waiting list, this is sometimes repeated up to six pairs, with the last donor contributing to the person at the top of the list. This method allows all organ recipients to get a transplant even if their donor's life does not match them. It benefits the people below from the recipients on the waiting list, as they move closer to the top of the list for dead donor organs. The Johns Hopkins Medical Center in Baltimore and Northwestern University's Northwestern Memorial Hospital have received important attention for such pioneering transplants. In February 2012, the last link in the 60-person domino chain of 30 kidney transplant records has been completed.
ABO-compatible transplant
Because very young children (generally under 12 months, but often as old as 24 months,) do not have a well developed immune system, it is possible for them to receive organs from incompatible donors. This is known as ABO-incompatible transplant (ABOi). Marriage resilience and population mortality are more or less the same between ABOi and ABO-compatible (ABOc) recipients. While the focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.
The most important factor is that the receiver does not produce isohemagglutinins, and that they have low T-cell-independent antigen levels. United Network for Organ Sharing (UNOS) regulations allow ABOi transplantation in children under two years of age if the isohemagglutinin titer is 1: 4 or lower, and if no suitable ABOc recipient is present. Studies have shown that the period in which a recipient may undergo ABOi transplantation may be prolonged by exposure to antifungal A and B without self. Furthermore, if the recipient (eg, B-positive type with AB-positive transplant) requires eventual retransplantation, the recipient may receive new organs from the blood group.
Limited success has been achieved in abortive ABO heart transplants in adults, although this requires adult recipients to have low levels of anti-A or anti-B antibodies. Kidney transplants are more successful, with long-term survival rates similar to ABOc transplants.
Transplantation in obese individuals
Until recently, people labeled as obese were not considered suitable candidates for kidney transplants. In 2009, doctors at the University of Illinois Medical Center performed the first robotic kidney transplant in obese recipients and continued to transplant people with a Body Mass Index (BMI) over 35 using robotic surgery. In January 2014, more than 100 people were supposed to be rejected because their weight had been successfully transplanted.
Maps Organ transplantation
Organ and network transplanted
Chest
- Heart (only from dead donors)
- Lung (lung transplant and live lung transplant)
- Heart/Lung (transplant donor and domino dead) Abstract
- Kidney (deceased donors and live donors)
- Hearts (late donors and live donors)
- Pancreas (only from donors who have died)
- Gut (donors and live donors who have died)
- Stomach (only from dead donors)
- Testes (deceased donors and live donors)
- Penis (only from dead donors)
- Hands (only from dead donors), see Clint Hallam's first recipient
- Cornea (only from dead donors) see optician Eduard Zirm
- Skin, including facial replant (autograft) and facial transplant (very rare)
- Langerhans Island (pancreas island cell) (deceased donors and live donors)
- Bone marrow/Adult stem cells (live-donor and autograft)
- Blood Transfusion/Blood Section Transfusion (live-donor and autograft)
- Blood Vessels (autograft and deceased)
- Heart valve (deceased-donor, live donor and xenograft [porcine/bovine])
- Bone (deceased donors and live donors)
- Artificial organs
- Beating heart mates
- Organ grown in lab
- Organ donation
- Regenerative Medicine
- Xenotransplantation
- World Health Organization (2008). Organ and human tissue transplants (PDF) . Geneva/New York: WHO. p.Ã, 13 . Retrieved December 24 2013 .
- The continuation rate of organ transplantation from Scientific Registry of Transplant Recipient
- Multi Organ Transplant
- The Gift of a Lifetime - Online Education Documentation
- Short film A Science of Miracles (2009) is available for free download on the Internet Archive
- "Overcoming Factor Rejection: First Organ Organ Transplant" online exhibition in the Waring Historical Library
Network, cell and fluid
Donor type
Organ donors may be alive or may have died from brain death or circulatory death. Most of the donors who died were those who died brain dead. Dead brain means the cessation of brain function, usually after receiving injury (either traumatic or pathological) to the brain, or cutting blood circulation to the brain (drowning, suffocation, etc.). Breathing is maintained through an artificial source, which, in turn, maintains a heartbeat. After a brain death has been declared the person may be considered for organ donation. Criteria of brain death vary. Because less than 3% of all deaths in the US are the result of brain death, the majority of deaths are not eligible for organ donation, resulting in severe shortages.
Organ donation is possible after heart death in some situations, especially when the person is deeply brain injured and is not expected to survive without artificial respiration and mechanical support. Regardless of any decision to donate, a person's close relatives may decide to terminate artificial support. If the person is expected to expire soon after the support is withdrawn, arrangements may be made to withdraw the support in the operating room to enable rapid organ recovery once circulatory death has occurred.
Tissue can be recovered from donors who die from brain death or circulation. In general, the tissue can recover from the donor up to 24 hours past the heart rate stoppage. Unlike organs, most tissues (except corneas) can be stored and stored for up to five years, which means they can "bend." Also, more than 60 graft can be obtained from a single network donor. Because of these three factors - the ability to recover from non-cardiac donors, the ability of bank networks, and the number of transplants 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 occur in the United States each year.
Live donor
In living donors, donors remain alive and donate renewable tissues, cells, or liquids (eg, blood, skin), or donate organs or parts of organs where the remaining organs can regenerate or take the workload away from the rest. of the organs (especially the single kidney donor, the partial donation of the liver, the lobe of the lung, the small intestine). Regenerative drugs may one day allow for organs grown in the laboratory, using the person's own cells through stem cells, or healthy cells that are extracted from the failed organs.
The late donor
The deceased population (formerly cadaver) are people who are declared brain dead and their organs are stored by ventilators or other mechanical mechanisms until they can be cut for transplantation. In addition to brain dead stem donors, who have formed the majority of donors who have died over the last 20 years, there is an increased use of donor-after-circulation-donor-death (formerly non-heart-beating donors) to increase the potential of donor pools as demand for transplant continues grow. Prior to the recognition of brain deaths in the 1980s, all organ donors who died had died from circulatory death. These organs have lower yields on the organs of brain-dead donors. For example, patients undergoing liver transplants using donor-after-circulatory-death (DCD) alografts have been shown to have lower grafted survival than those derived from post-cerebral-death (DHF) alografies due to biliary and PNF complications. However, given the appropriate scarcity of organs and the number of dead people waiting, any potentially potent organs should be considered.
Organ allocation
In most countries there is a shortage of organs suitable for transplantation. Countries often have a formal system to manage the process of determining who is an organ donor and in what order the organ recipient receives the available organs.
The majority of donor organs that die in the United States are allocated by federal contracts to the Procurement of Organs and Transplantation Networks (OPTN), which have been held since the Organ Transplant Act of 1984 by the United Network for Organ Sharing or UNOS. (UNOS does not handle donor corneal tissue; corneal donor tissue is usually handled by various eye banks.) The local organizing organization (OPO), all members of the OPTN, are responsible for the identification of suitable donors and the collection of donated organs. UNOS then allocates organs based on methods deemed most just by scientific leadership in the field. The allocation methodology varies somewhat by the organ, and changes periodically. For example, the liver allocation is based in part on the MELD score, the empirical score based on the value of the lab showing the person's illness from liver disease. In 1984, the National Organ Transplantation Law (NOTA) was passed which gave way to the Procurement of Organs and Transplantation Networks that maintained organ registrations and ensured fair allocation of organs. The Scientific Registry of Transplant Recipients was also established to undertake ongoing studies into the evaluation and clinical status of organ transplants. In 2000, the Child Health Act passed and requires NOTA to consider the specific issues surrounding pediatric patients and organ allocation (the Service).
An example of a "line jump" occurred in 2003 at Duke University when doctors attempted to recover from obvious errors. An American teenager receives a heart-lung donation with the wrong blood type for her. He then receives a second transplant even though he is in poor physical condition so he is usually not considered a good candidate for transplantation.
In an April 2008 article on The Guardian, Steven Tsui, head of the transplant team at Papworth Hospital in the UK, was quoted in raising the ethical issue for not holding false hopes. He stated, "Conventionally we would say if people's life expectancy is a year or less we would consider them as candidates for heart transplantation, but we also have to manage expectations.If we know that in an average year we will do 30 transplants heart, there's no point in putting 60 people on our waiting list, because we know half of them will die and not properly give them false hopes. "
Experiencing a somewhat increasing popularity, but still very rarely, is a directed or targeted donation, in which the families of the deceased donors (often honoring the wishes of the deceased) ask for an organ given to a particular person. If medically fit, the allocation system is subverted, and the organ is given to that person. In the United States, there is a wide range of waiting time due to the availability of different organs in different UNOS areas. In other countries such as the UK, only medical factors and positions on the waiting list can affect who receives the organs.
One of the more publicized cases of this type is the transplant of Chester and Patti Szuber in 1994. This is the first time that parents receive a heart donated by one of their own children. Although the decision to accept the heart of a recently murdered child is not an easy decision, the Szuber family agrees that giving Patti's heart to his father will be something he wants.
Access to organ transplants is one of the reasons for the growth of medical tourism.
Donor reasons and ethical issues.
Living life donors are donated to family members or friends where they have emotional investment. The risk of surgery is offset by the psychological benefits of not losing someone associated with them, or not seeing them suffering the ill effects of waiting for the list.
Paired exchange
A "pairing exchange" is a live donor matching technique that is willing for compatible recipients using serotyping. For example, couples may be willing to donate kidneys to their partners but can not because there are no biological pairs. The couple's kidneys are willing to donate to a suitable recipient who also has an incompatible but willing partner. The second donor must match the first recipient to complete the exchange of pairs. Usually operations are scheduled simultaneously in case one of the donors decides to withdraw and the pair remains anonymous to each other until after the transplant.
The couples exchange program was popularized in the New England Journal of Medicine article "The Ethics of a Kidney Exchange Program" in 1997 by L.F. Ross. This was also proposed by Felix T. Rapport in 1986 as part of a preliminary proposal for a live donor transplant "Case for recording of international emotionally related kidney donor transfers" in Transplant Proceedings . Couples exchange is the simplest case of a much larger exchange registration program in which donors are willing to be matched with a number of compatible recipients. The transplant exchange program was proposed in the early 1970s: "Typing programs and cooperative kidney exchange."
The first pair exchange transplant in the US was in 2001 at Johns Hopkins Hospital. The first multihospital kidney exchange complex involving 12 people was conducted in February 2009 by Johns Hopkins Hospital, Barnes-Jewish Hospital in St. Petersburg. Louis and Baptist Integris Medical Center in Oklahoma City. Another 12-person multihospital kidneys exchange was done four weeks later by the Saint Barnabas Medical Center in Livingston, New Jersey, Beth Newark Israel Medical Center, and New York Presbyterian Hospital. The surgical team led by Johns Hopkins continues to pioneer in this field by having a more complex exchange chain such as an eight-way multihospital kidney exchange. In December 2009, 13 recipients of 13 organs matching the kidney exchange occurred, coordinated through Georgetown University Hospital and Washington Hospital Center, Washington DC.
Donor-pair exchanges, led by work at the New England Kidney Exchange Program and at Johns Hopkins University and Ohio OPO may be more efficient at allocating organs and leading to more transplants.
Good Samaritan
The good contribution of the Samaritans or "altruistic" contributes to someone who is not well known by the donor. Some people choose to do this because they have to donate. Some donations to the next person on the list; others use several methods to select recipients based on criteria that are important to them. Website is being developed that facilitates the donation. It has been featured in recent television journalism that more than half the members of Jesus Christian, an Australian religious group, have donated kidneys in such a way.
Financial compensation
Now monetary compensation for organ donation is legalized in Australia, and only in case of kidney transplant in Singapore case (minimal reimbursement is offered in case of other organ harvesting by Singapore). Organizations of kidney disease in both countries have expressed their support.
In compensated donations, donors earn money or other compensation in return for their organs. This practice is common in some parts of the world, whether legal or not, and is one of the many factors that drive medical tourism.
On the illegal black market, donors may not get treatment after adequate surgery, kidney prices may be above $ 160,000, intermediaries take most of the money, operations are more dangerous to donors and recipients, and recipients often get hepatitis or HIV. In the legal market in Iran, the price of the kidney is $ 2,000 to $ 4,000.
An article by Gary Becker and Julio Elias on "Introducing Incentives in the Market for Living Organ and Cadaver Donations" says that free markets can help solve the problem of organ transplant scarcity. Their economic modeling is able to estimate the price tag for human kidney ($ 15,000) and the human heart ($ 32,000).
In the United States, The National Organ Transplant Act of 1984 makes the sale of illegal organs. In the United Kingdom, the 1989 Organ Transplant Organs Act first made the sale of illegal organs, and has been replaced by the Human Tissue Act 2004. In 2007, two major European conferences recommended opposing the sale of organs. Recent developments of websites and personal advertisements for organs among registered candidates have increased the stakes when it comes to organ sales, and has also sparked significant ethical debate over directed donations, "Samaritans" donations, and current US organ allocation. Policy. Bioethicist Jacob M. Appel argues that the application of organs on billboards and the internet can actually increase the overall supply of organs.
Many countries have different approaches to organ donations such as: opt-out approach and many organ donation ads, encouraging people to donate. Although these laws have been implemented to certain countries, they are not forced solely because they are individual decisions.
Two books, Kidney Sale by Owner by Mark Cherry (Georgetown University Press, 2005); and Stakes and Kidneys: Why the market in the human body is a moral imperative by James Stacey Taylor: (Ashgate Press, 2005); advocacy uses the market to increase the supply of organs available for transplantation. In a 2004 journal article, Economist Alex Tabarrok argues that allowing the sale of organs, and the removal of organ donor lists will increase supply, lower costs and reduce social anxiety on organ markets.
Iran has had a legal market for kidneys since 1988. The donor is paid around US $ 1200 by the government and also usually receives additional funding from both the recipients and the local charities. The Economist and the Ayn Rand Institute approves and advocates legal markets elsewhere. They argue that if 0.06% of Americans between 19 and 65 sell a kidney, the national waiting list will disappear (which the Economist writes in Iran). The Economist believes that donating a kidney is no more risky than a surrogate mother, which can be legally paid for in most countries.
In Pakistan, 40 to 50 percent of the population in some villages have only one kidney because they sell others for transplants to the rich, perhaps from other countries Farhat Moazam from Pakistan, at the World Health Organization. conference. Pakistani donors offered $ 2,500 for the kidney but only received about half of it because the intermediaries took so much. In Chennai, southern India, poor fishermen and their families sold their kidneys after their livelihoods were destroyed by the Indian Ocean tsunami on December 26, 2004. About 100 people, mostly women, sold their kidneys for 40,000-60,000 rupees ($ 900- $ 1,350). Thilakavathy Agatheesh, 30, who sold the kidney in May 2005 for 40,000 rupees, said: "I used to make money selling fish but now my postoperative stomach cramps prevent me from going to work." Most kidney sellers say that selling their kidneys is a mistake.
In Cyprus in 2010 police closed a fertility clinic under the charge of human trafficking. The Petra Clinic, as it is known locally, imports women from Ukraine and Russia to harvest eggs and sell genetic material to foreign fertility tourists. This type of reproductive trade is unlawful in the EU. In 2010 Scott Carney reported for the Pulitzer Center on Crisis Reporting and Fast Company magazine explored the illicit fertility network in Spain, the United States and Israel.
Forced Donation
There is concern that certain authorities take organs from people who are considered undesirable, such as prison populations. The World Medical Association states that detainees and other individuals in detention are not in a position to grant permission freely, and therefore their organs should not be used for transplantation.
According to Chinese Vice Minister of Health Huang Jiefu, about 95% of all organs used for transplants come from executed prisoners. The lack of public donation programs in China is used as a justification for this practice. In July 2006, the Kilgour-Matas report stated, "the source of 41,500 transplants for the six-year period 2000 to 2005 is unexplained" and "we believe that has existed and continues to this day as a large-scale organ attack of non-Falun Gong practitioners wish. " Investigative journalist Ethan Gutmann estimates that 65,000 Falun Gong practitioners were killed for their organs from 2000 to 2008. But the 2016 report updated the number of deaths over the 15 years since the persecution of Falun Gong began placing the death toll at 150 thousand to 1.5 million. In December 2006, after receiving no guarantees from the Chinese government on allegations relating to Chinese detainees, two major organ transplant hospitals in Queensland, Australia suspended transplant training for Chinese surgeons and banned joint research programs into organ transplants with China.
In May 2008, two United Nations Special Rapporteurs reaffirmed their request for "the Chinese government to fully explain the allegations of taking vital organs from Falun Gong practitioners and organ sources for a sudden increase in organ transplants that have taken place in China since 2000". People in other parts of the world respond to the availability of these organs, and a number of individuals (including US and Japanese citizens) have chosen to travel to China or India as medical travelers to receive organ transplants that may be sourced from what might be considered elsewhere as unethical way.
Usage
Some estimates of the number of transplants performed in various regions of the world come from the Global Burden of Disease Study.
According to the Council of Europe, Spain through the Spanish Transplant Organization shows the highest rate in the world from 35.1 donors per million inhabitants in 2005 and 33.8 in 2006. In 2011, it was 35.3.
In addition to people waiting for organ transplants in the US and other developed countries, there is a long waiting list around the world. More than 2 million people need organ transplants in China, 50,000 wait in Latin America (90% of them are waiting for kidney), as well as thousands of others in undocumented African continent. Donor bases vary in developing countries.
In Latin America, the donor level is 40-100 per million per year, similar to that in developed countries. However, in Uruguay, Cuba, and Chile, 90% of organ transplants are from cadaver donors. Cadaver donors represent 35% of donors in Saudi Arabia. There is ongoing effort to improve the utilization of cadaver donors in Asia, but the popularity of life, a single kidney donor in India results in Indian cadaver donor prevalence of less than 1 pmp.
Traditionally, Muslims believe that blasphemy in life or death is forbidden, and thus many refuse organ transplants. But most Muslim authorities today receive practice if other lives will be saved. For example, it can be assumed in countries like Singapore with a cosmopolitan population that includes Muslims, a governing body of the Majlis Ugama Islam Singapore established to safeguard the interests of the Singapore Muslim community over issues that include arranging their funerals.
Organ transplants in Singapore are an option for Muslims, generally overseen by the National Organ Transplant Unit of the Ministry of Health (Singapore). Due to the diversity of mindsets and religious viewpoints, while Muslims on the island are generally not expected to donate their organs even at death, the youth in Singapore are educated on the Human Organ Transplant Act at the age of 18 which is around the age of military conscripts. The Organ Donor Register stores two types of information, first of all Singaporeans who donate their organs or bodies for transplantation, research, or education after their death, under the Medical Act (Therapy, Education and Research) (MTERA), and second people who object to removing kidney, liver, heart and cornea after death for transplant purposes, under the Human Organ Transplant Act (HOTA). Live On's awareness social movement was also formed to educate Singaporeans about organ donation.
Organ transplants in China have occurred since the 1960s, and China has one of the largest transplant programs in the world, culminating in over 13,000 transplants per year in 2004. But organ donations conflict with Chinese traditions and culture, and voluntary organ donation are illegal under Chinese law. China's transplant program caught the attention of the international news media in the 1990s because of ethical concerns about organs and tissues removed from the corpses of commercially traded executed criminals for transplants. In 2006 it became clear that about 41,500 organs were taken from Falun Gong practitioners in China since 2000. With regard to organ transplants in Israel, there was a severe organ shortage due to religious objections by some rabbis who opposed all organ donations and others suggested that a rabbi participate in all decision making on a particular donor. One third of all heart transplants performed on Israelis were conducted in the People's Republic of China; the other is done in Europe. Dr Jacob Lavee, head of the heart transplant unit, Sheba Medical Center, Tel Aviv, believes that "transplant tours" are unethical and Israeli insurance companies should not pay for it. The HODS Organization (Organ Donor Society of Halachic) ​​works to increase knowledge and participation in organ donation among Jews around the world.
The rate of transplantation also differs based on race, sex, and income. A study conducted with people who started long-term dialysis suggests that sociodemographic barriers to renal transplantation are present even before the patient is on the transplant list. For example, different groups expressed a definite interest and performed a complete pre-transplant examination at different levels. Previous attempts to create a fair transplant policy have focused on people currently on the transplant waiting list.
In the United States nearly 35,000 organ transplants performed in 2017, an increase of 3.4 percent by 2016. About 18 percent of them come from living donors - people who give one kidney or part of their heart to another. But 115,000 Americans remain on the waiting list for organ transplants.
History
Successful human alotransplants have a relatively long history of surgical skills that existed long before the need for postoperative survival was discovered. Rejection and the side effects of preventing rejection (especially infection and nephropathy) are, and always a major problem.
Some of the transplant apocryphal records existed long before the scientific understanding and progress required for them to actually occur. Chinese physician Pien Chi'ao reportedly exchanged hearts between a man who had a strong but weak spirit with a weak but strong man in an effort to achieve balance in every man. The Roman Catholic account reports the 3rd-century saints, Damian and Cosmas, in place of toxic gangrene feet or cancer, Justinian with the feet of a recently deceased Ethiopian. Most accounts have saints transplanting in the 4th century, decades after their death; some accounts require that they only instruct the surgeon who performs the procedure.
It is more likely that early transplant accounts are associated with skin transplants. The first fair account was the Indian surgeon Sushruta in the 2nd century BC, who used autograft skin transplants in nasal reconstruction, nasal surgery. The success or failure of this procedure is not well documented. Centuries later, Italian surgeon Gasparo Tagliacozzi performed successful skin autografts; it also fails consistently with allografts, offering the first suggestion of rejection centuries before the mechanism could possibly be understood. He attributes it to "the strength and strength of individuality" in his work Deirtoria Chirurgia per Insitionem .
The first successful corneal allogenic transplant was performed in 1837 in the gazelle model; the first successful human corneal transplant, keratoplastic surgery, was performed by Eduard Zirm in Olomouc Eye Clinic, now Czech Republic, in 1905. The first transplant in the modern sense - implantation of organ tissues to replace organ function - was a thyroid transplant in 1883. This was done by Swiss surgeon and then Nobel laureate Theodor Kocher. In the previous decades Kocher has perfected the abolition of excessive thyroid tissue in cases of goiter to the degree that it is able to remove all organs without the person dying from surgery. Kocher did total organ removal in some cases as a measure to prevent recurrent goitre. In 1883, the surgeon noticed that the complete organ uptake led to the complex special symptoms we have now studied to be associated with thyroid hormone deficiency. Kocher reverses these symptoms by implanting thyroid tissue to these people and thus performing the first organ transplant. In the ensuing years Kocher and other surgeons use thyroid transplants as well to treat spontaneous thyroid deficiencies that appear spontaneously, without the removal of previous organs. Thyroid transplantation is a model for a new therapeutic strategy: organ transplantation. After thyroid examples, other organs were transplanted in the decade around 1900. Some of these transplants were performed on animals for research purposes, where organ removal and transplantation became a successful strategy for investigating organ function. Kocher was awarded the Nobel Prize in 1909 for the discovery of the function of the thyroid gland. At the same time, organs are also transplanted to treat diseases in humans. The thyroid gland is a model for transplantation of the adrenal and parathyroid glands, pancreas, ovaries, testes and kidneys. In 1900, the idea that a person can successfully treat an internal disease by replacing the failed organ through a transplant has been generally accepted. The pioneering work in transplant surgery was done in the early 1900s by the French surgeon Alexis Carrel, with Charles Guthrie, with an artery or vein transplant. The operation of their skilled anastomosis and new sewing techniques laid the groundwork for subsequent transplant surgery and won Carrel, the 1912 Nobel Prize in Physiology or Medicine. From 1902, Carrel conducted a transplant experiment on dogs. With the success of surgery in moving the kidneys, heart, and spleen, he was one of the first to identify the problem of rejection, which has remained insurmountable for decades. The discovery of immune transplantation by German surgeon Georg SchÃÆ'¶ne, the various matching strategies of donors and recipients, and the use of different agents for immune suppression did not result in substantial improvements so organ transplants were largely abandoned after World War I.
In 1954, the first organ transplant was successfully performed at Brigham & amp; Women's Hospital in Boston, Ma. Surgery performed by Dr. Joseph Murray, who received the Nobel Prize in Medicine for his work. The reason for his success is due to Richard and Ronald Herrick of Maine. Richard Herrick is a man in the Navy and became seriously ill with acute kidney failure. His brother Ronald donated his kidney to Richard, and Richard lived 8 years before his death. Prior to this, transplant recipients did not survive more than 30 days. The key to successful transplantation is the fact that Richard and Ronald are identical twin brothers and do not need anti-rejection drugs, which nobody knows at this point. This is the most important moment in transplant surgery because now the transplant team knows that it can work and the role of the rejection/anti-rejection drug.
Major steps in skin transplants occurred during the First World War, especially in the work of Harold Gillies at Aldershot. Among its advances is the tubed tubular graft, which maintains the meat connection from the donor site until the graft forms its own blood stream. Gillies' assistant, Archibald McIndoe, continued his work into World War II as a reconstructive surgery. In 1962, the first successful replanting operation - reinstalled the function and feelings that were disconnected and restored (limited).
The transplant of one gonad (testis) from a live donor was done in early July 1926 in Zaje? Ar, Serbian, by surgeon ÃÆ'  © migrà ©  © Russia Peter Vasil'evi? Kolesnikov. The donor was a convicted murderer, an Ilija Krajan, whose death sentence was reduced to 20 years in prison, and he was led to believe it was done because he had donated his testicles to an elderly doctor. Both donors and beneficiaries survived, but the indictment was brought to justice by the public prosecutor against Dr. Kolesnikov, not to perform surgery, but because of lying to donors.
The first human donor transplant performed by the first human was performed by Ukrainian surgeon Yuri Voronyi in the 1930s; but fails because of Ischemia. Joseph Murray and J. Hartwell Harrison performed the first successful transplant, a kidney transplant between identical twins, in 1954, because no immunosuppression was required for genetically identical individuals.
In the late 1940s Peter Medawar, working for the National Institute of Medical Research, increased his understanding of rejection. Identifying an immune response in 1951, Medawar suggested that immunosuppressive drugs could be used. Cortisone was recently discovered and a more effective azathioprine was identified in 1959, but it was not until the discovery of cyclosporine in 1970 that transplantation surgery found a strong enough immunosuppressive.
There was a successful donor lung transplant that died to emphysema and lung cancer patients in June 1963 by James Hardy at the University of Mississippi Medical Center in Jackson, Mississippi. Patient John Russell survived for eighteen days before dying of kidney failure.
Thomas Starzl of Denver attempted a liver transplant that same year, but he did not make it until 1967.
In the early 1960s and before long-term dialysis became available, Keith Reemtsma and his colleagues at Tulane University in New Orleans tried to transplant chimpanzee kidneys into 13 human patients. Most of these patients live only one to two months. However, in 1964, a 23-year-old woman lived for nine months and even returned to her job as a schoolteacher until she suddenly collapsed and died. It is assumed he died of acute electrolyte disturbance. On autopsy, the kidneys are not rejected or there are other obvious causes of death. One source said this patient died of pneumonia. Tom Starzl and his team in Colorado used a kidney kidney with six human patients who lived a month or two, but no survivors. Others in the United States and France have limited experience.
Heart is the ultimate gift for transplant surgeons. However, behind the problem of rejection, the heart worsens within minutes of death, so any surgery must be done at high speed. Development of heart-lung machine is also needed. The pioneer lung James Hardy was ready to try a human heart transplant in 1964, but when Boyd Rush's premature heart failure arrested Hardy without human donors, he used a chimpanzee liver, which ticked on his patient's chest for about an hour and then failed. The first partial success was achieved on December 3, 1967, when Christiaan Barnard of Cape Town, South Africa, performed the world's first human-to-human heart transplant with patient Louis Washkansky as the recipient. Washkansky survived eighteen days amid what many see as an unpleasant publicity circus. Interest in media encourages a spate of heart transplants. Over a hundred performed in 1968-1969, but almost everyone died within 60 days. Barnard's second patient, Philip Blaiberg, lived for 19 months.
It is the emergence of cyclosporine that converts transplantation from surgical research into life-saving treatment. In 1968, pioneer surgery Denton Cooley performed 17 transplants, including the first heart-lung transplant. Fourteen of his patients died within six months. In 1984 two thirds of all cardiac transplant patients survived for five years or more. With organ transplants being commonplace, limited only by donors, surgeons move to more risky areas, including transplantation of several organs in humans and animal-wide transplantation studies in animals. On March 9, 1981, the first successful heart-lung transplant occurred at Stanford University Hospital. The chief surgeon, Bruce Reitz, recognizes the patient's recovery to cyclosporine-A.
As trans- dation rates increase and modern immunosuppression makes transplants more common, the need for more organs becomes critical. Transplants from living donors, especially relatives, have become increasingly common. In addition, there is substantive research into xenotransplantation, or transgenic organs; although these forms of transplantation have not been used in humans, clinical trials involving the use of specific cell types have been performed with promising results, such as using the Langerhans pig island to treat type 1 diabetes. However, there are still many problems that need to be solved before they become an option appropriate for people who need transplant.
Recently, researchers have sought to reduce the general burden of immunosuppression. Common approaches include steroid avoidance, reduced exposure to calcineurin inhibitors, and other ways weaning the drug based on patient outcomes and function. While short-term results appear promising, long-term results are still unknown, and in general, decreased immunosuppression increases the risk of rejection and reduces the risk of infection. The risk of early rejection increases if corticosteroid immunosuppression is avoided or withdrawn after a kidney transplant.
One of the driving forces for illegal organ trafficking and for "transplant tours" is the difference in prices for organs and transplant operations in different regions of the world. According to the New England Journal of Medicine, human kidneys can be purchased in Manila for $ 1000- $ 2000, but in urban areas of Latin America the kidneys may cost more than $ 10,000. The kidney in South Africa has sold for $ 20,000. Price gaps based on donor races are an attractive driving force for organ sales in South Africa, as well as in other parts of the world.
In China, a kidney transplant surgery runs for about $ 70,000, a heart costing $ 160,000, and a heart rate of $ 120,000. Although these prices are still unaffordable for the poor, compared to the costs in the United States, where kidney transplants may demand $ 100,000, $ 250,000 liver, and liver $ 860,000, Chinese prices have made China the primary provider of organs and transplant surgery for other countries.
In India, a kidney transplant surgery runs about $ 5000.
Security
In the United States, tissue transplants are regulated by the US Food and Drug Administration (FDA) which establish strict regulations on transplant safety, especially those aimed at preventing the spread of infectious diseases. Rules include criteria for donor screening and testing as well as strict rules on processing and distribution of tissue graft. Organ transplants are not regulated by the FDA.
In November 2007, the CDC reported the first HIV and hepatitis C cases simultaneously transferred through organ transplants. A donor is a 38-year-old man, considered "high risk" by the donation organization, and his organs transmit HIV and Hepatitis C to four recipients. Experts say that disease reasons do not appear on screening tests may be because they are contracted within three weeks before donor death, so antibodies will not be present in sufficiently high numbers to be detected. The crisis has caused many people to call for a more sensitive screening test, which can take antibodies faster. Currently, the screen can not take a small amount of antibodies produced in HIV infection within the last 90 days or Hepatitis C infection within the last 18-21 days before the donation is made.
NAT (nucleic acid testing) is now being conducted by many organ-procurement organizations and is able to detect HIV and Hepatitis C directly within seven to ten days after exposure to the virus.
Transplantation law
Developed and developed countries have forged policies to try to improve the security and availability of organ transplants to their citizens. Austria, Brazil, France, Italy, Poland and Spain have ruled all potential adult donors with "opt-out" policies, unless they reach an unspecified card. However, while potential recipients in developing countries may reflect their more advanced counterparts in despair, potential donors in developing countries do not. The Indian government is having trouble tracking the growing black market of organs in their country, but has recently changed its transplant organ law to make stricter penalties for commercial transactions in organs. It also includes a new clause in legislation to support donations of dead organs, such as requiring it to ask for organ donations in case of brain death. Other countries that are victims of illegal organ trafficking have also adopted legislative reactions. Moldova has made international adoption illegal for fear of organ traders. China sold its illegal organ in July 2006 and claimed that all donor organs of the prisoners had applied for permission. However, doctors in other countries, such as Britain, have accused China of abusing high rates of death penalty. Despite these efforts, illegal organ trafficking continues to grow and can be attributed to corruption in the health care system, which has been traced as high as the doctors themselves in China and Ukraine, and blind eyes that economically compress the government and health care programs sometimes have to change. for organ trading. Some organs are also sent to Uganda and the Netherlands. This was the main product in triangle trading in 1934.
Beginning May 1, 2007, doctors involved in trading commercial organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to transplant organs to curb illegal transplants. Organ harvesting without donor consent is also considered a crime.
On 27 June 2008, Indonesia, Sulaiman Damanik, 26, pleaded guilty in a Singapore court to sell his kidney to the executive chair of Tang Tang, Tang Wee Sung, 55, for 150 million rupiah (S $ 22,200). The Transplant Ethics Committee must approve a live donor kidney transplant. Organ trafficking is banned in Singapore and in many other countries to prevent the exploitation of "socially disadvantaged and disadvantaged donors who can not make informed choices and suffer from potential medical risks." Toni, 27, was another accused, donating a kidney to an Indonesian patient in March, accusing him of being a adopted child, and paid 186 million rupiah (20,200USD). After the punishment, both will suffer respectively, 12 months in prison or 10,000 Singapore dollars (7,600 USD) fine.
In an article appearing in the April 2004 issue of Econ Journal Watch, economist Alex Tabarrok examines the impact of the law on direct approval of the availability of transplant organs. Tabarrok found that the social pressures that resist the use of transplanted organs decreased over time as individual decision opportunities increased. Tabarrok concluded his study showed that the gradual removal of organ donation restrictions and the move to free markets in organ sales would increase the supply of organs and encourage wider social acceptance of organ donation as a practice.
Ethical issues
The existence and distribution of organ transplant procedures in developing countries, while almost always beneficial to those who receive them, raises many ethical concerns. Sources and methods for getting organs for transplantation are the major ethical issues to consider, as well as the idea of ​​distributive justice. The World Health Organization believes that transplants promote health, but the idea of ​​"transplant tourism" has the potential to violate human rights or exploit the poor, to have undesirable health consequences, and to provide unequal access to services, all of which can cause harm. Apart from the "gift of life", in the context of developing countries, this may be coercive. Coercion practices may be considered exploiting the poor, violating human rights under Articles 3 and 4 of the Universal Declaration of Human Rights. There is also a strong opposing view, that organ trading, if properly regulated and effective to ensure that the seller is fully informed of all the consequences of the donation, is a mutually beneficial transaction between two consenting adults, and that prohibiting itself would be a violation of Article 3 and 29 of the Universal Declaration of Human Rights.
Even in developed countries there is a concern that enthusiasm for increasing the supply of organs can trample respect for the right to life. Questions are made more complicated by the fact that the "irreversible" criterion for the death of the law can not be adequately defined and can easily change with changing technology.
Artificial organ transplant
Surgeons, especially Paolo Macchiarini, in Sweden performed the first implantation of synthetic trachea in July 2011, for a 36-year-old patient with cancer. Stem cells taken from the patient's hip were treated with growth factors and incubated on a natural tracheal plastic replica.
According to the information found by the Swedish documentary "Document InifrÃÆ'  ¥ n: Experimenten" (Swedish: "Document from Within: The Experiments") patient, Andemariam later suffered an increasingly frightening cough and eventually bleed to death, incubated, at the hospital. At that point, determined by the autopsy, 90% of the synthetic throat rod has been removed. He allegedly made several trips to see Macchiarini for his complications, and at one point underwent another operation to change his synthetic throat rod, but Macchiarini was very difficult to get an appointment. According to the autopsy, the old synthetic throat rod does not seem to be replaced.
Macchiarini's academic credentials have been questioned and he was recently charged with allegedly violating his research.
Left-Ventricular Assist Devices (LVADs) as often used as "bridges" to provide additional time while patients await transplantation. For example, former US vice-president Dick Cheney had LVAD implanted in 2010 and then twenty months later received a heart transplant in 2012. By 2012, about 3,000 ventricular aids are inserted in the United States, compared to about 2,500 hearts. transplant. The use of airbags in cars and the use of larger helmets by cyclists and skiers has reduced the number of people with fatal head injuries, which is a common source of donor hearts.
Research
The company's initial medical and research laboratory, called Organovo, designs and develops a functional, three-dimensional human network for medical research and therapeutic applications. The company uses NovoGen MMX Bioprinter for 3D bioprinting. Organovo anticipates that bioprinting human tissue will accelerate preclinical drug testing and discovery processes, allowing maintenance to be made faster and at a lower cost. In addition, Organovo has long-term expectations that this technology can be suitable for surgical and transplant therapy.
See also
References
Further reading
External links
Source of the article : Wikipedia
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