ORGAN TRANSPLANTATION

Transplantation is the act of surgically removing an organ from one person and placing it into another person. Transplantation occurs because the recipient's organ has failed or has been damaged through illness or injury.
external image organ-transplant-statistic2.gif

The organs that can be transplanted are:

  • Liver (partial or whole)
  • Kidney
  • Pancreas
  • Kidney/pancreas (can be transplanted at the same time)
  • Heart
  • Lung
  • Heart/lung (can be transplanted at the same time)
  • Intestine
  • Cornea

Scientific Aspects:


Types of Transplants

  • Allograft- transplant of organ from genetically non-identical member of the same species
  • Isograft- allograft between identical twins
  • Xenotransplant- transplant of organ from one species to another

Overview of Organ Transplantation
Organ transplants are a feasible option when a particular organ is failing

Living Donors
- people who can spare an extra organ (i.e. kidney and liver portions)
Cadaverous Donors- deceased donor who gives lungs, heart, pancreas, or cornea; usually brain
-dead but on life
support because organs deteriorate quickly after body expires


Part 1: The Surgery

A) Harvesting Procedure [removing heart from donor]


Donor:

  1. Cut open chest
  2. Reveal heart
  3. Clamps vessels to heart
  4. Stops heart with solution
  5. Remove heart and place in preservative chemical in bag
  6. Pack bag in cooler with ice
  7. Rushed to recipient's hospital
Recipient:
  1. Recipient fully anethesized waiting for organ
  2. Wheeled to surgery room covered in sterile cloths only chest exposed
  3. Surgery begins when heart arrives

B) Operating Procedure [transplanting donor heart into recipient]

[Pre-Surgery] Hook IV and inject anticoagulant into bloodstream
  1. Cut open chest
  2. Reveal heart
  3. Heart-lung machine used so surgeons will not disrupt circulation and respiration [releases carbon dioxide, regulate blood temperature]
  4. Surgeons remove the diseased part of the heart, leaving the atria alone
  5. Removes donor's atria and suture donor's heart with recipient's heart together
  6. Suture the blood vessels originally going to the diseased heart to the blood vessels coming out of the donor's heart
  7. Give heart time to adjust letting the machine go on working
  8. Surgeons wrap up with wiring breastbone back together and suturing the chest with dissolving stitches

Takes 5 hours for patient to regain consciousness- a week to recover but a lifetime to make sure the organ continues to function properly

Part 2: Living with New Organ

Ricipients must have continued medical treatment for the rest of their lives because of their immune system's reaction to the transplant. The immune system destroys anything foreign that enters the body in order the prevent anything harmful from entering. The donor organ is made up of completely foreign cells, so the body's immune system will attack it. Surgeons prevent that by making sure the donor and recipient have the same blood and tissue types. Even with a good match though, the body will reject the organ, destroying it a cell at a time. Immunosuppressive drugs are used to prevent organ rejection. (Exception: corneal transplants)

Transplant rejection is when the recipient's immune system attacks a transplanted organ or tissue.

3 types of rejection:
  1. Hyperacute rejection- happens immediately organ's transplanted; antibodies react with the donor's organ because the blood types are imcompatible
  2. Acute rejection- occurs few days after surgery; body has time to recognize the foreign material; normal response to foreign matter
  3. Chronic rejection- gradual rejection lasting over long period of time

Symptoms

  • Organ dysfunctional
  • General discomfort, uneasy feeling
  • Pain or swelling in organ transplant area
  • Fever
  • Also depend on specific organ (i.e. kidney transplant- less urine)

Examining/Testing for Transplant Rejection

  • Feel location of transplanted organ for tenderness
  • Signs like shortness of breathe for heart transplant
  • Biopsy of organ will determine whether it is being rejected

Treatment
Goal: to assure the organ functions properly at the same time supressing the immune system to prevent transplant rejection


  • Many immunosuppressive drugs
  • Dosage depends on patient's status: high dosage when rejection is occurring and lower dosages to prevent rejection from occurring

Complications
  • Loss of function of transplanted organ
  • Infections due to suppressed immune system
  • Side effects of medications

Outlook
Some organs are more successfully transplanted and accepted than other organs. Rejection may be suppressed by immunosuppressive drugs, but the recipients would be dependent on the medicine for the rest of their lifetimes. However, there is a possibility the drugs will fail to prevent rejection.


The Legal Aspects:
All policies and bylaws governing the Organ Procurement and Transplantation Network are developed by the OPTN and considered for final approval by the U.S. Department of Health and Human Services (HHS) under federal regulation governing the OPTN.


The Matching Process in Organ Transplantation contains five steps:
  1. An organ is donated: information is sent concerning medican and genetic information (organ size, condition, blood type, and tissue type)
  2. UNOS generates a list of potential transplant recipients who have medical and biologic profiles compatible with the donor. They are ranked by clinical characteristics and time spent on the waiting list.
  3. The transplant center is notified of an available organ for a patient that is a match.
  4. The transplant team considers the organ for the patient. It bases its acceptance or refusal of the organ upon established medical criteria, organ condition, candidate condition, staff and patient availability and organ transportation. They have only one hour to make its decision.
  5. The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

external image organ-transplant-procedure.gif
There is no set amount of time for how long a patient will have to wait for a donor, and no way to know how long a patient must wait to receive a donor organ.
Factors that affect waiting times are patient medical status, availability of donors in the local area and the level of match between the donor and recipient
.

UNOS policies permit "multiple listing" for waiting lists at Hospitals for Organ Donors. Each hospital has its own criteria for listing patients and may have different rules about patients listing at other hospitals.

The organs are distributed locally first, and if no match is found they are then offered regionally, and then nationally, until a recipient is found. Every attempt is made to place donor organs.

Transplant hospitals in America do not just perform transplantation on US citizens. Patients from other countries may travel here to receive transplants. Once accepted by a UNOS transplant center, international patients receive organs based on the same policies as U.S. citizen
s

If a patient needs a heart transplant, a double lung transplant, a pancreas transplant or a cornea transplant, they will need to get it from a cadaverous (deceased) donor. Usually, acceptable donors are people who are brain dead but on artificial life support. Although they are technically "dead", their body is still functioning, which means the organs remain healthy. Organs deteriorate very quickly after the body itself expires, making them unusable for transplant.

Legislation Impacting Organ and Tissue Donattion
Federal Legislation

l. The Uniform Anatomical Gift Act of 1968
(AGA)
2. The National Organ Transplant Act
3. The Omnibus Budget Reconciliation Act of 1986
4. The Right to Refuse Medical Treatment: The Patient Self Determination Act of 1991

State Legislation
l. State Anatomical Gift Acts
2. Required Request Laws
3. State Laws Regarding Advance Care Directives
àA Living Will
àDurable Powers of Attorney For Health Care
àAdvance Care Medical Directives
4. Presumed Consent Laws


The Ethical Aspects:
  • Organ sources
    • Status: brain-dead, comatose, life support, mentally ill, catatonic, live, etc.
    • Criminals?
  • Procurement system
  • Paying for organs – Recipient? Donor? Insurance?
  • Recipients
    • Repeated recipients
    • Alcoholics, smokers, addicts, criminals, prostitutes, etc.
    • Social status (money?)
    • Prioritization: proximity, need, waiting time, age, or relation?
  • Obligation?
  • Domino transplants – familial amyloidotic polyneuropathy (liver)
  • Xenotransplants
    • Pig heart valve (successful)
    • Baboon heart (failed)
    • Fish islets of Langerhans (experimental)
  • “Unnatural” transplants
    • Brain?
    • Genitalia between genders?
    • Redundant or extraneous organs/systems?
  • Are transplants really worth the
    • Monetary costs?
    • Lifestyle costs?


Bibliography
http://www.lawsmart.com/documents/orgdonr1.shtml</span>
http://www.nlm.nih.gov/medlineplus/organtransplantation.html</span>
http://www.transplantliving.org/beforethetransplant/qa.aspx#matchCrit
http://health.howstuffworks.com/organ-transplant.htm
http://atheism.about.com/library/weekly/aa052302a.htm</span>
http://www.nlm.nih.gov/medlineplus/ency/article/000815.htm#Causes,%20incidence,%20and%20risk%20factors<span




WebsiteURL: http://www.nlm.nih.gov/medlineplus/ency/article/000815.htm#Causes,%20incidence,%20and%20risk%20factors
Name of Reviewer: Rachel Tang

Date of Review: May 28, 2008

Review of Site: The website, “Medline Plus,” concerning an informative all-encompassing view of organ transplant rejections, has a neutral, objective standpoint and has accurate information. Updated by Donald Accetta on 4/28/08, the information presented gives an in-depth analysis of each part of a transplant rejection, the symptoms, causes, prognosis, complications, and more. It explicates each of the categories, and when describing the prognosis, the author does warn the reader of an unpleasant outcome that may occur.
I would recommend my peers to peruse this website based on my positive web evaluation. It provides accurate insight on transplant rejection, and does not in any way influence the reader to any position. It let’s the readers decide for themselves on their standpoint concerning transplant rejections.





WebsiteURL:
[[http://health.howstuffworks.com/organ-transplant.htm%3C/span%3E%3C/span%3E%3C/span%3E%3C/span|http://health.howstuffworks.com/organ-transplant.htm
</span]]>

Name of Reviewer: Emily Schon
Date of Review: May 21, 2008
Review of Site:
Author: Tom Harris
Last Updated in 2008
The website “howstuffworks” concerning organ transplants has accurate information and an objective viewpoint. It explains in depth the different aspects of organ transplantation, consequences, and statistics. The purpose of the information on this website is to inform users on “how organ transplants work”.
Based on my evaluation of this website, I would recommend it to others interested in the topic of Organ Transplantation because it is accurate, informative, and easy to read. Also, the visual aspects of the website are valid and help to enhance the site.

WebsiteURL: http://atheism.about.com/library/weekly/aa052302a.htm<span

Name of Reviewer:Cassidy Stevens


Date of Review:
May 27th, 2008

Review of Site: **Author/Institution: About.com–Atheism/Agnosticism
Although this specific essay is, in fact, a joint review/synopsis of two new books, it provides a brief overview of possible ethical complications resulting from the field of organ transplantation. The information depicted herein is as factually accurate as ethical conjecture can be (which is to say, neither truly accurate nor inaccurate), and although the “institution” responsible for the writing most likely has a religious or philosophical, the writing carefully avoids any statements that might reduce its objectivity. The information itself is designed to provide a background against which the two publications may be critiqued; it is (apparently) not meant to persuade, educate, support, or instruct. It is hardly a complete overview, but it is sufficient for the purposes of sparking further thought and speculation.