ORGAN DONATION AND TRANSPLANTATION

“I wouldn’t have thought of not doing it.  He was my grandson, he needed a liver, and I was a match.  He was born with a severe liver defect, and he needed a new liver.   Seth was three years old, I was 54.  I gave him 24% of my liver, and he is now 12 and healthy.  My liver regenerated inside me,  his new liver grew inside him, and we are both so lucky.”

– Claire, grandmother of Seth.

 

“My heart breaks for the family of the person who died suddenly—I understand it was a car accident—but my daughter Lila has a new heart, saved by the selfless gift of the donor.  I wish I could reach out to them, show them what a gift their loved one gave; perhaps in time I will.  For now I will cherish Lila and the fact that she was not taken by the severe virus that suddenly attacked her heart.  Within days of her illness beginning, we were looking at losing her.  She has a long road of recovery ahead of her, but she is alive and will be well again.”

– Maria, mother of Lila.

Some of us sign our organ donor card on our driver’s license without much thought, unless your life has been touched by the selfless gift of organ donation.  In America, we have an opt-in system for organ donation:  If you choose to be a donor, you indicate this wish on your driver’s license, or through the donor registry at the U.S. Department of Health and Environment, or through Donate Life America at donatelife.net.

Some industrialized countries have an opt-out system for organ donation.  In this system, every citizen is considered a potential donor, unless they complete the paperwork that indicates that they have chosen not to be a donor.   These countries can see rates for potential donors eight times as high as opt-in systems.

In America there are currently about 121,600 people awaiting organ donation.  Up to one third are inactive from time to time due to medical factors.  Typically, 75% of that group is awaiting a kidney.  Because this is the organ most in demand, the wait is typically the longest, averaging about 15 months.  Kidneys are in the highest demand for several reasons:  Advances in kidney dialysis have extended the lives of the patients, with the dialysis patients surviving longer than even before.  Secondly, as the life span in America increases, so too does the prevalence of high blood pressure and diabetes, thus increasing the need for transplanted kidneys.

Those waiting for a heart transplant typically wait three weeks when they are on the priority list, and three months for a pancreas or a liver.

A sensitive and debatable area concerning liver transplants is the issue of providing liver transplants to alcoholics.  Some view this as a disease that should be treated no differently than any other disease, while others feel is should be granted only after a long period of sobriety.

OTHER ETHICAL ISSUES

Organ donation and transplantation is a hotbed of debate on many levels.   For prison inmates, there are several issues.  Typically, the prison environment is a risky environment for communicable diseases, which is part of the reason why, currently, inmates can donate only to family members.  In addition, it is felt that prisoners are not fully liberated to make their own decisions, and thus may decide to donate due to coercion.   For prisoners who are receiving dialysis, the cost to the American prison system is approximately $120,000 per year to the taxpayer.  A kidney transplant would cost the taxpayer approximately $111,000.

In defining actual death, there is a distinction between brain death and cardiac death.  In the United States, the Uniform Declaration of Death Act defined death in the 1980’s as the irreversible cessation of the function of either the brain or the heart and lungs. When a patient is pronounced brain dead, his or her other organs may be functioning at a high level, and could provide optimal opportunities for organ donation.  With cardiac death, however, “irreversible” can be a gray area.  In some cases, a patient can potentially be revived up to 10 minutes after the cardiac arrest, and thus cannot be declared “dead.”

There are religious issues surrounding organ transplantation and donation as well.  All major Christian and Jewish religions see donation and transplantation as a necessary and right thing to do in order to save other’s lives.  Some do impose certain restrictions, while members of other small sects have been known to donate kidneys in large numbers to strangers, because they feel this is the best way to live out The Golden Rule:  Do Unto Others As You Would Have Them Do Unto You.    Other sects disapprove of organ donation and transplantation, and attempt to forbid their members form participating in either.

There is always the issue of organs for sale.  United States law prevents, it, but there was a U.S. citizen who advertised “one functional human kidney” on eBay in September 1999.  Under U.S. law, eBay was obligated to dismiss the auction, but the bidding had reached $5.7 million.  Other countries have legalized sale of organs, with conflicting results.  Unfortunately, there does exist a black market for organs, whereby they are purchased illegally, often harvested from unwilling donors.

Online advertising for organs, as well as billboards posted along busy interstate highways have become a reality.  These attempts typically come with an emotional plea in hopes of a stranger deciding to donate.  These methods are criticized because they undermine the traditional system of list-based allocation of donated organs.

While the damage is already done, the use of organs from a person who committed suicide is unnerving to some.  However, most family members of the suicide victim agree to donate any organs, and for an unknown reason, those who commit suicide have a higher donation rate in place prior to the suicide.  In many cases, the organs can be kept functional and viable with mechanical ventilation, thus providing optimal transplant opportunities.

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Many organs and tissues can be transplanted, including:

ORGANS:

Heart—deceased to donor only

Lung—deceased and living related transplantation

Heart/Lung—deceased donor/domino transplant

Kidney—deceased and living donors

Liver—deceased and living donors

Pancreas—deceased only

Intestine—deceased and living donor

Stomach—deceased donor only

TISSUES, CELLS, FLUIDS:

Hand—deceased donor only

Cornea—deceased donor only

Skin, including face—autograft

Islets of Langerhans (pancreas cells)—deceased 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/living donor; xenograft—pig/cow

Bone—deceased and living donor

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The history of organ donation and transplantation is relatively young, in terms of success:  (Dates indicate successful transplantation unless otherwise noted, though some recipients did not live long-term.)

1823:  1st skin graft/transplantation from one location on an individual’s body to another location on their body, Germany.

1905:  1st cornea transplant, Czech Republic.

1908:  1st skin graft from donor to recipient, Switzerland.

1933:  1st kidney transplant from cadaver donor, though incompatible. USSR

1950:  1st successful cadaver kidney transplant, USA

1954:  1st living related kidney transplant between identical twins, USA.

1955:  1st heart valve transplant from donor, Canada.

1962:  1st kidney transplant from a deceased donor, USA

1966:  1st  pancreas transplant, USA.

1967:  1st  liver transplant, USA.

1967:  1st heart transplant, South Africa.

1981:  1st heart/lung transplant, USA.

1983:  1st lung lobe transplant, Canada.

1986:  1st double lung transplant, Canada.

1998:  1st hand transplant, France.

1998:  USA’s 1st living donor-to-donor liver transplant

1999:  1st tissue-engineered bladder, USA

2005:  1st ovarian transplant, India

2005:  1st partial face transplant, France

2008:  1st baby born from transplanted ovary (country not specified)

2008:  1st transplant of human windpipe with patient’s stem cells, Spain

2010:  1st full facial transplant, Spain

2011:  1st double leg transplant, Spain

2012:  1st robotic parathyroid transplant, USA

2013:  1st urgent life-saving entire face transplant, Poland

2014:  1st uterine transplant resulting in live birth, Sweden.

 

There are several distinctions to be made in transplant terminology:

*Autograft:  transplant of tissue from same person

*Allograft and Allotransplantation:  organ or tissue transplantation between two genetic non-identical of same species.  Most human tissue and organ transplants are of this type.

**Isograft:  a subset of an allograft, whereby organs or tissues are transplanted between two genetically identical humans—typically identical twins.  This eliminates one of the greatest risks, that of rejection due to an immune response, because they are identical in terms of genetics.

Xenograft/xenotransplantation:  Transplantation of organs or tissues from one species to another, typically from porcine (pigs) sources to humans.    The most common is the heart valve transplant.

Split transplants:  in rare cases, an adult liver can be divided between an adult recipient and a child recipient.

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Organ donation and transplantation are continually evolving fields, constantly improving and saving human lives.

Your help is important, please consider becoming an organ donor if you haven’t done so already.  Contact your driver’s license office, or visit donatelife.net, as well as the US Department of Health and Humans Services at hhs.gov.

Please consider this old adage:   You can’t take it with you.