History

Organs and tissues transplanted

Types of transplant
Types of donor
Allocation of donated organs
Reasons for donation and ethical issues
Statistics and future of transplantation
By
Peter
Egorov
Organs that can be
transplanted are:
Heart

Kidneys
Liver Thymus
Pancreas Lungs Intestine
Tissues that can be
transplanted are:
Bones
Tendons Cornea
Vein
Heart valves
Skin of leg
Skin of
face

01/01/0300
Comos and Damian Allotransplantation
in humans was first conceived in the middle
ages. In this account, the leg of the
sacristan Deacon Justinian was
amputated to treat a cancerous lesion.
The leg of a recently slain Ethiopian Moor
gladiator was retrieved from the
battlefield and transplanted to the
amputation site. Cosmos and Damian,
twin Arab brothers who were converts to
Christianity performed the operations.

First successful Bone Graft
First successful bone graft documented by Job
Van Meeneren.
Job van Meekeren (1611 6 December 1666,
Amsterdam) was a Dutch surgeon. Became a
surgeon in Amsterdam in 1635. He showed a
great interest in hand surgery, and interesting
is a demonstration of flexor tendon repairs on
corpses by one of his pupils. He wrote a book,
which gives a good representation of the state
of the art of surgery in the seventeenth century
in Amsterdam.
01/01/1668
01/01/1878
First Sucessful Human to Human Bone
Transplant
First successful human-to-human bone
transplant. This operation, which used bone
from a cadaver, remained unusual because
there was no way to process and preserve
human tissues.
09/07/1905
First successful cornea
transplant by Eduard Zirm
(18 March 1863 - 15 March 1944), was
born in Vienna, Austria.
That day Zirm first met man blinded in both eyes called
Glogar. At the same time, a boy was brought to his clinic
after an accident that left metal pieces in his eyes. The
attempts to save boy's eyes were unsuccessful. Zirm
enucleated them and saved the corneas for transplantation
into Glogar's eyes. Although complications affected one eye,
the other remained clear allowing Glogar to return to work.[
The operation and healing were
difficult at that time because without a
microscope it was impossible to suture
the cornea. Therefore, Zirm
successfully used sutures from the
outside. Although eye surgeons
around the world had been
unsuccessful in the operation in
humans for over a hundred years,
parallel advances in anaesthesia and
asepsis have also been credited in
Zirm's success.
Zirm 's method remains the basis for
repairing corneal damage.
Eduard Konrad Zirm
December
1954
Firts Kidney
transplantation
Pioneer medical team that
received the 1961 Amory
Prize of the American
Academy of Arts and
Sciences for bringing
kidney transplantation to
the world.
Left to right, Drs.
Harrison, Merrill and
Murray
Dr. Harrison, Joseph E.
Murray, John P. Merrill ...
Dr. Harrison
Joseph Edward
Murray
John
Putnam
Merrill
and others achieved the first successful
kidney transplant, between identical twins.
Murray shared the Nobel Prize in
Physiology or Medicine in 1990. In 1971,
Dr. Harrison received the Purkinje Medal
from Czechoslovakia. In May 1983, he
was awarded the Keyes Medal from the
American Assn.
Pioneer medical
team
1966
The first pancreas transplantation
by Richard Lillehei and William Kelly
(Minnesota, U.S.A.)
A pancreas along with kidney and duodenum was
transplanted into a 28-year-old woman and her
blood sugar levels decreased immediately after
transplantation, but eventually she died three
months later from pulmonary embolism. In 1979
the first living-related partial pancreas
transplantation was done.
Vladimir Petrovich
Demikhov
July
18,
1916
November
22,
1998
Kulini
Farm
(Volgograd
Oblast)
Moscow
(Russian
Federation)
1947 - The first isolated lung transplantation
1948 - The first liver transplantation
1951 - The world's first orthotopic heart transplant
without the use of cardiopulmonary bypass
1952 - The world's first mammarno-coronary bypass
surgery (1988 - State Prize)
1954 - The first transplant second head dog
First operations in the
World made by Demichov:
1937 - The first artificial heart
1946 - The first Heterotopic heart
transplantation 1946 - The
first transfer complex heart-lung
1967
Christiaan Neethling
Barnard (8 November 1922
2 September 2001) was a South
African cardiac surgeon who
performed the world's first
successful human-to-human
heart transplant. Following the first
successful kidney transplant in
1953, in the United States, Barnard
performed the first kidney transplant
in South Africa in October 1967.
Christian Barnard all his life
considered Demikhov his teacher.
1979
First successful live-
donor partial pancreas
transplant by David E
Sutherland.
First successful ovarian transplant
by Dr P N Mhatre (wadia hospital
mumbai,India)
2005
2008
First successful
transplantation of
near total area
(80%) of face,
(including palate,
nose, cheeks, and
eyelid by Maria
Siemionow
(Cleveland, USA)

Autograft
Allograft and allotransplantation
Isograft
Xenograft and xenotransplantation
Split transplants
Domino transplants
Autotransplantation
Transplant of tissue to the same person. 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 an autograft 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).
In a rotationplasty a distal joint is used to replace a more
proximal one, typically a foot and ankle joint is used to
replace a knee joint. The patient's foot is severed and
reversed, the knee removed, and the tibia joined with the
femur.
Allotransplantation
and
Allograft
An allograft is a transplant of an organ or tissue
between two genetically non-identical members of
the same species.
Most human tissue and organ transplants are
allografts. Due to the genetic difference between
the organ and the recipient, the recipient's
immune system will identify the organ as foreign
and attempt to destroy it, causing transplant
rejection. The Risk of transplant rejection can be
estimated by measuring the Panel reactive
antibody level.
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 do not trigger an immune response.
Xenograft
and
xenotransplantation
A transplant of organs or tissue from one species to
another. An example is porcine heart valve transplant,
which is quite common and successful. Another example
is attempted piscine-primate (fish to non-human primate)
transplant of islet (i.e. pancreatic or insular tissue) tissue.
The latter research study was intended to pave the way for
potential human use, if successful. However,
xenotransplantion is often an extremely dangerous type of
transplant because of the increased risk of non-
compatibility, rejection, and disease carried in the tissue.
Split transplants
Sometimes a deceased-donor organ,
usually a liver, may be divided between
two recipients, especially an adult and a
child. This is not usually a preferred
option because the transplantation of a
whole organ is more successful.
Domino transplants
This term also refers to a series of living donor transplants in which one
donor donates to the highest recipient on the waiting list and the
transplant center utilizes that donation to facilitate multiple transplants.
These other transplants are otherwise impossible due to blood type or
antibody barriers to transplantation. The "Good Samaritan" kidney is
transplanted into one of the other recipients, whose donor in turn donates
his or her kidney to an unrelated recipient. Depending on the patients on
the waiting list, this has sometimes been repeated for up to six pairs, with
the final donor donating to the patient at the top of the list. This method
allows all organ recipients to get a transplant even if their living donor is
not a match to them.
In patients with cystic fibrosis (), where both lungs need
to be replaced, it is a technically easier operation with a higher rate of
success to replace both the heart and lungs of the recipient with those of
the donor. As the recipient's original heart is usually healthy, it can then
be transplanted into a second recipient in need of a heart transplant.

Living donor

Deceased donor
Organ donors may be living, or brain dead. Brain dead means the
donor must have received an injury to the part of the brain that
controls heartbeat and breathing. Breathing is maintained via
artificial sources, which, in turn, maintains heartbeat. Once brain
death has been declared the person can be considered for organ
donation. Tissue may be recovered from donors who are cardiac
dead. That is, their breathing and heartbeat has ceased. They are
referred to as cadaveric donors. The American Association of Tissue
Banks estimates that more than one million tissue transplants take
place in the United States each year.
Living donor
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).
Regenerative medicine may one day allow for
laboratory-grown organs, using patient's own
cells via stem cells, or healthy cells extracted
from the failing organs.
Deceased donor
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 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.
Statistics of donation
The Need for Organ Donors in the Greater New
York Metropolitan Area
More than 8,200 people are waiting for organ
transplants in the New York Organ Donor Network's
service area.
Of these, more than 6,400 await kidneys; more than
1,400 need livers; and more than 250 need hearts.
Others also need pancreas (more than 100), lungs
(around 40) and intestine (around 10). Some patients
need both a kidney and a pancreas (more than 100).

Number of Deceased Organ Donors in the
Greater New York Metropolitan Area, the Region
Served by the New York Organ Donor Network:
2004-2011
In 2011, there were 264 deceased organ donors in the
Greater New York metropolitan area compared with 242
in 2010.
Economy Statistics of Donor
Top 10 countries:
# 1 USA $23,530,000,000.00
# 2 UK $12,460,000,000.00
# 3 France $10,600,000,000.00
# 4 Germany $10,440,000,000.00
# 5 Japan $ 7,500,000,000.00
# 6 Netherlands $ 5,452,000,000.00
# 7 Sweden $ 3,955,000,000.00
# 8 Canada $ 3,900,000,000.00
# 9 Spain $ 3,814,000,000.00
#10 Italy $ 3,641,000,000.00
Here are some statistics and facts
about organ donation for people over
50
Two thirds of the individuals waiting for an organ transplant in 2011 were
50 years old or older. That year 2,242 deceased donors were between
5064 years of age. Five hundred and ninety-five deceased donors were
65 or older.
In 2011, 17,089 of the 28,535or 59.9%of the people transplanted
were 50+.
According to the 2005 National Survey of Organ and Tissue Donation
Attitudes and Behaviors, conducted by The Gallup Organization, 20.13%
of people over 65 years of age mistakenly think they are too old to donate
an organ while 11.73% believe they are too old to receive one.
As of April 13, 2012, according to OPTN, there are 51,718 people
between 50 and 64 years old on the national waiting list and 21,172
people over 65 years old on the national waiting list.
Donation Problems
In USA over 78,000 men, women, and children waiting for organ
transplants, and 14 of these people die every day while waiting to
receive an organ transplant. There are more than five people
waiting for every organ made available by donation.
An estimated two in three Americans have not indicated their
wishes about donation. The United Network for Organ Sharing
found slow growth in the number of organs from deceased donors.
In 1999, there were a total of 21,715 transplants performed in the
United States, up 44 percent from 1990.
More and more people with HIV and/or hepatitis B and/or hepatitis
C are going to need organ transplants, particularly liver
transplants.
Problems of
Transplantation
The number of donated organs hasstayed fairly constant
over the last few years while the number of people
needing organscontinues to increase.
Infection. You will be given fairly high doses of
immunosuppressant medications that will make you more
susceptible to infection. During the first few weeks the
most common sites of possible infection are your chest.
CMV Infection. This is a viral infection which usually
comes on about four weeks after transplant. It may cause
fevers, aches and pains.
Problems of
Transplantation
Other possible post operative problems. Include problems
related to the flow of bile from your liver, either a possible bile
leak or the development of a stricture (narrowing) in one of the
bile ducts. There may be problems with flow with the blood
vessels going into the liver.
Emotional changes to expect. Not only does transplantation
involves many physical changes to the body, but it also means
many emotional changes. It is a tense, anxious time for both
patient and family while they live through the waiting period,
the transplant itself and often a prolonged recovery period.The
drugs given produce physical side effects that can be
distressing to patients as they face changes in their body image
and can also contribute to increased mood changes.
The future of organ transplantation
No challenge in medicine can be more urgent than the devising of new strategies for
replacing organs. The need for organ replacement not only exceeds by far the supply of
organs available for transplantation, the need is likely to increase dramatically. The
induction of tolerance to spare transplanted organs and the use of animal organs, i.e.
xenotransplantation, could help address this problem but neither appears close to
application. Here discussed a strategy involving the sequential generation of pleuripotent
stem cells, formation of human organs in an adoptive xenogeneic host, the harvesting of
human cells, tissues or organs from that host and implantation into the individual from
whom the stem cells were obtained as one potential way to generate histocompatible
organs. The promise, limitations and uncertainties of these steps are discussed as well. This
approach, while speculative and perhaps unlikely, may lead to development of further new
technologies and insights, the pursuit of which could provide new approaches to replacing
organ function.