Organ Transplantation PDF

# Organ Transplantation ## Learning Objectives - Define the term of organ transplantation - List major organs and tissues transplanted - Enumerate types of transplants - Mention tests that are done for all organ transplant candidates - Enumerate postoperative complications in transplantation ##...

# Organ Transplantation ## Learning Objectives - Define the term of organ transplantation - List major organs and tissues transplanted - Enumerate types of transplants - Mention tests that are done for all organ transplant candidates - Enumerate postoperative complications in transplantation ## Definition Organ transplantation 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. Organ donors can be living or deceased (previously referred to as cadaveric). Organs and tissues are removed in procedures similar to surgery, and all incisions are closed at the conclusion of the surgery. People of all ages may be organ and tissue donors. Traditionally, Muslims believe body desecration in life or death to be forbidden, and thus many reject organ transplantation. However most Muslim authorities nowadays accept the practice if another life will be saved. ## History of Organ Transplantation in Egypt Kidney transplantation is carried out in Egypt since the 1970s and cornea transplants since the 1950s. However, efforts to initiate a national organ transplant program have consistently failed in Egypt since the late 1970s. There has been legal opposition to the recognition of "brain-death" as "legal death" and organs are not legally or routinely procured from heart-beating brain-dead patients as they are elsewhere. Patients, family members, physicians, and others in Egypt differ in opinions about whether it is permissible to take a body part from the dead, whether it is a safe or beneficial practice to cut into a healthy # Suitability of the Cadaveric Organ Donor Medical suitability of the organ donor is determined by an assessment of the following donor parameters: - Detailed medical and social history - Complete physical examination - Review of current hospital course - Organ-specific function - Age - Infectious disease status - Screen for malignancy ## Tests That Are Done for All Organ Transplant Candidates Include: - **A cross matches for transplant.** This is a blood test that shows whether the body will reject the donor organ immediately. The cross match will mix a donor's blood with recipient's blood to see whether antibodies attack the antigens of the donor. - **Antibody screen.** A panel-reactive antibody (PRA) test measures whether you have antibodies against a broad range of people, and if you do it means you are at higher risk of having rejection, even if the cross match shows that recipient and the donor are a good match. - **Blood type.** This is a blood test that identifies which type of blood you have - type A, B, O, or AB. Recipient blood type should be compatible with the organ donor's blood type, although it is sometimes possible to transplant an organ from a donor with a different blood type. - **Tissue type.** This is a blood test that identifies the genetic makeup of your body's cells. Each of us has a genetic marker on the surface of our white blood cells. We inherit three # Types of Donors 1. **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 2. **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) 3. **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. 4. **Compensated donation** Compensated donation, donors receive 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. In 2006, Iran became the only country to legally allow individuals to sell their kidneys. 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. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami in December 26, 2004. 5. **Forced donation** This is organ donation that is done against the will being such as prison populations. # Types of Transplants 1. **Autograft** A transplant of a pack 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 for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site. ## Contraindications of Organ Transplantation - Systemic and/or uncontrolled infection. - Active untreated malignancy. - Active alcohol and/or other substance abuse Requires six months of documented alcohol and substance cessation. - Significant uncorrectable life-limiting medical conditions Severe cardiovascular disease. - Neuropsychiatric disorder. - Irreversible severe brain damage. - Extremes of age. - HIV infection. ## 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) ## Other Organs - Kidney (Deceased-donor and Living-Donor) - Liver (Deceased-donor and Living-Donor) - Pancreas (Deceased-donor only) - Intestine (Deceased-donor and Living-Donor) ## Tissues, Cells, Fluids - Hand (Deceased-donor only) - Cornea (Deceased-donor only) - Skin graft including Face replant (autograft) and Face transplant (extremely rare) - Penis (Deceased-donor only) - Islets of Langerhans (Pancreas Islet Cells) (Deceased-donor and Living-Donor) - Bone marrow/Adult stem cell (Living-Donor and Autograft) - Blood transfusion/Blood Parts Transfusion (Living-Donor and Autograft) - Blood vessels (Autograft and Deceased-Donor) - Heart valve (Deceased-Donor, Living-Donor, and Xenograft[Porcine/bovine]) - Bone (Deceased-Donor, Living-Donor, and Autograft) - Skin (Deceased-Donor, Living-Donor, and Autograft) # 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 allograft. 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. # Isograft A subset of allograft in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin). <start_of_image> It is a transplant of organs or tissue from one species to another. Examples include porcine heart valve transplants, which are quite common and successful. Other xenotransplants attempted include piscine-primate (fish to non-human primate) islet (i.e. pancreatic or insular tissue) transplant. # Split Transplants Sometimes, a deceased-donor organ (specifically the 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 Transplantation 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 embolic. As the recipient's native heart is usually healthy, this can then itself be transplanted into someone needing a heart transplant. # Organ Preservation Organ preservation is the ability to maintain exvivo organ viability in addition to the capacity to restore normal organ function at the time of restitution of physiological blood flow, Clinically, when the organ does not regain normal function rapidly after implantation surgery and reperfusion, there is either delayed graft function (DGF) or primary nonfunctional (PNF). Delayed graft function (DGF) is impaired function that eventually returns to normal. On the other hand, graft primary