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Encyclopedia > Organ transplant

An organ transplant is the moving of a whole or partial 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 failing organ with a working one from the donor site. Organ donors can be living or deceased (previously referred to as cadaveric). Organ transplants can be categorized as "life-saving", while tissue transplants are "life-enhancing". In agriculture and gardening, transplanting is the technique of starting a plant from seed in optimal conditions, such as in a greenhouse or protected nursery bed, then replanting it in another, usually outdoor, growing location. ... This article is about the biological unit. ... Organ donation is the removal of specific tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting them into other persons. ...


Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, and intestine. Tissues include bones, tendons, cornea, heart valves, veins, and skin.

Contents

Types of transplants

Autograft

A transplant of tissue from one to oneself. 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 this 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). Skin Graft is an influential contemporary no wave, noise rock, art punk, rock label based in Chicago. ... A coronary artery bypass graft (CABG) or heart bypass is a surgical procedure performed in patients with coronary artery disease (see atherosclerosis) for the relief of angina and possible improved heart muscle function. ... For other uses, see Blood (disambiguation). ... “Surgeon” redirects here. ...


Allograft

An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. Most human tissue and organ transplants are allografts. This however will result in the receiver of organs to take immunosuppressive drugs to prevent their body's antibodies causing transplant rejection, destroying the new organ. This dramatically affects the entire immune system making the body vulnerable to pathogens. For other uses, see Species (disambiguation). ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ...


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 are closer to autografts in terms of the recipient's immune response. Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ... Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. ...


Xenograft and Xenotransplantion

A transplant of organs or tissue from one species to another. Xenotransplantion is often an extremely dangerous type of transplant. Examples include porcine heart valves, which are quite common and successful, a baboon-to-human heart (failed), and piscine-primate (fish to non-human primate) islet (i.e. pancreatic or insular tissue), the latter's research study directed for potential human use if successful. See: xenotransplantation. The pancreas is a retroperitoneal organ that serves two functions: exocrine - it produces pancreatic juice containing digestive enzymes endocrine - it produces several important hormones Anatomy The pancreas is a retroperitoneal organ located posterior to the stomach on the posterior abdominal wall. ... (xeno- from the Greek meaning foreign) is the transplantation of living cells, tissues or organs from one species to another such as from pigs to humans (see Medical grafting). ...


Split transplants

Sometimes, a deceased-donor organ (specifically the liver) may be divided between two recipients, especially an adult and a child.But it is not usually preferred, because the transplantations of whole organs are more useful.


Domino transplants

This operation is usually performed for cystic fibrosis as both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs en bloc. As the recipient's native heart is usually healthy, this can then itself be transplanted into someone 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 in which the liver (slowly) produces a protein that damages other organs; their liver can be transplanted into an older patient who is likely to die from other causes before a problem arises.[1] For other uses, see Amyloid (disambiguation). ...


Major organs and tissues transplanted

Thoracic organs

  • Heart (Deceased-donor only)
  • Lung (Deceased-donor and Living-Donor)
  • En bloc Heart/Lung (Deceased-donor and Domino transplant)

Diagram illustrating the placement of a donor heart in an orthotopic procedure. ... Lung transplantation is a surgical procedure in which a patients diseased lungs are partially or totally replaced by lungs which come from a donor. ... A heart-lung transplant is a procedure carried out to replace both heart and lungs in a single operation. ...

Other organs

  • Kidney (Deceased-donor and Living-Donor)
  • Liver (Deceased-donor and Living-Donor)
  • Pancreas (Deceased-donor only)
  • Intestine (Deceased-donor only)

The donor kidney is typically placed inferior of the normal anatomical location. ... Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. ... A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who has diabetes. ...

Tissues, cells, fluids

Hand transplantation is a surgical procedure to transplant a hand from one human to another. ... Cornea Transplant A cornea transplant, also known as a corneal graft or penetrating keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced by a donor. ... Skin Graft is an influential contemporary no wave, noise rock, art punk, rock label based in Chicago. ... A face transplant is a skin graft that involves replacing part or all of a patients face with a donor face. ... Penis transplantation is a surgical transplant procedure in which a replacement penis, either one grown artificially (untested in humans) or from a deceased human donor (allograft), is transplanted onto a patient. ... A porcine islet of Langerhans. ... Bone marrow transplantation or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ... Mouse embryonic stem cells with fluorescent marker. ... Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Grays Fig. ... This article is about the skeletal organs. ... For other uses, see Skin (disambiguation). ...

History

Successful human allotransplants have a relatively long history; the operative skills 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. The transplantation of organs between members of the same species. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ... Nephropathy refers to damage to or disease of the kidney. ...

Cosmas and Damian miraculously transplant the (black) leg of the Ethiopian onto the (white) body of Justinian. Ditzingen, 16th century.
Cosmas and Damian miraculously transplant the (black) leg of the Ethiopian onto the (white) body of Justinian. Ditzingen, 16th century.

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 third-century saints Damian and Cosmas as replacing the gangrenous leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian. Most accounts have the saints performing the transplant in the fourth century, decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure. Ditzingen is a town in the district of Ludwigsburg, Baden-Württemberg, Germany. ... Early Christian physician, born in Arabia who along with his brother Saint Cosmas, practiced the art of healing in the seaport of Ægea (modern Ayash) on the Gulf of Iskanderun. ... Early Christian physician, born in Arabia who along with his brother Saint Damian, practiced the art of healing in the seaport of Ægea (modern Ayash) on the Gulf of Iskanderun. ... Gangrene is a complication of necrosis (i. ... Justinian may refer to: Justinian I, a Roman Emperor; Justinian II, a Byzantine Emperor; Justinian, a storeship sent to the convict settlement at New South Wales in 1790. ... The Federal Democratic Republic of Ethiopia (Ityopiya, Amharic ኢትዮጵያ) is a country situated in the Horn of Africa. ...


The more likely accounts of early transplants deal with skin transplantation. The first reasonable account is of the Indian surgeon Sushruta in the second century BC, who used autografted skin transplantation in nose reconstruction 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. It has been suggested that this article or section be merged with Sushruta Samhita. ... For the album by Primus, see Rhinoplasty (album). ... Italian surgeon Gasparo Tagliacozzi (1546 - November 7, 1599) was born in Bologna. ... An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. ... Events February 5 - 26 catholics crucified in Nagasaki, Japan. ...


The first successful corneal allograft transplant was performed in 1837 in a gazelle model; the first successful human corneal transplant, a keratoplastic operation, was performed by Eduard Zirm in Austria in 1905. Pioneering work in the surgical technique of transplantation was made in the early 1900s by the French surgeon Alexis Carrel, with Charles Guthrie, with the transplantation of arteries or veins. Their skillful anastomosis operations, the new suturing techniques, laid the groundwork for later transplant surgery and won Carrel the 1912 Nobel Prize for Medicine or Physiology. From 1902 Carrel performed transplant experiments on dogs. Surgically successful in moving kidneys, hearts and spleens, he was one of the first to identify the problem of rejection, which remained insurmountable for decades. Cornea Transplant A cornea transplant, also known as a corneal graft or penetrating keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced by a donor. ... Memorial plaque at Eye Clinic in hospital in Olomouc shows the text in the Czech language: . Eduard Konrad Zirm (18 March 1863 - 15 March 1944) was an ophthalmologist who performed the first successful organ transplant¹ on 7 December 1905. ... Alexis Carrel Alexis Carrel (June 28, 1873 – November 5, 1944) was a French surgeon and biologist. ... Section of an artery For other uses, see Artery (disambiguation). ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... // Anastomosis (plural anastomoses) refers to a form of network in which streams both branch out and reconnect. ... The Nobel Prize (Swedish: ) was established in Alfred Nobels will in 1895, and it was first awarded in Physics, Chemistry, Physiology or Medicine, Literature, and Peace in 1901. ... Year 1902 (MCMII) was a common year starting on Wednesday (link will display calendar) of the Gregorian calendar (or a common year starting on Tuesday [1] of the 13-day-slower Julian calendar). ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... The heart and lungs, from an older edition of Grays Anatomy. ... The spleen is an organ located in the abdomen, where it functions in the destruction of old red blood cells and holding a reservoir of blood. ... Rejection may mean: In psychology, rejection is an emotion felt by most humans (and possibly other higher animals) when another person denies a personal request, particularly if it is an emotional advance. ...


Major steps in skin transplantation occurred during World War I, notably in the work of Harold Gillies at Aldershot. Among his advances was the tubed pedicle graft, maintaining a flesh connection from the donor site until the graft established its own blood flow. Gillies' assistant, Archibald McIndoe, carried on the work into World War II as reconstructive surgery. In 1962 the first successful replantation surgery was performed - re-attaching a severed limb and restoring (limited) function and feeling. An organ transplant is the transplantation of a whole or partial organ from one body to another, for the purpose of replacing the recipients damaged or failing organ with a working one from the donor. ... “The Great War ” redirects here. ... Harold Gillies in 1916 Sir Harold Delf Gillies (June 17, 1882 - September 10, 1960) was a New Zealand-born, and later Londoner, otolaryngologist widely considered as the father of plastic surgery. ... Sir Archibald McIndoe (May 4, 1900 - April 11, 1960) was a plastic surgeon who worked for the Royal Air Force during World War II who greatly improved the treatment and rehabilitation of badly burned aircrew. ... Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000... This article does not cite any references or sources. ...


The first attempted human deceased-donor transplant was performed by the Ukrainian surgeon Yu Yu Voronoy in the 1930s; rejection resulted in failure. Joseph Murray performed the first successful transplant, a kidney transplant between identical twins, in 1954, successful because no immunosuppression was necessary in genetically identical twins. Joseph E. Murray (born 1 April 1919), American surgeon, performed the first successful human kidney transplant from an adult to his identical twin. ...


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. Sir Peter Brian Medawar (February 28, 1915 – October 2, 1987) was a Brazilian-born English scientist best known for his work on how the immune system rejects or accepts organ transplants. ... The National Institute For Medical Research, commonly abbreviated to NIMR, is a large medical research facility situated in rural Mill Hill, England, on the outskirts of London. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Cortisone (IPA:ˈkôrtəˌsōn) is a steroid hormone. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ...


Dr. 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 patient survived for eighteen days before dying of kidney failure. Thomas Starzl of Denver attempted a liver transplant in the same year, but was not successful until 1967. Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. ... For other uses, see 1963 (disambiguation). ... This article is about Jackson, the city and related subjects within the city. ... Thomas Starzl was a pioneer in transplant surgery and has often been referred to as the modern-day father of transplantation. ...


The heart was a major prize for transplant surgeons. But, as well as 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 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 December 3rd 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 1968-69, but almost all the patients died within sixty days. Barnard's second patient, Philip Blaiberg, lived for 19 months. A heart-lung machine (upper right) in a coronary artery bypass surgery. ... James Hardy (born on December 24, 1985 in Fort Wayne, Indiana) is an American football wide receiver and currently playing for the Indiana Hoosiers. ... is the 337th day of the year (338th in leap years) in the Gregorian calendar. ... Year 1967 (MCMLXVII) was a common year starting on Sunday (link will display full calendar) of the 1967 Gregorian calendar. ... Christiaan Neethling Barnard (November 8, 1922 – September 2, 2001) was a South African cardiac surgeon, famous for performing the worlds first successful human-to-human heart transplant. ... Nickname: Motto: Spes Bona (Latin for Good Hope) Location of the City of Cape Town in Western Cape Province Coordinates: , Country Province Municipality City of Cape Town Metropolitan Municipality Founded 1652 Government [1]  - Type City council  - Mayor Helen Zille  - City manager Achmat Ebrahim Area  - Total 2,499 km² (964. ... Louis Washkansky (1913 – 21 December 1967) was the recipient of the worlds first human heart transplant. ... Philip Blaiberg (1909 - August 17, 1969) was a South African dentist and the second person to receive a heart transplant in the world. ...


It was the advent of cyclosporine that altered transplants from research surgery to life-saving treatment. In 1968 surgical pioneer Denton Cooley performed seventeen transplants including the first heart-lung transplant. Fourteen of his patients were dead within six months. By 1984 two-thirds of all heart transplant patients survived for five years or more. With organ transplants becoming commonplace, limited only by donors, surgeons moved onto more risky fields, multiple organ transplants on humans and whole-body transplant research on animals. On March 9th 1981 the first successful heart-lung transplant took place at Stanford University Hospital. The head surgeon, Bruce Reitz, credited the patient's recovery to cyclosporine-A. Dr. Denton A. Cooley (b. ... is the 68th day of the year (69th in leap years) in the Gregorian calendar. ... AUGUST 25 1981 US Marine Sean Vance is Born on the 25th of August {ear nav|1981}} Year 1981 (MCMLXXXI) was a common year starting on Thursday (link displays the 1981 Gregorian calendar). ... The heart and lungs, from an older edition of Grays Anatomy. ... For the village in Tibet, see Lung, Tibet. ... Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ...


As the rising success rate of transplants and modern immunosuppression make transplants more common, the need for more organs has become critical. Advances in living-related donor transplants have made that increasingly common. Additionally, there is substantive research into xenotransplantation or transgenic organs; although these forms of transplant are not yet being used in humans, clinical trials involving the use of specific cell types have been conducted with promising results, such as using porcine islets of Langerhans to treat type one diabetes. However, there are still many problems that would need to be solved before they would be feasible options in patients requiring transplants. (xeno- from the Greek meaning foreign) is the transplantation of living cells, tissues or organs from one species to another such as from pigs to humans (see Medical grafting). ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... A porcine islet of Langerhans. ... This article is about the disease that features high blood sugar. ...


Recently, researchers have been looking into steroid-free immunosuppression. This type of immunosupporession is being pioneered on large scale at Northwestern University in Chicago and other smaller institutions, while steroid minimization is being employed at the University of Wisconsin at Madison and other smaller institutions. This would avoid the side-effects of steroids. While short-term outcomes are outstanding, long-term outcomes are still unknown. Northwestern University (NU) is a private, nonsectarian, coeducational research university with campuses located in Evanston, Illinois and downtown Chicago. ... For other uses, see Chicago (disambiguation). ...


In addition, calcineurin-Inhibitor-Free Immunosuppression is currently undergoing extensive trialing, the result of which would be to allow sufficient immunosuppression, without the nephrotoxicity associated with standard regimens that include calcineurin inhibitors. Positive results have yet to be demonstrated in any trial.


An FDA approved immune function test from Cylex has shown effectiveness in minimizing the risk of infection and rejection in post-transplant patients[4] by enabling doctors to tailor immunosuppressant drug regimens. By keeping a patient's immune function within a certain window, doctors can adjust drug levels to prevent organ rejection while avoiding infection. Such information could help physicians reduce the use of immunosuppressive drugs, lowering drug therapy expenses while reducing the morbidity associated with liver biopsies, improve the daily life of transplant patients, and could prolong the life of the transplanted organ. Cylex, Inc is a biotechnology company developing and manufacturing products that use the immune system for predicting and managing human health. ...


Many other new drugs are under development for transplantation.[5]


Timeline of successful transplants

  • 1905: First successful cornea transplant by Eduard Zirm[6]
  • 1954: First successful kidney transplant by Joseph Murray (Boston, U.S.A.)
  • 1966: First successful pancreas transplant by Richard Lillehei and William Kelly (Minnesota, U.S.A.)
  • 1967: First successful liver transplant by Thomas Starzl (Denver, U.S.A.)
  • 1967: First successful heart transplant by Christiaan Barnard (Cape Town, South Africa)
  • 1970: First successful Human head transplant by Robert White (Cleveland, U.S.A.)
  • 1981: First successful heart/lung transplant by Bruce Reitz (Stanford, U.S.A.)
  • 1983: First successful lung lobe transplant by Joel Cooper (Toronto, Canada)
  • 1986: First successful double-lung transplant (Ann Harrison) by Joel Cooper (Toronto, Canada)
  • 1987: First successful whole lung transplant by Joel Cooper (St. Louis, U.S.A.)
  • 1995: First successful laparoscopic live-donor nephrectomy by Lloyd Ratner and Louis Kavoussi (Baltimore, U.S.A.)
  • 1998: First successful live-donor partial pancreas transplant by David Sutherland (Minnesota, U.S.A.)
  • 1998: First successful hand transplant (France)
  • 2005: First successful partial face transplant (France)
  • 2005: First successful penis transplant (China)[7]

Cornea Transplant A cornea transplant, also known as a corneal graft or penetrating keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced by a donor. ... Memorial plaque at Eye Clinic in hospital in Olomouc shows the text in the Czech language: . Eduard Konrad Zirm (18 March 1863 - 15 March 1944) was an ophthalmologist who performed the first successful organ transplant¹ on 7 December 1905. ... A pancreas transplant is an organ transplant that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. ... Liver transplantation is the replacement of a diseased liver with a healthy liver allograft. ... A heart transplant , is a surgical transplant procedure performed on patients with heart failure or severe coronary artery disease. ... A pancreas transplant is an organ transplant that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. ... A hand transplant is a medical operation to transplant a hand from one human to another. ... A face transplant is a skin graft that involves replacing part or all of a patients face with a donor face. ... Penis transplantation is a surgical transplant procedure in which a replacement penis, either one grown artificially (untested in humans) or from a deceased human donor (allograft), is transplanted onto a patient. ...

Types of donor

Living or deceased

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, or pancreas).


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 - DCD- 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. Brain death is defined as a complete and irreversible cessation of brain activity. ...


Reasons for donation and ethical issues

Living related donors

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.


Paired-exchange

A "paired-exchange" is a technique of matching willing living donors to compatible recipients. For example a spouse may be more than willing to donate a kidney to their partner but cannot since there is not a biological match. 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.


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[8]. It was also proposed by Felix T. Rapport[9] 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[10]. 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[11]. A transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program."[12]. The first pair exchange transplant in the U.S. was in 2001 at Johns Hopkins hospital[13]. The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ...


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.


Good Samaritan

"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 [14]. Jesus Christians are considered a radical Christian movement (or a cult of Christianity by some) that practice communal living and distribute Bible-based comics and books. ...


Compensated donation

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. Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care. ...


In the United States, The National Organ Transplant Act of 1984 made organ sales illegal; regulation by the OPTN has probably eliminated organ sales.[citation needed] In the United Kingdom, the Human Tissue Act 1961 made organ sales illegal. The National Organ Transplant Act (1984 Public Law 98-507), approved October 19, 1984 and amended in 1988 and 1990, outlawed the sale of human organs and provided for the establishment of the Task Force on Organ Transplantation; authorized the Secretary of HHS to make grants for the planning, establishment...


In 2007, two major European conferences recommended against the sale of organs[8].


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.[citation needed]


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 2006, Iran became the only country to legally allow individuals to sell their kidneys, and the market price is of the order of US$2,000 to US$4,000. The Economist[15] and the Ayn Rand Institute[16] approved and advocated 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. The Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd and edited in London. ... The Ayn Rand Institute: The Center for the Advancement of Objectivism (ARI) was established in 1985, three years after Ayn Rands death, by Leonard Peikoff, Rands legal and intellectual heir. ... Surrogacy is an arrangement whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. ...


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 World Health Organization conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much[9]. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami two years ago. about 100 people, mostly women, sold their kidneys for 40,000-60,000 rupees ($900-$1,350)[10]. 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[11].


Forced donation

This is organ donation that is done against the will of the donor. There have been various accusations that certain authorities are harvesting organs from those the authorities deem undesirable, such as prison populations. The World Medical Association stated that individuals in detention are not in the position to give free consent to donate their organs [12]. Illegal dissection of corpses is a form of body-snatching and may have taken place to obtain allografts. [17] Body-snatching was the secret disinterment of bodies in churchyards to sell them for dissection or anatomy lectures in medical schools. ...


According to the Chinese Deputy Minister of Health, Huang Jiefu, [13] 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. However reports in Chinese media raised concerns if executed criminals are the only source for organs used in transplants.


In October 2007, bowing to international pressure, the Chinese Medical Association agreed on a moratorium of commercial organ harvesting from condemned prisoners, but did not specify a deadline. China agreed to restrict transplantations from donors to their immediate relatives.[14][15]


People in other parts of the world are responding to this availability of organs, and a number of individuals (including US and Japanese citizens) have elected to travel to China or India as medical tourists to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical ways (see later). [18] [19] [20]. Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care. ...


Allocation of donated organs

The overwhelming majority of deceased-donor organs in the United States are allocated by federal contract to the Organ Procurement and Transplantation Network (OPTN), held since it was created by the Organ Transplant Act of 1984 by the United Network for Organ Sharing or UNOS. UNOS does not handle donor cornea tissue. Corneal donor tissue is usually handled by various eye banks. This allocates organs based on the method considered most fair by the scientific leadership in the field. For kidneys, for instance, that is by waiting time; for livers, it is by MELD (Model of End-Stage Liver Disease), an empirical score based on lab values indicative of the sickness of the patient from liver disease. 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 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. If this is not the desired person, it is noted that this puts them higher on the list. Located in Richmond, Virginia, the United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the nations only Organ Procurement and Transplantation Network (OPTN), established by the U.S. Congress in 1984. ... The United Kingdom of Great Britain and Northern Ireland is a country in western Europe, and member of the Commonwealth of Nations, the G8, the European Union, and NATO. Usually known simply as the United Kingdom, the UK, or (inaccurately) as Great Britain or Britain, the UK has four constituent...


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 their 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.[16]


Access to organ transplantation is one reason for the growth of medical tourism. Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care. ...


Organ transplantation in different countries

Demographics

Despite efforts of international transplantation societies, it is not possible to access an accurate source on the number, rates and outcomes of all forms of transplantation globally; the best that we can achieve is estimations. This is not a sound basis for the future and thus one of the crucial strategies for the Global Alliance in Transplantation is to foster the collection and analysis of global data. Image File history File links Emblem-important. ...

Transplantation of organs in different continents/regions year/ 2000

Kidney

(pmp*)

Liver

(pmp)

Heart

(pmp)

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

Source: [21],[22]

Muslims do not donate their organs as they believe their bodies must be intact if they are to enter heaven. [17]


The Spanish Transplant Organization led by Dr Rafael Matesanz claims the highest worldwide rate of 35.1[18] donors per million population in 2005 and 33.8[19] in 2006.


In addition to the citizens waiting for organ transplants in the US 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.


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.


China does 10,000 transplants a year, with sources claiming up to 90% of organs are taken from executed prisoners, without signed consent, since Chinese have taboos against donating organs of deceased family members.[20][21] Amnesty International has criticized this practice, and accused the Chinese of executing people without fair trials.[22] Close relative donations represent only 2% of transplants[citation needed].


In Israel, there is a severe organ shortage due to religious objections by some rabbis, some of whom oppose all organ donations and others who advocate that a rabbi participate all decision making regarding a particular donor. This shortage has resulted in one-third of all heart transplants performed on Israelis being done in the Peoples' Republic of China; others are done in Europe. Dr. Jacob Lavee, head of the heart-transplant unit, Sheba Medical Center, Tel Aviv, believes that "transplant tourism" is unethical and Israeli insurers should not pay for it.[23]


Comparative costs

One of the driving forces for illegal organ trafficking and “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. The Voluntary Health Association of India reports the prospect of such a small fortune has enticed about 2,000 impoverished Indians to sell a kidney every year as the price in India is substantially lower compared to the price in the West [24]. In China, a kidney transplant operation runs for around $70,000, liver for $160,000, and heart for $120,000 [23]. Although these prices are still unattainable to 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.


Safety

Compensation for donors also increases the risk of introducing diseased organs to recipients because these donors often yield from poorer populations unable to receive health care regularly and organ dealers may evade disease screening processes. The majority of such deals include one major payment and no follow up care for the donor. Some cases argue that there is a possibility of 1:18 to acquire HIV from such transplants.[citation needed]


In November 2007, the CDC reported the first-ever case of HIV and Hepatitis C being simultaneously transferred through an organ transplant. The donor was a 38-year-old gay male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients, none of whom had been told he was "high-risk." Experts say that the reason the diseases didn't show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies wouldn't have existed in high enough numbers to detect. The crisis has caused many to call for more sensitive screening tests, which could pick up anitbodies sooner. Currently, the screens cannot pick up on the small number of anitbodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18-21 days before a donation is made.


Organ transplant laws

Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens. Brazil, Italy, Poland and Spain have ruled all adults potential donors with the “opting out” policy, unless they attain cards specifying not to be. Iran is the only country in the world where it is lawful for one citizen to sell an organ to another for transplantation.[citation needed] However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not. The Indian government has had difficulty tracking the flourishing organ black market in their country and have yet to officially condemn it. Other countries victimized by illegal organ trade have implemented legislative reactions. Moldova has made international adoption illegal in fear of organ traffickers. China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent. However, doctors in other countries, such as the United Kingdom, have accused China of abusing its high capital punishment rate. Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China, Ukraine, and India, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking. Some organ deals are also insulated: Japanese citizens living in China can take advantage of Japan’s strict organ transplant laws and sell Chinese organs to Japanese citizens at home.


Starting on May 1, 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.[25]


Ethical concerns

The existence and distribution of organ transplantation procedures in developing countries, while almost always beneficial to those receiving them, raise many ethical concerns. Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of distributive justice. The World Health Organization argues that transplantations promote health, but the notion of “transplantation tourism” has the potential to violate human rights or exploit the poor, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. Regardless of the “gift of life”, in the context of developing countries, this might be coercive. The practice of coercion could be considered exploitative of the poor population, violating basic human rights according to Articles 3 and 4 of the Universal Declaration of Human Rights. There is also a powerful opposing view, that trade in organs, if properly and effectively regulated to ensure that the seller is fully informed of all the consequences of donation, is a mutually beneficial transaction between two consenting adults, and that prohibiting it would itself be a violation of Articles 3 and 29 of the Universal Declaration of Human Rights. A developing country is a country with low average income compared to the world average. ... Ethics is a general term for what is often described as the science (study) of morality. In philosophy, ethical behavior is that which is good or right. ... Distributive justice - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... WHO redirects here. ... Human rights are rights which some hold to be inalienable and belonging to all humans. ... The Universal Declaration of Human Rights (abbreviated UDHR) is an advisory declaration adopted by the United Nations General Assembly (A/RES/217, 10 December 1948 at Palais de Chaillot, Paris). ... The Universal Declaration of Human Rights (abbreviated UDHR) is an advisory declaration adopted by the United Nations General Assembly (A/RES/217, 10 December 1948 at Palais de Chaillot, Paris). ...


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 [26]. Legal death is a legal pronouncement by a qualified person that further medical care is not appropriate, and that a patient should be considered dead under the law. ...


See also

This list of notable organ transplant donors and recipients includes people who were the first to undergo certain organ transplant procedures or were people who made significant contributions to their chosen field and who have either donated or received an organ transplant at some point in their lives, as confirmed... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ... HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... Main article: Allegation of Organ harvesting of Falun Gong practitioners in China ... Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care. ...

References

  1. ^ Mayo Clinic Link
  2. ^ Clint Hallam
  3. ^ Eduard Zirm
  4. ^ Cylex's Immune Function Test, ImmuKnow(R), Identifies Optimal Immune Status For Post-Transplant Therapy
  5. ^ NEW DRUGS in TRANSPLANTATION, EBMT Meeting, France, March 2007 C. PAILLET, Pharmacist, Pharm D. C. RENZULLO, Pharmacist, Pharm D. Edouard Herriot Hospital, Lyon, FRANCE
  6. ^ Restore Sight Organization website
  7. ^ UPI news story
  8. ^ [1]Shopped Liver: The worldwide market in human organs, By William Saletan, Salon, April 14, 2007. Many links.
  9. ^ [2]WHO Says Organ Demand Outstrips Supply, Alexander G. Higgins, Associated Press, March 30, 2007
  10. ^ [3]Indian police probe kidney sales by tsunami victims, By R. Bhagwan Singh, Reuters, Jan 16, 2007.
  11. ^ Ethical and social consequences of selling a kidney, Rothman DJ, JAMA. 2002 Oct 2;288(13):1640-1. [PMID 12350195]
  12. ^ WMA - Policy : Council Resolution on Organ Donation in China
  13. ^ 世界日報──大陸新聞
  14. ^ Pact to block harvesting of inmate organs, Pg 1, South China Morning Post, October 7, 2007
  15. ^ Press release, Chinese Medical Association Reaches Agreement With World Medical Association Against Transplantation Of Prisoners's Organs, Medical News Today, Oct 07 2007
  16. ^ Saved By His Daughter's Heart. Man Dying From Heart Disease Gets Gift From Late Daughter (English). CBS Broadcasting Inc (August 20, 2004). Retrieved on October 10, 2006.
  17. ^ [4]
  18. ^ Organización Nacional de Transplantes, Donantes de órganos en España. Número total y tasa anual (p. m. p.)
  19. ^ Transplant Commission of the Council of Europe, La ONT estima en 94.500 los transplantes de órganos solidos realizados en 2006 en todo el mundo, 28 August 2007.
  20. ^ [5]Wall Street Journal, April 7, 2007, Change of heart: China reconsiders fairness of 'Transplant Tourism'; foreigners pay more for scarce organs; Israelis debate reform, Andrew Batson and Shai Oster.
  21. ^ [6]China admits taking executed prisoners' organs; Demand is high, and supply is low -- except on death row; the nation leads worldwide in capital punishment. By Mark Magnier and Alan Zarembo. Los Angeles Times, November 18, 2006
  22. ^ Amnesty International
  23. ^ [7]Wall Street Journal, April 7, 2007, Change of heart: China reconsiders fairness of 'Transplant Tourism'; foreigners pay more for scarce organs; Israelis debate reform, Andrew Batson and Shai Oster.
  24. ^ Why is organ transplantation cheaper in the East than in the West?
  25. ^ "China issues new rules on organs", BBC, 2007-04-07. Retrieved on 2007-04-07. 
  26. ^ Whetstine L, Streat S, Darwin M, Crippen D. (2005). "Pro/con ethics debate: when is dead really dead?". Critical Care (London, England) 9 (6): 538-42. PMID 16356234. 

Clint Hallam (born in New Zealand) was the first recipient of a human hand transplant. ... Memorial plaque at Eye Clinic in hospital in Olomouc shows the text in the Czech language: . Eduard Konrad Zirm (18 March 1863 - 15 March 1944) was an ophthalmologist who performed the first successful organ transplant¹ on 7 December 1905. ... The South China Morning Post, together with its Sunday edition, the Sunday Morning Post, is the dominant English-language newspaper in Hong Kong, with a circulation of 104,000. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Anthem Ode to Joy (orchestral)  ten founding members joined subsequently observer at the Parliamentary Assembly observer at the Committee of Ministers  official candidate Seat Strasbourg, France Membership 47 European states 5 observers (Council) 3 observers (Assembly) Leaders  -  Secretary General Terry Davis  -  President of the Parliamentary Assembly Rene van der Linden... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... For other uses, see BBC (disambiguation). ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ...

Sources and bibliography

  • Appel, Jacob M. and Fox, Mark D. (2005) Organ Solicitation on the Internet: Every Man for Himself? Hastings Center Report 35(3):14–15.
  • Lock, M. (2002) Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley, CA: University of California Press. ISBN 0-520-22605-4.
  • Morris, PJ. Transplantation — A Medical Miracle of the 20th Century. N Engl J Med 2004;351:2678-80. PMID 15616201.
  • Finn, R. (2000). Organ Transplants: Making the Most of Your Gift of Life. Sebastopol: O'Reilly & Associates. ISBN 1-56592-634-X.
  • Hu, W (2006) A Preliminary Report of Penile Transplantation. Urology Amsterdam: Elsevier.
  • Taylor, James Stacey (2005) Stakes And Kidneys: Why Markets In Human Body Parts Are Morally Imperative. Ashgate Publishing. ISBN 0754641090.
  • Köchler, Hans, ed. (2001). Transplantationsmedizin und personale Identität. Medizinische, ethische, rechtliche und theologische Aspekte der Organverpflanzung. (Transplantation Medicine and Personal Identity. Medical, Ethical, Legal and Theological Aspects of Organ Transplantation / German) Frankfurt a. M. etc.: Peter Lang. ISBN 3-631-38363-0
  • Cherry, Mark J. (2005). Kidney For Sale By Owner: Human Organs, Transplantation, And The Market. Georgetown University Press. ISBN 158901040X.

The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... Hans Köchler (born October 18, 1948 in Schwaz, Tyrol, Austria) is a professor of Philosophy at the University of Innsbruck, Austria. ...

External links

Scientific/academic societies Image File history File links Broom_icon. ...

Journalism

Patented technology The Christian Science Monitor (CSM) is an international newspaper published daily, Monday through Friday. ...

Philanthropy and support

Websites about Illegal Organ Procurement

  • Doctors Against Forced Organ Harvesting
  • BLOODY HARVEST Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China
  • 'Blood Money' National Catholic Register - Organ Trafficking

United States Federally Contracted Services

  • United Network for Organ Sharing
  • International Organ Transplant Donors Organization
  • Organ Transplant survival rates from the Scientific Registry of Transplant Recipients
  • TransWeb (partly outdated)

Websites avocating sale of organs

  • Deadly Shortage - How the federal ban on profit incentive is killing those awaiting organ transplants
  • Organ Donations, Egalitarian Envy, and the High Cost of Busybodies - by Thomas Sowell [Capitalism Magazine]
  • Paying Living Organ Providers - by Shaun Pattinson

Procedural descriptions

  • How Stuff Works description of how organ transplants work
  • Liver Transplant Procedure description - by Children's Hospital of Pittsburgh

Islamic opposition to organ transplantation Children’s Hospital of Pittsburgh is the only hospital is western Pennsylvania dedicated solely to the care of infants, children and young adults. ...

  • [24]

List of organ transplantation web sites

  • Organ transplants-related web sites from Biosites.org


  Results from FactBites:
 
Organ Transplant Policy (3441 words)
Organ transplant surgery has given life where death was once a certainty for tens of thousands of chronically ill Americans.
In 1991, the HHS Inspector General found that the national Organ Procurement and Transplantation network was inequitable, particularly with respect to race and geography, and that it did not meet the intent of the 1984 Act.
Organ Procurement Organizations that have worked hard to obtain transplantable organs are concerned that organs will flow from their state, leaving a shortage.
  More results at FactBites »

 
 

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