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The History of Transplantation

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    The history of transplantation is an epic journey describing the medical community’s need to understand how the human body works and how you can ultimately defy illness and death. The most important component is the generosity of organ and tissue donors, and the courage of those whom receive the transplant. Transplantation goes back many Centuries, in the 9th Century BC Ancient folklore in most cultures describe how supernatural forces weave together body parts from different animals.

    Then in the 4th Century BC Chinese texts describe Tsin Yue-Jen, a surgeon who switches the hearts of two soldiers; these accounts say that both soldiers survived, but give no reason for the transplant. This is the first known description of body-to-body transfer. In the 3rd Century AD according to Christian mythology Saints Cosmos and Damian replace a patient’s leg with that of a cadaver. This is the first description of the body of a dead person helping a living person.

    In the 1600’s William Harvey documents the human circulatory system, the first transfusion of blood which was from a lamb to a 15 year old boy was documented and the first bone transplant was documented where they used bone from a dog’s skull to repair a defect in a Russian soldier’s skull. In the 1800’s there is record of the first Human-To-Human blood transfusion, the first successful Human-To-Human bone transplant, first reported use of skin graft, and first attempts at bone marrow transplant.

    In the 1900’s much more successes have occurred in transplantation, such as, first successful cornea transplant, first transplant of a knee, first animal to human kidney transplant, first successful human-to-human kidney transplant, first functional blood bank, first eye bank, first bone bank, first heart valve and artery transplants, first successful liver transplant, first U. S. heart transplant, first successful single lung transplant, first heart/lung combined transplant, first intestine transplant, first split-liver transplant, first hand transplant, and first partial face transplant.

    As you can see there have been a great number of improvements that have helped in the success of transplantation. In 1983 the Food and Drug Administration approved the use of cyclosporine which can improve transplant outcomes as its immunosuppressive qualities lessons the potential for organ rejection. In 1987 Medicare approved payment for heart transplants performed at hospitals that meet criteria set by the Health Care Financing Administration (Now Centers for Medicare and Medicaid Services).

    In 1999 the Organ Donor Leave Act was passed by Congress to allow federal employees to receive paid leave and serve as a living organ or marrow donors. In 2001 the number of living donors exceeded the number of deceased donors for the first time. In 2006 Donate Life America launched its Donor Designation Collaborative to increase the total number of registered donors in the U. S. to 100 million, and in 2009 the End The Wait! Campaign launched by the National Kidney Foundation to increase organ donation and eliminate the Kidney waiting list.

    In response to the shortage of organs for transplantation, relatives, friends, loved ones and even individuals who wish to remain anonymous may serve as living donors for the more than 100,000 people on the national organ transplant waiting list. During each of the past five years, more than 6,200 transplants were made possible by living donors. A living donor can save and/or greatly improve the quality of life of a transplant of a transplant candidate. However donating an organ is a personal decision that should only be made after you are fully informed about the possible risks and benefits.

    There are different types of living donor transplants by organ types: Kidney (entire organ), Liver (segment), Lung (lobe), Intestine (section), and Pancreas (portion). A Directed donation: Biologically-related donors are blood relatives, such as parents, brothers/sisters, and adult children. Unrelated donors can include people who have some type of social connection with a transplant candidate, such as a spouse or significant other, friend, or coworker. Other unrelated donors may be acquaintances or even strangers who have learned about a transplant candidate.

    A Non-Directed Donation is one that the individual donates to an anonymous candidate on the national waiting list. Some of these donors may eventually meet the transplant recipients, but only if both parties agree. Who can be a living donor? Living donors should be in overall physical and mental health and free from uncontrolled high blood pressure, diabetes, cancer, HIV/AIDS, hepatitis, and organ diseases. Most living donors are older than 18 years of age and compatible with the intended transplant candidate.

    Since some donor health conditions can prevent the donation and transplant from being successful, it is important that you share all information about your physical and mental health. You must be fully informed of the risks involved and complete a full medical and psychosocial evaluation. Your decision to serve as a donor should be completely voluntary and free of pressure and guilt. A living donor cannot be paid for the donated organ because it is illegal under the National Organ Transplant Act of 1984.

    However, living donors may receive reimbursement for certain expenses related to the donation process. You would talk to a social worker or financial coordinator at the transplant center to find out about these possible reimbursements. Some of the tests that you may have to complete to be a living donor include: 1) Blood test to check blood type compatibility between you and the candidate, Tissue typing: this blood test checks the tissue compatibility between you and the transplant candidate, Crossmatching: this test determines how the transplant candidate will react to your organ.

    A “positive” crossmatch means that your organ is Incompatible with the candidate. A “negative” crossmatch means that your organ is compatible with the candidate. An Antibody Screen: when a foreign substance (antigen) enters a person’s body, a protein substance (antibody) is created in response to that antigen. (Blood from transfusions and viruses are examples of antigens). Results of this test will show if the transplant candidate has antibodies in his/her body that would react to your antigens. The last blood test would be to screen for transmissible diseases: these tests determine if ou have HIV/AIDS, hepatitis, cancer, and other transmissible diseases. 2) Urine Tests: a 24-hour urine sample is collected to look at your kidney function.

    3) Chest X-Ray and electrocardiogram (EKG): these tests screen for heart and lung disease. Depending upon your age and medical history, other heart and lung tests may be needed. 4) Radiologic testing: these tests help physicians view the organ you want to donate, including its blood vessel supply. They can include a CAT scan, MRI, and arteriogram. ) Psychosocial and/or psychological evaluation: this tool assesses your mental health, whether you feel pressure from others to donate, your ability to understand information and make an informed decision, and your daily life circumstances (such as the possible impact on your job, whether you would have any help while recovering from donation, and your family’s views about the donation). 6) Gynecological examination: female donors may receive a gynecological examination. 7) Cancer screening: these tests may include a colonoscopy, mammogram, prostate exam, and skin cancer screening.

    Your transplant team will determine your individual needs. The qualifications for a non-living donor: soon after a registered patient dies the organs are immediately harvested and kept cold to delay the decaying process, while it becomes registered for the waiting list. The longer the organ is outside the body without a fresh supply of blood the less chance the organ will be accepted once transplanted into the candidate. Normally the harvested organ must be transplanted within hours, each organ has an amount of time in which the organ must be transplanted or the organ would no longer be viable.

    All previous qualifications would still apply to the deceased donor. There are many dark sides to organ donation and transplantation. While these procedures improve and save the lives of millions each year, sometimes the donors face a steep price for their kindness. Millions of people die each year simply because the organ they need is not available, not available fast enough, or worst of all-not in their price range. Desperation always creates opportunity, even in situations of life and death that does not change.

    Cons of being an individual donor include but are not limited to: Physical isks before and after the surgery: There is a risk of injury or death with any surgical procedure, chance of infection, higher risk of long-term health conditions are a possibility with some donations, and painful scars or scar tissue. Mental issues before and after the surgery: Organ donation is a wonderful, but huge decision, People need to be sure that they are doing this for the right reasons, The donation will affect the donor mentally and emotionally; as well as physically, donors may suffer remorse, When someone gives up part of themselves it does change who they are.

    Potential financial burden for self or family: Donor may need to take time off from work, Pay for surgery related or aftercare medications, pay a percentage of surgery expenses out of pocket, suffer unforeseen side effects related to donation that call for long-term care, and possible effects on life insurance policies. Potential issues with phantom pain: some donors do not experience the phenomenon of phantom pain at all.

    Others find it to be an annoyance that passes soon after surgery. Some donors however, suffer through this pain for the rest of their lives; it prevents them from living, functioning and working normally. Though it is rare overall it is a big enough problem that there has been a fund set up to help compensate those donors that suffer from this condition.

    And limitations one may face after some types of donations: Certain donations limit a donor’s future career opportunities, donors may no longer be able to participate in certain strenuous leisure activities that they enjoy, each organ, or section of organ that is donated has its own limiting qualities. Pros of organ donation include but are not limited to: Eye donors can still be accepted to donate their bodies to medical research. Previous medical conditions do not automatically preclude a person from donating their organs.

    Transplant professionals will evaluate the condition of your organs at the time of death, No age limit, Organ donation can save lives, organ donation is consistent with the beliefs of most religions, organ donation is highly admirable and responsible, 95% of eye donations enable the receiver to see again, sharing of life gratitude and love, you may save up to 8 lives through organ donation and enhance many others through tissue donation, Both state and federal legislation has been put in place to provide the safest and most equitable system for allocation, distribution and transplantation f organs. The transplant team includes: The Clinical Transplant Coordinators they have the responsibility for the patients evaluation, treatment, and follow-up care. The Transplant Physicians are the doctors who manage the patient’s medical care, tests and medications. He or she does not perform surgery. The transplant physician works closely with the transplant coordinator to coordinate the patients care until transplanted, and in some centers, provide follow-up care to the recipient. The Transplant Surgeons perform the transplant surgery and may provide the follow-up care for the recipient.

    The transplant surgeon has special training to perform transplants. The Financial Coordinators have detailed knowledge of financial matters and hospital billing. The financial coordinator works with other members of the transplant team, insurers, and administrative personnel to coordinate and clarify the financial aspects of the patients care before, during, and after the transplant. The Social Workers help the patient and their families understand and cope with a variety of issues associated with a patient’s illness and/or the various side effects of the transplant itself.

    In some cases, the social worker may perform some of the financial coordinators duties as well. How long a patient waits depends on many factors. These can include: Blood Type (Some are rarer than others), Tissue Type, Height and Weight of transplant candidate, size of donated organ, Medical urgency, Time on waiting list, The distance between the recipients hospital and the potential donor organ, How many donors there are in the local area over a period of time, and the transplant center’s criteria for accepting organ offers.

    There are many reasons for transplants according to what organ it is: reasons for a pancreas transplant can include: retransplant or graft failure, diabetes mellitus Type l or Type ll, diabetes secondary to chronic pancreatitis without pancreatectomy, diabetes secondary to cystic fibrosis without pancreatectomy, pancreatic cancer, bile duct cancer, other cancers, and pancreatectomy prior to pancreas transplant.

    Reasons for a kidney transplant can include: glomerular disease, diabetes, polycystic kidneys, hypertensive nephrosclerosis, Reno vascular and other vascular diseases, congenital, rare familial, and metabolic disorders, tubular and interstitial diseases, neoplasm’s. Retransplant or graft failure, and other. Reasons for liver transplants include: non-cholestatic cirrhosis, cholestatic liver disease/cirrhosis, biliary atresia, acute hepatic necrosis, metabolic diseases, malignant neoplasms, and other.

    Children have different reasons than adults, which include: cholestatic diseases, metabolic diseases, fulminant liver failure, chronic active hepatitis, malignancy, Budd Chiari Syndrome, Tramua, Caroli’s disease, urea cycle defects, Crigler-Najjar. Tyrosinemia, cystic fibrosis, and retransplantation. Reasons for heart transplants include: cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease, retransplant or graft failure, and other.

    Reasons for Lung and heart/lung transplants include: congenital disease, emphysema/COPD, cystic fibrosis, idiopathic pulmonary fibrosis, primary pulmonary pulmonary hypertension, Alpha-1-antitrypsin deficiency, retransplant, graft failure, and other. Reasons for intestine transplants include: short gut syndrome and functional bowel problems. Organ transplantation is an effective therapy for end-stage organ failure and is widely practiced around the world. According to WHO, kidney transplants are carried out in 91 countries.

    Around 66,000 kidney transplants, 21,000 liver transplants, and 6,000 heart transplants were performed globally in 2005. The access of patients to organ transplantation, however, varies according to their national situations, and is partly determined by the cost of health care, the level of technical capacity, and most importantly, the availability of organs. The problem is that the shortage of organs is virtually a universal problem. In some countries, the development of a deceased organ donation program is hampered by socioculture, legal and other factors.

    Even in developed countries, where rates of deceased organ donation tend to be higher than in other countries, organs from this source fail to meet the increasing demand. The use of liver donors for kidney and liver transplantation is also practiced, but the purchase and sale of transplant organs from live donors are prohibited in many countries. There have been some successes fighting organ trafficking around the world, but organ trafficking continues to flourish because criminals exploit shortages of organ donors.

    This implies that as long as there is an organ shortage there will always be criminals to exploit the desperate and helpless. Currently the majority of organ selling is occurring in third world countries, and the buyers come from all around the world when they find out they will not be getting what they need. The intermediaries that carry out the legwork, are often transferring between two to three countries to create barriers between governments, so that they can carry on their business without government intervention.

    Organ trafficking is on the rise, as desperate people seek transplants in a world that does not have enough donors. About 5,000 people sell organs on the black market each year. These are only the ones that have been successfully tracked. Increasing the number of organ and tissue donors is a key strategy for increasing transplant rates in Canada, and is one of the easiest for the public to relate to and act upon. But it overshadows a much bigger troubling issue.

    The current organ and tissue donation and transplantation (OTDT) system is failing Canadians. Despite the goodwill of potential donors, and the tremendous efforts of those who work in the field of donation and transplantation, the lack of a national, integrated system prevents significant progress. This is a viable option to reduce black market sales and to make the organ transplants more successful and insure they are carried out in a safe environment.

    There are dangers to having organ sales being legal, but are they any worse than the dangers posed by the current laws? If black market trade of organs and the killing of innocent people for harvesting can be reduced by making organ sales legal, should we do it then? These are just a couple of questions that could start the government agencies talking to make changes in the laws that govern organ transplantation and issues with the involvement of the black market with those who are desperate to survive.

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    The History of Transplantation. (2017, Jan 16). Retrieved from

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