Organ transplantation

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Organ transplantation

  1. 1. Organtransplantation 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 transplantationByPeterEgorov
  2. 2. Organs that can betransplanted are:Heart Kidneys LiverThymusPancreasLungs Intestine
  3. 3. Tissues that can betransplanted are:Bones Tendons CorneaVeinHeart valves Skin of legSkin offace
  4. 4. •History
  5. 5. 01/01/0300Comos and Damian Allotransplantationin humans was first conceived in the middleages. In this account, the leg of thesacristan Deacon Justinian wasamputated to treat a cancerous lesion.The leg of a recently slain Ethiopian Moorgladiator was retrieved from thebattlefield and transplanted to theamputation site. Cosmos and Damian,twin Arab brothers who were converts toChristianity performed the operations.
  6. 6. First successful Bone GraftFirst successful bone graft documented by JobVan Meeneren.Job van Meekeren (1611 – 6 December 1666,Amsterdam) was a Dutch surgeon. Became asurgeon in Amsterdam in 1635. He showed agreat interest in hand surgery, and interestingis a demonstration of flexor tendon repairs oncorpses by one of his pupils. He wrote a book,which gives a good representation of the stateof the art of surgery in the seventeenth centuryin Amsterdam.01/01/1668
  7. 7. 01/01/1878First Sucessful Human to Human BoneTransplantFirst successful human-to-human bonetransplant. This operation, which used bonefrom a cadaver, remained unusual becausethere was no way to process and preservehuman tissues.
  8. 8. 09/07/1905First successful corneatransplant by Eduard Zirm(18 March 1863 - 15 March 1944), wasborn in Vienna, Austria.That day Zirm first met man blinded in both eyes calledGlogar. At the same time, a boy was brought to his clinicafter an accident that left metal pieces in his eyes. Theattempts to save boys eyes were unsuccessful. Zirmenucleated them and saved the corneas for transplantationinto Glogars eyes. Although complications affected one eye,the other remained clear allowing Glogar to return to work.[
  9. 9. The operation and healing weredifficult at that time because without amicroscope it was impossible to suturethe cornea. Therefore, Zirmsuccessfully used sutures from theoutside. Although eye surgeonsaround the world had beenunsuccessful in the operation inhumans for over a hundred years,parallel advances in anaesthesia andasepsis have also been credited inZirms success.Zirm s method remains the basis forrepairing corneal damage.Eduard Konrad Zirm
  10. 10. December1954Firts KidneytransplantationPioneer medical team thatreceived the 1961 AmoryPrize of the AmericanAcademy of Arts andSciences for bringingkidney transplantation tothe world.Left to right, Drs.Harrison, Merrill andMurray
  11. 11. Dr. Harrison, Joseph E.Murray, John P. Merrill ...Dr. HarrisonJoseph EdwardMurrayJohnPutnamMerrill… and others achieved the first successfulkidney transplant, between identicaltwins. Murray shared the Nobel Prize inPhysiology or Medicine in 1990. In 1971,Dr. Harrison received the PurkinjeMedal from Czechoslovakia. In May1983, he was awarded the Keyes Medalfrom the American Assn.Pioneer medicalteam
  12. 12. 1966The first pancreas transplantationby Richard Lillehei and William Kelly(Minnesota, U.S.A.)A pancreas along with kidney and duodenum wastransplanted into a 28-year-old woman and herblood sugar levels decreased immediately aftertransplantation, but eventually she died threemonths later from pulmonary embolism. In 1979the first living-related partial pancreastransplantation was done.
  13. 13. VladimirPetrovichDemikhovJuly18,1916November22,1998KuliniFarm(VolgogradOblast)Moscow(RussianFederation)
  14. 14. 1947 - The first isolated lung transplantation1948 - The first liver transplantation1951 - The worlds first orthotopic heart transplantwithout the use of cardiopulmonary bypass1952 - The worlds first mammarno-coronary bypasssurgery (1988 - State Prize)1954 - The first transplant second head dogFirst operations in theWorld made by Demichov:1937 - The first artificial heart1946 - The first Heterotopic hearttransplantation1946 - The first transfer complex heart-lung
  15. 15. 1967Christiaan NeethlingBarnard (8 November 1922 –2 September 2001) was a SouthAfrican cardiac surgeon whoperformed the worlds firstsuccessful human-to-humanheart transplant. Following the firstsuccessful kidney transplant in1953, in the United States, Barnardperformed the first kidney transplantin South Africa in October 1967.Christian Barnard all his lifeconsidered Demikhov his teacher.
  16. 16. 1979First successful live-donor partial pancreastransplant by David ESutherland.
  17. 17. First successful ovarian transplantby Dr P N Mhatre (wadia hospitalmumbai,India)2005
  18. 18. 2008First successfultransplantation ofnear total area(80%) of face,(including palate,nose, cheeks, andeyelid by MariaSiemionow(Cleveland, USA)
  19. 19. • Types oftransplantAutograftAllograft and allotransplantationIsograftXenograft and xenotransplantationSplit transplantsDomino transplants
  20. 20. AutotransplantationTransplant of tissue to the same person. Sometimes this isdone with surplus tissue, or tissue that can regenerate, ortissues more desperately needed elsewhere (examplesinclude skin grafts, vein extraction for CABG, etc.)Sometimes an autograft is done to remove the tissue andthen treat it or the person, before returning it (examplesinclude stem cell autograft and storing blood in advance ofsurgery).In a rotationplasty a distal joint is used to replace a moreproximal one, typically a foot and ankle joint is used toreplace a knee joint. The patients foot is severed andreversed, the knee removed, and the tibia joined with thefemur.
  21. 21. AllotransplantationandAllograftAn allograft is a transplant of an organ or tissuebetween two genetically non-identical membersof the same species.Most human tissue and organ transplants areallografts. Due to the genetic difference betweenthe organ and the recipient, the recipientsimmune system will identify the organ as foreignand attempt to destroy it, causing transplantrejection. The Risk of transplant rejection can beestimated by measuring the Panel reactiveantibody level.
  22. 22. IsograftA subset of allografts in which organs ortissues are transplanted from a donor toa genetically identical recipient (such asan identical twin).Isografts are differentiated from othertypes of transplants because while theyare anatomically identical to allografts,they do not trigger an immune response.
  23. 23. XenograftandxenotransplantationA transplant of organs or tissue from one species toanother. An example is porcine heart valve transplant,which is quite common and successful. Another exampleis 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 forpotential human use, if successful. However,xenotransplantion is often an extremely dangerous type oftransplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue.
  24. 24. Split transplantsSometimes a deceased-donor organ,usually a liver, may be divided betweentwo recipients, especially an adult and achild. This is not usually a preferredoption because the transplantation of awhole organ is more successful.
  25. 25. Domino transplantsThis term also refers to a series of living donor transplants in which onedonor donates to the highest recipient on the waiting list and thetransplant center utilizes that donation to facilitate multiple transplants.These other transplants are otherwise impossible due to blood type orantibody barriers to transplantation. The "Good Samaritan" kidney istransplanted into one of the other recipients, whose donor in turn donateshis or her kidney to an unrelated recipient. Depending on the patients onthe waiting list, this has sometimes been repeated for up to six pairs, withthe final donor donating to the patient at the top of the list. This methodallows all organ recipients to get a transplant even if their living donor isnot a match to them.In patients with cystic fibrosis (муковисцидоз), where both lungs needto be replaced, it is a technically easier operation with a higher rate ofsuccess to replace both the heart and lungs of the recipient with those ofthe donor. As the recipients original heart is usually healthy, it can thenbe transplanted into a second recipient in need of a heart transplant.
  26. 26. •Types of donor• Living donor Deceased donorOrgan donors may be living, or brain dead. Brain dead means thedonor must have received an injury to the part of the brain thatcontrols heartbeat and breathing. Breathing is maintained viaartificial sources, which, in turn, maintains heartbeat. Once braindeath has been declared the person can be considered for organdonation. Tissue may be recovered from donors who are cardiacdead. That is, their breathing and heartbeat has ceased. They arereferred to as cadaveric donors. The American Association of TissueBanks estimates that more than one million tissue transplants takeplace in the United States each year.
  27. 27. Living donorIn "living donors", the donor remains aliveand donates a renewable tissue, cell, or fluid(e.g. blood, skin), or donates an organ or part ofan organ in which the remaining organ canregenerate or take on the workload of the restof the organ (primarily single kidney donation,partial donation of liver, small bowel).Regenerative medicine may one day allow forlaboratory-grown organs, using patients owncells via stem cells, or healthy cells extractedfrom the failing organs.
  28. 28. Deceased donorDeceased (formerly cadaveric) are donors who have beendeclared brain-dead and whose organs are kept viable byventilators or other mechanical mechanisms until they canbe excised for transplantation. Apart from brain-stem deaddonors, who have formed the majority of deceased donors forthe last twenty years, there is increasing use of Donationafter Cardiac Death Donors (formerly non-heart beatingdonors) to increase the potential pool of donors as demandfor transplants continues to grow. These organs have inferioroutcomes to organs from a brain-dead donor; however giventhe scarcity of suitable organs and the number of people whodie waiting, any potentially suitable organ must beconsidered.
  29. 29. •Statistics of donationThe Need for Organ Donors in the Greater NewYork Metropolitan AreaMore than 8,200 people are waiting for organtransplants in the New York Organ Donor Networksservice area.Of these, more than 6,400 await kidneys; more than1,400 need livers; and more than 250 need hearts.Others also need pancreas (more than 100), lungs(around 40) and intestine (around 10). Some patientsneed both a kidney and a pancreas (more than 100).
  30. 30. Number of Deceased Organ Donors in theGreater New York Metropolitan Area, theRegion Served by the New York OrganDonor Network: 2004-2011In 2011, there were 264 deceased organ donors in theGreater New York metropolitan area compared with 242in 2010.
  31. 31. Economy Statistics of DonorTop 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
  32. 32. Here are some statistics and factsabout organ donation for people over50Two thirds of the individuals waiting for an organ transplant in 2011 were50 years old or older. That year 2,242 deceased donors were between50–64 years of age. Five hundred and ninety-five deceased donors were65 or older.In 2011, 17,089 of the 28,535—or 59.9%—of the people transplantedwere 50+.According to the 2005 National Survey of Organ and Tissue DonationAttitudes and Behaviors, conducted by The Gallup Organization, 20.13%of people over 65 years of age mistakenly think they are too old todonate 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 peoplebetween 50 and 64 years old on the national waiting list and 21,172people over 65 years old on the national waiting list.
  33. 33. Donation ProblemsIn USA over 78,000 men, women, and children waiting for organtransplants, and 14 of these people die every day while waiting toreceive an organ transplant. There are more than five peoplewaiting for every organ made available by donation.An estimated two in three Americans have not indicated theirwishes about donation. The United Network for Organ Sharingfound slow growth in the number of organs from deceased donors.In 1999, there were a total of 21,715 transplants performed in theUnited States, up 44 percent from 1990.More and more people with HIV and/or hepatitis B and/or hepatitisC are going to need organ transplants, particularly livertransplants.
  34. 34. Problems ofTransplantationThe number of donated organs hasstayed fairly constantover the last few years while the number of peopleneeding organscontinues to increase.Infection. You will be given fairly high doses ofimmunosuppressant medications that will make you moresusceptible to infection. During the first few weeks themost common sites of possible infection are your chest.CMV Infection. This is a viral infection which usuallycomes on about four weeks after transplant. It may causefevers, aches and pains.
  35. 35. Problems ofTransplantationOther possible post operative problems. Include problemsrelated to the flow of bile from your liver, either a possible bileleak or the development of a stricture (narrowing) in one of thebile ducts. There may be problems with flow with the bloodvessels going into the liver.Emotional changes to expect. Not only does transplantationinvolves many physical changes to the body, but it also meansmany emotional changes. It is a tense, anxious time for bothpatient and family while they live through the waiting period,the transplant itself and often a prolonged recovery period.Thedrugs given produce physical side effects that can bedistressing to patients as they face changes in their body imageand can also contribute to increased mood changes.
  36. 36. The future of organtransplantationNo challenge in medicine can be more urgent than the devising of new strategies forreplacing organs. The need for organ replacement not only exceeds by far the supply oforgans available for transplantation, the need is likely to increase dramatically. Theinduction of tolerance to spare transplanted organs and the use of animal organs, i.e.xenotransplantation, could help address this problem but neither appears close toapplication. Here discussed a strategy involving the sequential generation of pleuripotentstem cells, formation of human organs in an adoptive xenogeneic host, the harvesting ofhuman cells, tissues or organs from that host and implantation into the individual fromwhom the stem cells were obtained as one potential way to generate histocompatibleorgans. The promise, limitations and uncertainties of these steps are discussed as well.This approach, while speculative and perhaps unlikely, may lead to development of furthernew technologies and insights, the pursuit of which could provide new approaches toreplacing organ function.

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