Organ transplantation has greatly improved over the last two decades and can save lives by improving quality of life for those with terminal organ failure. Kidneys are the most commonly transplanted organ worldwide. There are several types of transplants including autografts, allografts, isografts, xenografts, and split or domino transplants. Major organs transplanted include heart, lungs, kidneys, liver, and more. Living donors and deceased donors are the main donor types. Proper allocation and preventing rejection are important for successful transplants. Transplantation has a long history and continues to help many but demand still outpaces availability of donor organs.

1. ORGAN
TRANPLANTATION
Chairperson : Dr. P.K.Biswas
Associate Professor, Dept of General Medicine
Speaker : Dr. Shalini Halder
1st year PGT, MD(General Medicine)

2. INTRODUCTION
o Organ transplantations save lives in patients affected by terminal
organ failures and improve quality of life on them. Organ
transplantations have gradually ameliorated in the last two decades
and usually provide excellent results in children and young adults.
o Although solid organ transplant programs activity has been
steadily growing but is still far from global needs, with great
differences among countries. Solid organ transplantations are
essential for developed and mature health care systems.
o Worldwide, kidneys are the most commonly transplanted organs,
followed by liver and then the heart.

3. Types of transplant
 Autograft – transplant of tissue to the same person
e.g. skin grafts, vein extraction for CABG, a distal joint
rotationplasty etc.
 Allograft – allo meaning “other” .Transplant of an
between two genetically non-identical members of the
Allografts can be referred to as “homostatic” if they are
inert when transplanted, such as bone and cartilage.
Cornea, Heart, Heart valves, kidney etc. the recipient's
system identifies the organ as foreign causing
 Isograft – organs or tissues transplanted from a donor
to a genetically identical recipient (identical twin). Does
immune response.

4. Types of transplant(contd.)
 Xenograft – transplant of organs or tissue from one
species to another. E.g. porcine heart valve transplant,
primate (i.e. fish to non-human primate) transplant of
Increased risk of non-compatibility, rejection and
the tissue. The Ganogen Research Institute is studying
transplant human fetal hearts and kidneys into animals
transplantation into human patients to address the
donor organs.
 Split Transplants – sometimes, a deceased-donor
liver) may be divided between two recipients, especially
a child. Usually not preferred because the
organ is more successful.

5. Types of transplant(contd.)
Domino transplants- derived from the dictionary meaning
of “domino effect” or cumulative effect that is produced
sets off a chain of similar events. Domino transplants are
 Simple Living Donor Exchange
Domino Transplantation –
interchange of organs between
multiple donor-recipient pairs
when a single donor-recipient pair
is incompatible.

6. Types of transplant(contd.)
Altruistic Living Non- Directed Organ
Donor Initiated DominoTransplantation –
At times in countries where altruism in
living organ donation is permitted, an
altruistic non- directed living organ donor
enters the domino chain and donates an
organ to the most compatible recipient
among a group of donor recipient
incompatible pairs.

7. Types of transplant(contd.)
 Recipient Facilitated DominoTransplantation –
a person in need of an organ receives a healthy organ from a living donor
or a deceased donor. His own organ which is removed could be healthy or
may have some healthy parts like a part of liver or heart valves.The healthy
organ or the parts of explanted organ are transplanted into other persons
for therapeutic purposes.so, In these cases the patient gets an opportunity
to become a recipient and donor simultaneously.
E.g. In patients suffering from familial amyloidotic polyneuropathy, a
disease where the liver slowly produces a protein that damages other
organs.The recipient's liver can then be transplanted into an older person
for whom the effects of the disease will not necessarily contribute
significantly to mortality.

8. History
SIR PETER MEDAWAR –
Father of transplantation.
He worked on graft rejection and
immune tolerance in 1944 and
showed skin allograft between
two mice are rejected.

9. TIMELINE OF TRANSPLANTS
 The first reasonable account is of the Indian surgeon ‘Sushruta’ in the 2nd century BC,
who used autografted skin transplantation in nose reconstruction. Success or failure of
these procedures is not well documented. Centuries later, in 1869, Carl Bunger
documented the first modern successful skin graft from the inner thigh to the nose.
 First successful cornea transplant by Eduard Zirm in 1905.
 Transplant of a single gonad (testis) from a living donor was carried out in 1926 by a
Russian surgeon Dr. PeterVasilevič Kolesnikov.
 First successful kidney transplant by Dr. Richard H. Lawler in the year 1950.
 successful deceased-donor lung transplant into an emphysema and lung cancer
sufferer in June 1963 by James Hardy.
 Thomas Starzl attempted a liver transplant in the same year, but he was not
successful until 1967.
 First Robotic Alloparathyroid transplant at the University of Illinois Chicago in the
year of 2012.
 First successful uterine transplant resulting in live birth at Sweden in 2014.

10. Major Organs and tissues transplanted
• Chest –
 Heart (deceased-donor only)
Lung (deceased-donor and living-related lung transplantation)
Heart/Lung (deceased-donor and domino transplant)
• Abdomen –
 Kidney (deceased-donor and living-donor)
Liver (deceased-donor and living-donor)
Pancreas (deceased-donor only)
Intestine (deceased-donor and living-donor)
Stomach (deceased-donor only)
Testis (deceased-donor and living-donor)
Penis (deceased-donor only)

11. Major Organs and tissues transplanted(contd.)
• Tissues, cells and fluids –
Hand (deceased-donor only)
Cornea (deceased-donor only)
Skin including face replant (autograft) and face transplant (extremely rare)
Islets of Langerhans (deceased-donor and living-donor)
Bone marrow/Adult stem cell (living-donor and autograft)
Blood transfusion/Blood ProductsTransfusion (living-donor and autograft)
BloodVessels (autograft and deceased-donor)
HeartValve (deceased-donor, living-donor and xenograft
[porcine/bovine])
Bone (deceased-donor and living-donor)

12. Types of donor
 Living donor –
the donor remains alive and donates a renewable
organ or part of an organ. The remaining organ can regenerate
workload of the rest of the organ in them.
e.g. single kidney donation, partial donation of liver, lung lobe,
Deceased donor –
people who have been declared brain-dead and
whose organs are kept viable by ventilators or other
until they can be excised for transplantation. Apart from brain-stem
donors, who have formed the majority of deceased donors, there is increasing
use of donation-after-circulatory-death also. These organs have inferior
outcomes to organs from a brain-dead donors.

13. Allocation of organs
In 1984, the National OrganTransplant
Act (NOTA) was passed which gave way to
the Organ Procurement and
Transplantation Network that maintains
the organ registry and ensures equitable
allocation of organs. The Scientific Registry
of Transplant Recipients was also
established to conduct studies on the
evaluation and clinical status of organ
transplants.

14. Demographics of organ transplantation on India
Fig:Annual trends of liver
transplants in India
Fig: Number of renal transplants
done in different states and union
territories of India from 2012-2014

15. Transplant Rejection
 Hyperacute – within minutes to days after transplantation.
mediated by preformed antibody
 Acute – first few weeks to months. Mediated byT cells.
 Chronic – over months to years. Secondary to B andT cell process or
nonimmune causes(drug toxicity, cardiovascular comorbid diseases)

16. Liver transplantation
 Indication –
• viral hepatitis B,C
• alcoholic, cryptogenic cirrhosis
• primary biliary cirrhosis
• primary sclerosing cholangitis
• autoimmune hepatitis
• malignancy
 contraindications –
• Uncontrolled bacterial and fungal
infections
• failure of another organ if that organ
cannot be replaced or expected to recover

17. Liver transplantation(contd.)
• portopulmonary hypertension
• not meeting MILAN criteria(single nodule of <5cm,<3 in number,largest
nodule <3cm of size).
 complications –
• infections
• Hepatic artery thrombosis
• Portal venous thrombosis
• Bile duct stricture or leakage

18. kidney tranplantation
 Indication –
• ESRD GFR <15 ml/L
• Malignancy
• Polycystic kidney disease
• Autoimmune conditions – lupus
nephritis, goodpastures syndrome
 contraindication –
• Severe cardiac and pulmonary
disease
• Active infection

19. kidney transplantation(contd.)
once the kidney is procured, it has to be transported to the
respective transplantation centres by the organ procurement
organisation(OPO). The predominant storage solution used is UNIVERSITY
OF WISCONSIN SOLUTION(VIASPAN). It is composed of –
• Adenosine
• Lactobionic acid
• KOH, NaOH
• Allopurinol
• Monopotassium phosphate
• Hydroxytethylstarch
• Glutathione
• Raffinose
• MgSO4
• Insulin
• Dexamethasone
• Bactrim

20. Heart and Lung transplantation
 Heart transplantation is indiacated in patients of refractory heart
failure owing to cardiomyopathy, CAD, congenital heart disease,
valvular heart disease etc. The highest survival noted among young
and paediatric patients.
 The main indication for lung transplantation is respiratory
insufficiency secondary to idiopathic pulmonary fibrosis, COPD and
cystic fibrosis. A new organ allocation scheme LAS(Lung Allocation
Score) introduced 7 years ago, which takes into account the risk in a
patient without transplant and post transplant.
 Major indications of heart-lung transplantation are congenital heart
disease, PAH and cystic fibrosis. Recipients who survive the first year
have generally good outcomes, with a half-life of 10 years.

21. conclusion
The organs from 1 donor can save or
help as many as 50 people. People of any
age or background can donate organ. For a
donor of less than 18 years of age the
parents or legal guardian needs to give
written consent. An adult person himself
can give consent by signing a donor
card.but of course he should let the family
members know about the wishes.

22. Thank you