The document discusses deceased organ donation and transplantation. It covers organ sources like living and cadaver donors. Commonly transplanted organs are listed. Principles of transplantation include immune responses and types of rejection. Organ procurement involves removal and preservation. Brain death is required for deceased donation and involves loss of brain stem function. Ethical concerns around donation and a brief history of transplantation are also summarized.

1. Deceased organ donation
Waqas Ali

2. Objectives
• To have a basic idea of solid organ
transplantation
• To know about Organ sources and donor types
• To know about brain death concept and
controversies

3. Solid organ transplantation
• Definition:
– Autograft: The transfer of a tissue or organ from one part
of the body to another within the same person
– Allograft:The transfer of a tissue or organ from one
individual to another individual.

4. Commonly transplanted organs
• Cornea
• Kidneys
• Skin
• Bone marrow
• Heart and heart valves
• Intestine
• Bone
• Lung
• Liver
• Pancreas

5. Principles of transplantation
• Transplant immunology
The immune system recognizes graft from
someone else as foreign and triggers response
via immune cells or substances they produce -
cytokines and antibodies
• Responses are via; recognition, amplification
and memory

6. Key
Stimulates
Gives rise to
+
Memory
Helper T cells
Antigen-
presenting cell
Helper T cell
Engulfed by
Antigen (1st exposure)
+
+
+
+ +
+
Defend against extracellular pathogens/Transplant rejection
Memory
B cells
Antigen (2nd exposure)
Plasma cells
B cell
Secreted
antibodies
Humoral (antibody-mediated) immune response
1/25/2017 bbinyunus2002@gmail.com 6

7. Organ rejections
• Rejection of transplanted organs is a bigger challenge than the technical
expertise required to perform the surgery. It results mainly from HLA and
ABO incompatibility
• Hyperacute: with in seconds to minutes
• Acute: In first six months
• Chronic: After 6 months
• Rejection is controlled by immunosuppression given as
– Induction
– Maintainance
– Rescue agents

8. Organ Donors
Living
-Relative
-Stranger
Cadaver
• Types of Living Donor Transplants
– Kidney (entire organ)
– Liver (segment)
– Lung (lobe)
– Intestine (portion)
– Pancreas (portion)
• After brain death (heart beating donor)
• Kidney
• Heart
• Liver
• Lungs
• Pancreas
• Intestine
• Heart valves
• Connective tissue
• Cadaver (non heart beating donor)
– After natural death
• Cornea
• Bone
• Skin
• Blood vessels

9. Living vs decease transplant
• Improved graft survival
• Less recipient morbidity
• Early function and
easier to manage
• Avoidance long waiting
time for transplant
• Less aggressive
immunosuppressive
regimen
• Relatively inferior graft
survivals
• More immunogenic
• Surgery of recipient is
unscheduled
• More likely to need
future retransplant
• Waiting time is more

10. Contra-indications for living donor
– Mental disease
– Diseased organ
– Morbidity and mortality risk
– ABO incompatibility
– Cross matching incompatibility
– Transmissible disease

11. Councelling
• May involve professional counselors/
psychotherapist
• Aimed at preventing / minimizing possible
complication
• Need for adherence to post-op maintenance
medications
• Regular follow-up with thorough evaluation
• Life style modification; smoking, alcohol,
sedentary life style, junks, excessive salt
ingestion.

12. Informed consent
• Living Donor
– Education
– Willingly not for any financial reason or under
duress
– Most undergo extensive screening – medical
psychological
– Involve family
– Surgery and anesthetic complications

13. Informed consent
• Decease donor
– Some factors influencing refusal to consent by
relatives;
• non-acceptance of brain death.
• Superstitions relating to being reborn with a missing organ
• A delay in funeral
• Lack of consensus within family members
• Fear of social criticism
• Dissatisfaction with the hospital staff
• Religious believes

14. Organ procurement
After removal, the organ is
flushed with chilled organ
preservation solution e.g
University of Wisconsin(UW)
Packaging

15. Non heart beating kidney donation

16. Ischemia duration
Warm ischemic time ; time an organ remains at
body temperature between which the blood
supply is cut off before cold perfusion. (within
30min)
Cold ischemic time ; the time between the
chilling of the organ, after blood supply has
been cut off and the time it is warmed by
reconnection

17. Maximum and optimal cold storage times (approximate)
• Organ Optimal (hours ) Safe
maximum(hours)
• Kidney < 24 48
• Liver < 12 24
• Pancreas < 10 24
• Small intestine < 4 8
• Heart < 3 6
• Lung < 3 8
Assuming zero warm ischemic time and organs obtained from
a non-marginal

18. Brain death
• When brain injury is refractory to aggressive
management and is considered nonsurvivable,
with loss of consciousness and brain stem
reflexes, a brain death protocol may be
initiated to determine death according to
neurological criteria

19. Brain death implications
• Heart-beating, brain-dead donors provide the
majority of organs for transplant.1
• Extended times between terminal brain stem
herniation, declaration of brain death, and
organ recovery risk loss of organs because of
refractory cardiopulmonary instability
• Cost of intensive care
1. United Network of Organ Sharing. 2012 data: spring regional meetings.

20. Lets watch a video

21. Pathophysiology of Brain Injury
• Terminal brain stem herniation is often the final stage in
refractory brain injury caused by trauma, ischemia or
infarction, hemorrhage, intracranial tumors, and infectious
processes such as encephalitis and meningitis
• Progression of injury follows a rostral to caudal path

22. Brain edema + Inc
ICP
Compressed cortex
Compromised
blood flow
Pathological
posturing/ seizures
Transtentorial
herniation
Brainstem
displacement
Cushing response;
HTN, brady, wide
pulse pressure
Sympathetic
outflow; HTN,
tachy,
Vasoconstriction
Catecholamine
depletion

23. Clinical brain stem assessment

26. Confounding factors in brain death
• spinal cord injury,
• movements in brain death (complex spinal
reflexes, muscle fasciculations, ventilator
autotriggering),
• therapeutic hypothermia
• transient brain stem depression after
cardiopulmonary arrest

28. Ethical concerns
• The World Health Organization argues that
transplantations promote health, but the notion of
“transplantation tourism” has the potential to violate
human rights or exploit the poor
• There is also a powerful opposing view, that trade in
organs, if properly and effectively regulated to ensure
that the seller is fully informed of all the
consequences of donation, is a mutually beneficial
transaction between two consenting adults, and that
prohibiting it would itself be a violation of Articles 3
and 29 of the Universal Declaration of Human Rights.

29. History of Organ transplant

30. The Chinese physician Pien Chi'ao reportedly exchanged
hearts between a man of strong spirit but weak will with
one of a man of weak spirit but strong will in an attempt to
achieve balance in each man.

31. • Roman Catholic accounts
report the third-century
saints Damian and
Cosmas as replacing the
gangrenous leg of the
Roman deacon Justinian
with the leg of a recently
deceased Ethiopian.

32. • The first reasonable
account is of the Indian
surgeon Sushruta in
the second century BC,
who used autografted
skin transplantation in
nose reconstruction
rhinoplasty.

33. • Centuries later,
the Italian
surgeon
performed
successful skin
autografts; he also
failed consistently
with allografts

34. • the first successful
human corneal
transplant, a
keratoplastic operation,
was performed by
Eduard Zirm in Austria
in 1905.

35. • Their skillful anastomosis
operations, the new
suturing techniques, laid
the groundwork for later
transplant surgery and
won Carrel the 1912 Nobel
Prize for Medicine or
Physiology

36. • Archibald McIndoe
carried on the work into World War II as reconstructive surgery

37. • The first attempted
human deceased-
donor transplant
was performed by
the Ukrainian
surgeon in the
1930s
Yu Yu Voronoy

38. • the late 1940s Peter
Medawar, working for
the National Institute
for Medica Research,
improved the
understanding of
rejection.

39. • On March 9th 1981 t the
first successful heart-
lung transplant took
place at Stanford
University Hospital. The
head surgeon, Bruce
Reitz, credited the
patient's recovery to
cyclosporine-A.

40. Timeline of successful transpants
• 1905: First successful cornea transplant by Eduard Zirm
• 1954: First successful kidney transplant by Joseph Murray (Boston, U.S.A.)
• 1966: First successful pancreas transplant by Richard Lillehei and William Kelly (Minnesota,
U.S.A.)
• 1967: First successful liver transplant by Thomas Starzl (Denver, U.S.A.)
• 1967: First successful heart transplant by Christiaan Barnard (Cape Town, South Africa)
• 1970: First successful monkey head transplant by Robert White (Cleveland, U.S.A.)
• 1981: First successful heart/lung transplant by Bruce Reitz (Stanford, U.S.A.)
• 1983: First successful lung lobe transplant by Joel Cooper (Toronto, Canada)
• 1986: First successful double-lung transplant (Ann Harrison) by Joel Cooper (Toronto,
Canada)
• 1987: First successful whole lung transplant by Joel Cooper (St. Louis, U.S.A.)
• 1995: First successful laparoscopic live-donor nephrectomy by Lloyd Ratner and Louis
Kavoussi (Baltimore, U.S.A.)
• 1998: First successful live-donor partial pancreas transplant by David Sutherland (Minnesota,
U.S.A.)
• 1998: First successful hand transplant (France)
• 2005: First successful partial face transplant (France)
• 2006: First successful penis transplant (China)

41. Thank you
• References
• Brain Death: Assessment, Controversy, and Confounding Factors
RICHARD B. ARBOUR, RN, MSN, CCRN, CNRN, CCNS
• LIVING DONOR KIDNEY TRANSPLANT
Kelli Willard West, MSSW, APSW Living Donation Outreach Educator
• PRINCIPLES INVOLVED IN ORGAN TRANSPLANT
DR BASHIR YUNUS SURGERY DEPT. AKTH 19/1/15
Wikipedia and google