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Organ and Tissue Donation and Transplantation
The transplantation of organs is a well-established therapeutic intervention and part and parcel of specialized surgical services in many hospitals all over the world. Organ transplantation entails the surgical replacement of irreparably damaged organs with healthy ones obtained from either living or deceased human or animal sources.
The number of organ transplants around the world is estimated at about 80,000 per year. Survival rates can vary significantly depending on many factors, such as the condition of the organ to implant, organ and receiver compatibility, the health status of the recipient, and so forth. Under satisfactory medical conditions, the rate of successful organ replacements is quite high. For example, survival rates for a patient after heart replacement surgery in the Cedars-Sinai Medical Center, Los Angeles, California, are more than 90#x0025; survival after 1 year and more than 80#x0025; after 3 years. The survival figures for patients after a kidney transplant is on average 97#x0025; after one year and 94#x0025; after 3 years; for transplantation of the liver, patient survival is 85#x0025; after one year and 80#x0025; after 3 years; and for pancreas transplantation it is 97#x0025; after 1 year and 90#x0025; after 3 years. The rate of survival for bone marrow transplantation with donated bone marrow is 73#x0025; after 1 year.
History
The first successful organ transplantation took place in 1954 after a number of years of failed attempts. A kidney transplant was performed at the Peter Bent Brigham Hospital, Boston, Massachusetts, where donor and receiver were identical twin brothers. The recipient lived for 25 years with the transplant. However, for genetically unrelated patients the results were less promising due to the recipient's immune system rejecting the “foreign” organ. Successive trials underscored the importance of a good blood and tissue compatibility between donor and receiver in order to avoid organ rejection. Compatibility guidelines were established and issued.
A major breakthrough in the avoidance of organ rejection was the development of immunosuppression drugs: cyclosporine in 1972 and tacrolimus in 1987. This made possible the transplantation from organs other than kidneys or hearts and the transplant of tissue from living donors, such as bone marrow, with good long-term results.
The Transplantation Process
Cadaveric Organ Donation
A major source of organs for transplantation is deceased people. The most common transplantations are of kidneys, heart, lungs, liver, pancreas, corneas, and also of parts of the intestine.
A transplantation can be divided in two phases, first the extraction of the organ from the donor body and, next, the reinsertion of the organ into the body of the recipient. The lapse of time between the organ extraction and the transplantation of the organ into the patient is of utmost importance because the longer the organ is outside of the body without blood circulation and oxygenation (i.e., ischemic time) the more the organ deteriorates. A heart, for example, extracted from the donor's body, even when kept in appropriate ice-cold fluids, cannot be maintained more than 4 hours. Kidneys can be maintained for up to 36 hours.
The organs are extracted from recently deceased donors or more commonly from brain-dead donors. Brain-dead donors are deceased by reason of their brain and brainstem function being irreversibly damaged (i.e., irreversible loss of consciousness, lack of autonomous respiration and reflexes), but whose blood circulation and respiratory function are artificially sustained.
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- Death, Anthropological Perspectives
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