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"Transplant" redirects here. For botanical transplants, see Transplanting. In Agriculture and Gardening, transplanting or replanting is the technique of moving a plant from one location to another

An organ transplant 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 from the donor site. In Biology, an organ ( Latin: organum, "instrument tool" from Greek όργανον - organon "organ instrument Organ donors can be living or deceased (previously referred to as cadaveric). Organ donation is the removal of the tissues of the Human body from a person who has recently Died, or from a living donor for the purpose of transplanting Organ transplants can be categorized as "life-saving", while tissue transplants are "life-enhancing".

Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, and intestine. Tissues include bones, tendons, cornea, heart valves, veins, and skin.

Contents

Types of transplants

Autograft

A transplant 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. Skin grafting is a type of Medical grafting involving the transplantation of Skin. Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure ) Sometimes an autograft is done to remove the tissue and then treat it or the person, before returning it (examples include stem-cell autograft and storing blood in advance of surgery). Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental

Allograft

An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. In Biology, a species is one of the basic units of Biological classification and a Taxonomic rank. Most human tissue and organ transplants are allografts. 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. Transplant rejection occurs when a transplanted organ or tissue fails to be accepted by the body of the transplant recipient This dramatically affects the entire immune system making the body vulnerable to pathogens.

Isograft

A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin). Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they are closer to autografts in terms of the recipient's immune response. Immunology is a broad branch of biomedical Science that covers the study of all aspects of the Immune system in all Organisms It deals with

Xenograft and Xenotransplantation

A transplant of organs or tissue from one species to another. Xenotransplantion is often an extremely dangerous type of transplant. Examples include porcine heart valves, which are quite common and successful, a baboon-to-human heart (failed), and piscine-primate (fish to non-human primate) islet (i. e. pancreatic or insular tissue), the latter's research study directed for potential human use if successful. The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates. See: xenotransplantation. Xenotransplantation ( xeno- from the Greek meaning "foreign" is the transplantation of living cells tissues or organs

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 transplants

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 en bloc. Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs As the recipient's native heart is usually healthy, this can then itself be transplanted into someone needing a heart transplant. That term is also used for a special form of liver transplant, in which the recipient suffers from familial amyloidotic polyneuropathy in which the liver (slowly) produces a protein that damages other organs; their liver can be transplanted into an older patient who is likely to die from other causes before a problem arises. Amyloids are insoluble fibrous Protein aggregates sharing specific structural traits [1]

Major organs and tissues transplanted

Thoracic organs

Other organs

Tissues, cells, fluids

History

Successful human allotransplants have a relatively long history; the operative skills were present long before the necessities for post-operative survival were discovered. Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage Heart failure or severe Coronary Lung transplantation is a surgical procedure in which a patient's diseased Lungs are partially or totally replaced by lungs which come from a donor A heart-lung transplant is a procedure carried out to replace both Heart and Lungs in a single operation Kidney transplantation or renal transplantation is the Organ transplant of a Kidney in a patient with End-stage renal disease. Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft. A pancreas transplant is an Organ transplant that involves implanting a healthy Pancreas (one that can produce insulin into a person who has Diabetes. Hand transplantation is a surgical procedure to transplant a hand from one human to another Corneal transplantation, also known as corneal grafting or penetrating keratoplasty, is a Surgical procedure where a damaged or diseased Cornea Skin grafting is a type of Medical grafting involving the transplantation of Skin. A face transplant is a still-experimental procedure to replace all or part of a person's face A face transplant is a still-experimental procedure to replace all or part of a person's face Penis transplantation is a surgical transplant procedure in which a Penis is transplanted to a patient Islets of Langerhans is the area in which the Endocrine (ie hormone-producing cells of the Pancreas are grouped Stem cells are cells found in most if not all multi-cellular Organisms. Blood transfusion is the process of transferring Blood or blood-based products from one person into the Circulatory system of another The blood vessels are part of the Circulatory system and function to transport Blood throughout the body In Anatomy, the heart valves are Valves in the Heart that maintain the unidirectional flow of blood by opening and closing depending on the difference Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce The skin is the outer covering of living tissue of an animal (or plant Allotransplantation ( allo- from the Greek meaning "other" is the transplantation of organs between members of the same Species Rejection and the side effects of preventing rejection (especially infection and nephropathy) were, are, and may always be the key problem. Transplant rejection occurs when a transplanted organ or tissue fails to be accepted by the body of the transplant recipient Nephropathy refers to damage to or disease of the Kidney. An older term for this is nephrosis.

Cosmas and Damian miraculously transplant the (black) leg of the Ethiopian onto the (white) body of Justinian. Ditzingen, 16th century.
Cosmas and Damian miraculously transplant the (black) leg of the Ethiopian onto the (white) body of Justinian. Ditzingen, 16th century. Ditzingen is a town in the district of Ludwigsburg, Baden-Württemberg, Germany.

Several apocryphal accounts of transplants exist well prior to the scientific understanding and advancements that would be necessary for them to have actually occurred. 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. Bian Que ( Chinese: 扁鹊 Wade-Giles: Pien Ch'üeh the characters of his name are also often pronounced Bian Qiao, Wade-Giles Pien Ch'iao) 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. Saints Cosmas and Damian (Κοσμάς και Δαμιανός (died ca Please do not add warnings to this page about the pictures Wikipedia is not censored for taste and has a guideline preventing such warnings - WikipediaNo disclaimers in articles Flavius Petrus Sabbatius Iustinianus ( Greek: Φλάβιος Πέτρος Σαββάτιος Ιουστινιανός; known in English as Justinian I or NOTE This intro is the result of careful NPOV work Please do not make potentially controversial edits to it without first discussing on the talk page Most accounts have the saints performing the transplant in the fourth century, decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure.

The more likely accounts of early transplants deal with skin transplantation. The first reasonable account is of the Indian surgeon Sushruta in the second century BC, who used autografted skin transplantation in nose reconstruction rhinoplasty. Sushruta was a surgeon and teacher of Ayurveda who flourished in the Indian city of Kashi by the 6th century BCE Rhinoplasty ( Rhinos, "Nose" + el ''Plassein'' "to shape" is a surgical procedure which is usually performed by either an Otolaryngologist Success or failure of these procedures is not well documented. Centuries later, the Italian surgeon Gasparo Tagliacozzi performed successful skin autografts; he also failed consistently with allografts, offering the first suggestion of rejection centuries before that mechanism could possibly be understood. Gasparo Tagliacozzi (1546 &ndash November 7, 1599) was an Italian surgeon. An allograft or allogeneic transplant or homograft is a transplant in which transplanted cells, tissues, or organs are sourced from He attributed it to the "force and power of individuality" in his 1596 work De Curtorum Chirurgia per Insitionem.

The first successful corneal allograft transplant was performed in 1837 in a gazelle model; the first successful human corneal transplant, a keratoplastic operation, was performed by Eduard Zirm in Austria in 1905. Corneal transplantation, also known as corneal grafting or penetrating keratoplasty, is a Surgical procedure where a damaged or diseased Cornea Eduard Konrad Zirm ( 18 March 1863 - 15 March 1944) was an Ophthalmologist who performed the first successful human Organ transplant Pioneering work in the surgical technique of transplantation was made in the early 1900s by the French surgeon Alexis Carrel, with Charles Guthrie, with the transplantation of arteries or veins. Alexis Carrel ( June 28, 1873 - November 5, 1944) was a French surgeon biologist and Eugenicist, who was awarded the Charles Claude Guthrie ( September 26, 1880 &ndash April 1963 was an American physiologist. Arteries are Blood vessels that carry blood away from the Heart. In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel 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. An anastomosis (plural anastomoses, from gr ἀναστόμωσις communicating opening) is a Network of streams that both branch out and reconnect The Nobel Prize (Nobelpriset (Nobelprisen is a Swedish prize established in the 1895 will of Swedish chemist Alfred Nobel; it was first awarded in Peace, Literature From 1902 Carrel performed transplant experiments on dogs. Year 1902 ( MCMII) was a Common year starting on Wednesday (link will display calendar of the Gregorian calendar (or a Common year starting Surgically successful in moving kidneys, hearts and spleens, he was one of the first to identify the problem of rejection, which remained insurmountable for decades. The kidneys are complicated organs that have numerous biological roles The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic The spleen is an organ found in all Vertebrate animals In humans the spleen is located in the abdomen of the body where it functions in the destruction of redundant Red

Major steps in skin transplantation occurred during World War I, notably in the work of Harold Gillies at Aldershot. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All Sir Harold Delf Gillies ( June 17, 1882 - September 10, 1960) was a New Zealand -born and later London based otolaryngologist Among his advances was the tubed pedicle graft, maintaining a flesh connection from the donor site until the graft established its own blood flow. Gillies' assistant, Archibald McIndoe, carried on the work into World War II as reconstructive surgery. Dr Sir Archibald McIndoe CBE FRCS ( May 4, 1900 - April 11, 1960) was a pioneering English plastic surgeon who World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including Reconstructive surgery is in its broadest sense the use of Surgery to restore the form and function of the body In 1962 the first successful replantation surgery was performed - re-attaching a severed limb and restoring (limited) function and feeling.

Transplant of a single gonad (testis) from a living donor was carried out in early July 1926 in Zaječar, Serbia, by a Russian emigré surgeon Dr. The gonad is the organ that makes Gametes The gonads in males are the Testes and the gonads in Females are the Ovaries. Zaječar ( Serbian Cyrillic: Зајечар Bulgarian: Зайчар- Zaychar, Romanian: Zaiciar is a City and municipality in Serbia (Србија Srbija) officially the Republic of Serbia (Република Србија Republika Srbija) is a Landlocked Country Émigré is a French term that literally refers to a person who has "migrated out" but often carries a connotation of politico-social self- Exile. Peter Vasil'evič Kolesnikov. The donor was a convicted murderer, one Ilija Krajan, whose death sentence was commuted to 20 years imprisonment and he was led to believe that it was done because he had donated his testis to an elderly medical doctor. Both the donor and the receiver survived, but charges were brought in a court of law by the public prosecutor against Dr. Kolesnikov, not for performing the operation, but for lying to the donor. (v. Timočki medicinski glasnik, Vol. 29 (2004) #2, p. 115-117 ISSN 0350-2899 article in Serbian)

The first attempted human deceased-donor transplant was performed by the Ukrainian surgeon Yu Yu Voronoy in the 1930s; rejection resulted in failure. Joseph Murray performed the first successful transplant, a kidney transplant between identical twins, in 1954, successful because no immunosuppression was necessary in genetically identical twins. Joseph E Murray (born 1 April 1919) American surgeon performed the first successful human kidney transplant from an adult to his identical

In the late 1940s Peter Medawar, working for the National Institute for Medical Research, improved the understanding of rejection. Sir Peter Brian Medawar, OM, FRS, ( February 28, 1915 &ndash October 2, 1987) was a Brazilian born The National Institute For Medical Research, commonly abbreviated to NIMR, is a large medical research facility situated in rural Mill Hill, on the outskirts of Identifying the immune reactions in 1951 Medawar suggested that immunosuppressive drugs could be used. For a list of immunosuppressive drugs see the Transplant rejection page. Cortisone had been recently discovered and the more effective azathioprine was identified in 1959, but it was not until the discovery of cyclosporine in 1970 that transplant surgery found a sufficiently powerful immunosuppressive. Cortisone (ˈkɔrtɨsoʊn or /ˈkɔrtɨzoʊn/ (ˈkôrtəˌsōn or -zōn (17-hydroxy-11-dehydrocorticosterone is a Steroid Hormone. Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely

Dr. Murray's success with the kidney led to attempts with other organs. There was a successful deceased-donor lung transplant into a lung cancer sufferer in June 1963 by James Hardy in Jackson, Mississippi. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. Year 1963 ( MCMLXIII) was a Common year starting on Tuesday (link will display full calendar of the Gregorian calendar. The patient survived for eighteen days before dying of kidney failure. Thomas Starzl of Denver attempted a liver transplant in the same year, but was not successful until 1967. Thomas E Starzl (born March 11, 1926) is an American physician, researcher, and is an expert on Organ transplants He performed the

The heart was a major prize for transplant surgeons. But, as well as rejection issues the heart deteriorates within minutes of death so any operation would have to be performed at great speed. The development of the heart-lung machine was also needed. Cardiopulmonary bypass (CPB is a technique that temporarily takes over the function of the Heart and Lungs during surgery maintaining the circulation of blood Lung pioneer James Hardy attempted a human heart transplant in 1964, but a premature failure of the recipient's heart caught Hardy with no human donor, he used a chimpanzee heart which failed very quickly. James Hardy is the name of James Hardy (American football (b 1985 James Hardy (basketball (b The first success was achieved December 3rd 1967 by Christiaan Barnard in Cape Town, South Africa. Events 1800 - War of the Second Coalition: Battle of Hohenlinden, French Year 1967 ( MCMLXVII) was a Common year starting on Sunday (link will display full calendar of the 1967 Gregorian calendar. Christiaan Neethling Barnard ( November 8, 1922 &ndash September 2, 2001) was a South African cardiac surgeon, famous for Cape Town (Kaapstad Xhosa: Ikapa) is the second most populous city in South Africa, forming part of the metropolitan municipality of the The Republic of South Africa (also known by other official names) is a country located at the southern tip of the continent of Africa Louis Washkansky, the recipient, survived for eighteen days amid what many saw as a distasteful publicity circus. Louis Washkansky (1913 &ndash 21 December 1967) was the recipient of the world's first human Heart transplant. The media interest prompted a spate of heart transplants. Over a hundred were performed in 1968-69, but almost all the patients died within sixty days. Barnard's second patient, Philip Blaiberg, lived for 19 months. Philip Blaiberg (1909 - August 17, 1969) was a South African Dentist and the second person to receive a Heart transplant.

It was the advent of cyclosporine that altered transplants from research surgery to life-saving treatment. In 1968 surgical pioneer Denton Cooley performed seventeen transplants including the first heart-lung transplant. Denton Arthur Cooley (born August 22, 1920) is a pioneering American heart surgeon. Fourteen of his patients were dead within six months. By 1984 two-thirds of all heart transplant patients survived for five years or more. With organ transplants becoming commonplace, limited only by donors, surgeons moved onto more risky fields, multiple organ transplants on humans and whole-body transplant research on animals. On March 9th 1981 the first successful heart-lung transplant took place at Stanford University Hospital. Events 590 - Bahram Chobin is crowned as king Barham VI of Persia. Year 1981 ( MCMLXXXI) was a Common year starting on Thursday (link displays the 1981 The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive The head surgeon, Bruce Reitz, credited the patient's recovery to cyclosporine-A. Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely

As the rising success rate of transplants and modern immunosuppression make transplants more common, the need for more organs has become critical. Advances in living-related donor transplants have made that increasingly common. Additionally, there is substantive research into xenotransplantation or transgenic organs; although these forms of transplant are not yet being used in humans, clinical trials involving the use of specific cell types have been conducted with promising results, such as using porcine islets of Langerhans to treat type one diabetes. Xenotransplantation ( xeno- from the Greek meaning "foreign" is the transplantation of living cells tissues or organs The cell is the structural and functional unit of all known living Organisms It is the smallest unit of an organism that is classified as living and is often called Islets of Langerhans is the area in which the Endocrine (ie hormone-producing cells of the Pancreas are grouped Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc However, there are still many problems that would need to be solved before they would be feasible options in patients requiring transplants.

Recently, researchers have been looking into steroid-free immunosuppression. This type of immunosupporession is being pioneered on large scale at Northwestern University in Chicago and other smaller institutions, while steroid minimization is being employed at the University of Wisconsin at Madison and other smaller institutions. Chicago (ʃɪˈkɑːgoʊ is the largest City by population in the state of Illinois and the American Midwest of the United States. This would avoid the side-effects of steroids. While short-term outcomes are outstanding, long-term outcomes are still unknown.

In addition, calcineurin-Inhibitor-Free Immunosuppression is currently undergoing extensive trialing, the result of which would be to allow sufficient immunosuppression, without the nephrotoxicity associated with standard regimens that include calcineurin inhibitors. Positive results have yet to be demonstrated in any trial.

An FDA approved immune function test from Cylex has shown effectiveness in minimizing the risk of infection and rejection in post-transplant patients[4] by enabling doctors to tailor immunosuppressant drug regimens. Cylex Inc is a biotechnology company developing and manufacturing products that use the Immune system for predicting and managing human health By keeping a patient's immune function within a certain window, doctors can adjust drug levels to prevent organ rejection while avoiding infection. Such information could help physicians reduce the use of immunosuppressive drugs, lowering drug therapy expenses while reducing the morbidity associated with liver biopsies, improve the daily life of transplant patients, and could prolong the life of the transplanted organ.

Many other new drugs are under development for transplantation. [5]

Timeline of successful transplants

Types of donor

Living or deceased

In living donors, the donor remains alive and donates a renewable tissue, cell, or fluid (e. Hand transplantation is a surgical procedure to transplant a hand from one human to another A face transplant is a still-experimental procedure to replace all or part of a person's face Penis transplantation is a surgical transplant procedure in which a Penis is transplanted to a patient 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 organ (primarily single kidney donation, partial donation of liver, small bowel, or pancreas).

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) to increase the potential pool of donors as demand for transplants continues to grow. Brain death is a legal definition of death that emerged in the 1960s as a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered.

Reasons for donation and ethical issues

Living related donors

Living related donors donate to family members or friends in whom they have an emotional investment. The risk of surgery is offset by the psychological benefit of not losing someone related to them, or not seeing them suffer the ill effects of waiting on a list.

Paired-exchange

A "paired-exchange" is a technique of matching willing living donors to compatible recipients. For example a spouse may be more than willing to donate a kidney to their partner but cannot since there is not a biological match. Willing spouse's kidney is donated to a matching recipient who also has an incompatible but willing spouse. The second donor must match the first recipient to complete the pair exchange. Typically the surgeries are scheduled simultaneously in case one of the donors decides to back out and the couples are kept anonymous from each other until after the transplant.

Paired exchange programs were popularized in the New England Journal of Medicine article "Ethics of a paired-kidney-exchange program" in 1997 by L. The New England Journal of Medicine ( N Engl J Med or NEJM) is an English-language Peer-reviewed Medical journal published F. Ross[9]. It was also proposed by Felix T. Rapport[10] in 1986 as part of his initial proposals for live-donor transplants "The case for a living emotionally related international kidney donor exchange registry" in Transplant Proceedings[11]. A paired exchange is the simplest case of a much larger exchange registry program where willing donors are matched with any number of compatible recipients[12]. A transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program. "[13]. The first pair exchange transplant in the U. S. was in 2001 at Johns Hopkins hospital[14].

Paired-donor exchange, led by work in the New England Program for Kidney Exchange as well as at Johns Hopkins University and the Ohio OPOs may more efficiently allocate organs and lead to more transplants.

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. Web sites are being developed that facilitate such donation. It has been featured in recent television journalism that over half of the members of the Jesus Christians, an Australian religious group, have donated kidneys in such a fashion. Jesus Christians is a small radical Christian group that practices communal living and distributes Bible-based Comics and Books. For a topic outline on this subject see List of basic Australia topics. [8]

Compensated donation

In compensated donation, donors get 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. Medical tourism (also called medical travel, health tourism or global healthcare is a term initially coined by travel agencies and the Mass media

In the United States, The National Organ Transplant Act of 1984 made organ sales illegal; regulation by the OPTN has probably eliminated organ sales. The National Organ Transplant Act (1984 Public Law 98-507 approved October 19 1984 and amended in 1988 and 1990 outlawed the sale of Human organs and provided for the establishment In the United Kingdom, the Human Tissue Act 1961 made organ sales illegal.

In 2007, two major European conferences recommended against the sale of organs[9].

Recent development of web sites and personal advertisements for organs among listed candidates has raised the stakes when it comes to the selling of organs, and have also sparked significant ethical debates over directed donation, "good-Samaritan" donation, and the current U. S. organ allocation policy.

Two books, Kidney for Sale By Owner by Mark Cherry (Georgetown University Press, 2005); and Stakes and Kidneys: Why markets in human body parts are morally imperative by James Stacey Taylor: (Ashgate Press, 2005); advocate using markets to increase the supply of organs available for transplantation.

In 2006, Iran became the only country to legally allow individuals to sell their kidneys, and the market price is of the order of US$2,000 to US$4,000. The Economist[15] and the Ayn Rand Institute[16] approved and advocated a legal market elsewhere. The Economist is an English-language weekly news and International affairs publication owned by The Economist Newspaper Ltd and edited in London The Ayn Rand Institute The Center for the Advancement of Objectivism (ARI is a 501(c(3 nonprofit think tank in Irvine California that promotes Ayn They argued that if 0. 06% of Americans between 19 and 65 were to sell one kidney, the national waiting list would disappear (which, the Economist wrote, happened in Iran). The Economist argued that donating kidneys is no more risky than surrogate motherhood, which can be done legally for pay in most countries. Surrogacy is a method of Reproduction whereby a woman agrees to become pregnant and deliver a child for a contracted party

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, probably from another country, said Dr. Farhat Moazam of Pakistan, at a World Health Organization conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much[10]. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami two years ago. about 100 people, mostly women, sold their kidneys for 40,000-60,000 rupees ($900-$1,350)[11]. Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, "I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work. " Most kidney sellers say that selling their kidney was a mistake[12].

Forced donation

This is organ donation that is done against the will of the donor. There have been various accusations that certain authorities are harvesting organs from those the authorities deem undesirable, such as prison populations. The World Medical Association stated that individuals in detention are not in the position to give free consent to donate their organs [13]. Illegal dissection of corpses is a form of body-snatching and may have taken place to obtain allografts. Body-snatching was the secret disinterment of bodies from Churchyards to sell them for Dissection or Anatomy lectures in Medical schools [17]

According to the Chinese Deputy Minister of Health, Huang Jiefu, [14] approximately 95% of all organs used for transplantation are from executed prisoners. The lack of public organ donation program in China is used as a justification for this practice. However reports in Chinese media raised concerns if executed criminals are the only source for organs used in transplants.

In October 2007, bowing to international pressure, the Chinese Medical Association agreed on a moratorium of commercial organ harvesting from condemned prisoners, but did not specify a deadline. China agreed to restrict transplantations from donors to their immediate relatives. [15][16]

People in other parts of the world are responding to this availability of organs, and a number of individuals (including US and Japanese citizens) have elected to travel to China or India as medical tourists to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical ways (see later). Medical tourism (also called medical travel, health tourism or global healthcare is a term initially coined by travel agencies and the Mass media [18] [19] [20].

Allocation of donated organs

The overwhelming majority of deceased-donor organs in the United States are allocated by federal contract to the Organ Procurement and Transplantation Network (OPTN), held since it was created by the Organ Transplant Act of 1984 by the United Network for Organ Sharing or UNOS. UNOS does not handle donor cornea tissue. Corneal donor tissue is usually handled by various eye banks. This allocates organs based on the method considered most fair by the scientific leadership in the field. For kidneys, for instance, that is by waiting time; for livers, it is by MELD (Model of End-Stage Liver Disease), an empirical score based on lab values indicative of the sickness of the patient from liver disease. Experiencing somewhat increased popularity, but still very rare, is directed or targeted donation, in which the family of a deceased donor (often honoring the wishes of the deceased) requests an organ be given to a specific person. If medically suitable, the allocation system is subverted, and the organ is given to that person. In the United States, there are various lengths of waiting due to the different availabilities of organs in different UNOS regions. In other countries such as the UK, only medical factors and the position on the waiting list can affect who receives the organ. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located If this is not the desired person, it is noted that this puts them higher on the list.

One of the more publicized cases of this type was the 1994 Chester and Patti Szuber transplant. This was the first time that a parent had received a heart donated by one of their own children. Although the decision to accept the heart from their recently killed child was not an easy decision, the Szuber family agreed that giving Patti’s heart to her father would have been something that she would have wanted. [17]

Access to organ transplantation is one reason for the growth of medical tourism. Medical tourism (also called medical travel, health tourism or global healthcare is a term initially coined by travel agencies and the Mass media

Organ transplantation in different countries

Demographics

Despite efforts of international transplantation societies, it is not possible to access an accurate source on the number, rates and outcomes of all forms of transplantation globally; the best that we can achieve is estimations. This is not a sound basis for the future and thus one of the crucial strategies for the Global Alliance in Transplantation is to foster the collection and analysis of global data.

Transplantation of organs in different continents/regions year/ 2000

Kidney

(pmp*)

 Liver

(pmp)

 Heart

(pmp)
USA 52 19 8
Europe 27 10 4
Turkey 11 3. 5 1
Asia 3 0. 3 0. 03
Latin America 13 1. 6 0. 5

Source: [21],[22]

Traditionally, muslims believe body desecration in life or death to be forbidden, and thus many reject organ transplant. [18] However most muslim authorities nowadays accept the practice if another life will be saved. [19]

The Spanish Transplant Organization led by Dr Rafael Matesanz claims the highest worldwide rate of 35. The National Transplant Organization (ONT is an institution belonging to the Spanish Ministry of Health and Consumption, put in charge of developing the competencies related 1[20] donors per million population in 2005 and 33. 8[21] in 2006.

In addition to the citizens waiting for organ transplants in the US and other developed nations, there are long waiting lists in the rest of the world. More than 2 million people need organ transplants in China, 50,000 waiting in Latin America (90% of which are waiting for kidneys), as well as thousands more in the less documented continent of Africa. Donor bases vary in developing nations.

In Latin America the donor rate is 40-100 per million per year, similar to that of developed countries. However, in Uruguay, Cuba, and Chile, 90% of organ transplants came from cadaveric donors. Cadaveric donors represent 35% of donors in Saudi Arabia. There is continuous effort to increase the utilization of cadaveric donors in Asia, however the popularity of living, single kidney donors in India yields India a cadaveric donor prevalence of less than 1 pmp.

China does 10,000 transplants a year, with sources claiming up to 90% of organs are taken from executed prisoners, without signed consent, since Chinese have taboos against donating organs of deceased family members. [22][23] Amnesty International has criticized this practice, and accused the Chinese of executing people without fair trials. [24] Close relative donations represent only 2% of transplants.

In Israel, there is a severe organ shortage due to religious objections by some rabbis, some of whom oppose all organ donations and others who advocate that a rabbi participate all decision making regarding a particular donor. This shortage has resulted in one-third of all heart transplants performed on Israelis being done in the Peoples' Republic of China; others are done in Europe. Dr. Jacob Lavee, head of the heart-transplant unit, Sheba Medical Center, Tel Aviv, believes that "transplant tourism" is unethical and Israeli insurers should not pay for it. [25]

Comparative costs

One of the driving forces for illegal organ trafficking and “transplantation tourism” is the price differences for organs and transplant surgeries in different areas of the world. According to the New England Journal of Medicine, a human kidney can be purchased in Manila for $1000- $2000, but in urban Latin America a kidney may cost more than $10,000. Kidneys in South Africa have sold for as high as $20,000. Price disparities based on donor race are a driving force of attractive organ sales in South Africa, as well as in other parts of the world.

In China, a kidney transplant operation runs for around $70,000, liver for $160,000, and heart for $120,000 [23]. Although these prices are still unattainable to poor, compared to the fees of the United States, where a kidney transplant may demand $100,000, a liver $250,000, and a heart $860,000, Chinese prices have made China a major provider of organs and transplantation surgeries to other countries.

Safety

Compensation for donors also increases the risk of introducing diseased organs to recipients because these donors often yield from poorer populations unable to receive health care regularly and organ dealers may evade disease screening processes. The majority of such deals include one major payment and no follow up care for the donor. Some cases argue that there is a possibility of 1:18 to acquire HIV from such transplants.

In November 2007, the CDC reported the first-ever case of HIV and Hepatitis C being simultaneously transferred through an organ transplant. The donor was a 38-year-old male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients, none of whom had been told he was "high-risk. " Experts say that the reason the diseases didn't show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies wouldn't have existed in high enough numbers to detect. The crisis has caused many to call for more sensitive screening tests, which could pick up anitbodies sooner. Currently, the screens cannot pick up on the small number of anitbodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18-21 days before a donation is made.

Organ transplant laws

Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens. Brazil, Italy, Poland and Spain have ruled all adults potential donors with the “opting out” policy, unless they attain cards specifying not to be. Iran is the only country in the world where it is lawful for one citizen to sell an organ to another for transplantation. However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not. The Indian government has had difficulty tracking the flourishing organ black market in their country and have yet to officially condemn it. Other countries victimized by illegal organ trade have implemented legislative reactions. Moldova has made international adoption illegal in fear of organ traffickers. China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent. However, doctors in other countries, such as the United Kingdom, have accused China of abusing its high capital punishment rate. Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China, Ukraine, and India, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking. Some organs are also shipped to uganda and the netherlands. This was a main product in the triangular trade in 1934.

Starting on May 1, 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime. [26]

Ethical concerns

The existence and distribution of organ transplantation procedures in developing countries, while almost always beneficial to those receiving them, raise many ethical concerns. Developing countries are countries that haven't reached Western-style standards of democratic government free market economy industrialization social programs and human rights guaranties Ethics is a major branch of Philosophy, encompassing right conduct and good life Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of distributive justice. Distributive justice concerns what is just or right with respect to the allocation of goods in a society 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, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. Human rights refers to the "basic Rights and freedoms to which all humans are entitled Regardless of the “gift of life”, in the context of developing countries, this might be coercive. The practice of coercion could be considered exploitative of the poor population, violating basic human rights according to Articles 3 and 4 of the Universal Declaration of Human Rights. The Universal Declaration of Human Rights ( UDHR) is a declaration adopted by the United Nations General Assembly ( 10 December 1948 at Palais 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. The Universal Declaration of Human Rights ( UDHR) is a declaration adopted by the United Nations General Assembly ( 10 December 1948 at Palais

Even within developed countries there is concern that enthusiasm for increasing the supply of organs may trample on respect for the right to life. The question is made even more complicated by the fact that the "irreversibility" criterion for legal death cannot be adequately defined and can easily change with changing technology [27]. Legal death is a legal pronouncement by a qualified person that further medical care is not appropriate and that a patient should be considered dead under the law

See also

References

  1. ^ Mayo Clinic Link
  2. ^ Clint Hallam
  3. ^ Eduard Zirm
  4. ^ Cylex's Immune Function Test, ImmuKnow(R), Identifies Optimal Immune Status For Post-Transplant Therapy
  5. ^ NEW DRUGS in TRANSPLANTATION, EBMT Meeting, France, March 2007 C. Transplant rejection occurs when a transplanted organ or tissue fails to be accepted by the body of the transplant recipient The human leukocyte antigen system ( HLA) is the name of the Major histocompatibility complex (MHC in humans Organ harvesting in the People's Republic of China refers to the practice of removing human organs and tissue to be used in transplants for Chinese and Medical tourism (also called medical travel, health tourism or global healthcare is a term initially coined by travel agencies and the Mass media Clint Hallam (born in New Zealand) was the first recipient of a human Hand transplant. Eduard Konrad Zirm ( 18 March 1863 - 15 March 1944) was an Ophthalmologist who performed the first successful human Organ transplant PAILLET, Pharmacist, Pharm D. C. RENZULLO, Pharmacist, Pharm D. Edouard Herriot Hospital, Lyon, FRANCE
  6. ^ Restore Sight Organization website
  7. ^ UPI news story
  8. ^ Would you give your kidney to a stranger?. CNN. com (2006-06-05). Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 70 - Titus and his Roman Legions breach the middle wall of Jerusalem in the Siege of Jerusalem Retrieved on 2008-05-02. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1194 - King Richard I of England gives Portsmouth its first Royal Charter.
  9. ^ [1]Shopped Liver: The worldwide market in human organs, By William Saletan, Salon, April 14, 2007. Many links.
  10. ^ [2]WHO Says Organ Demand Outstrips Supply, Alexander G. Higgins, Associated Press, March 30, 2007
  11. ^ [3]Indian police probe kidney sales by tsunami victims, By R. Bhagwan Singh, Reuters, Jan 16, 2007.
  12. ^ Ethical and social consequences of selling a kidney, Rothman DJ, JAMA. 2002 Oct 2;288(13):1640-1. [PMID 12350195]
  13. ^ WMA - Policy : Council Resolution on Organ Donation in China
  14. ^ 世界日報──大陸新聞
  15. ^ Pact to block harvesting of inmate organs, Pg 1, South China Morning Post, October 7, 2007
  16. ^ Press release, Chinese Medical Association Reaches Agreement With World Medical Association Against Transplantation Of Prisoners's Organs, Medical News Today, Oct 07 2007
  17. ^ Saved By His Daughter's Heart. Man Dying From Heart Disease Gets Gift From Late Daughter (English). The South China Morning Post, together with its Sunday edition the Sunday Morning Post, is an English-language Newspaper of Hong CBS Broadcasting Inc (August 20, 2004). Retrieved on October 10, 2006.
  18. ^ [4]
  19. ^ [5] "These institutes all call upon Muslims to donate organs for transplantation:the Shariah Academy of the Organisation of Islamic Conference (representing all Muslim countries), the Grand Ulema Council of Saudi Arabia, the Iranian Religious Authority, the Al-Azhar Academy of Egypt "
  20. ^ Organización Nacional de Transplantes, Donantes de órganos en España. Número total y tasa anual (p. m. p.)
  21. ^ Transplant Commission of the Council of Europe, La ONT estima en 94.500 los transplantes de órganos solidos realizados en 2006 en todo el mundo, 28 August 2007. The Council of Europe (Conseil de l'Europe is the oldest International organisation working towards European integration, being founded in 1949
  22. ^ [6]Wall Street Journal, April 7, 2007, Change of heart: China reconsiders fairness of 'Transplant Tourism'; foreigners pay more for scarce organs; Israelis debate reform, Andrew Batson and Shai Oster. Events 529 - First draft of Corpus Juris Civilis (a fundamental work in Jurisprudence) is issued by Eastern Roman Emperor Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century.
  23. ^ [7]China admits taking executed prisoners' organs; Demand is high, and supply is low -- except on death row; the nation leads worldwide in capital punishment. By Mark Magnier and Alan Zarembo. Los Angeles Times, November 18, 2006
  24. ^ Amnesty International
  25. ^ [8]Wall Street Journal, April 7, 2007, Change of heart: China reconsiders fairness of 'Transplant Tourism'; foreigners pay more for scarce organs; Israelis debate reform, Andrew Batson and Shai Oster. Events 529 - First draft of Corpus Juris Civilis (a fundamental work in Jurisprudence) is issued by Eastern Roman Emperor Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century.
  26. ^ "China issues new rules on organs", BBC, 2007-04-07. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 529 - First draft of Corpus Juris Civilis (a fundamental work in Jurisprudence) is issued by Eastern Roman Emperor Retrieved on 2007-04-07. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 529 - First draft of Corpus Juris Civilis (a fundamental work in Jurisprudence) is issued by Eastern Roman Emperor  
  27. ^ Whetstine L, Streat S, Darwin M, Crippen D. (2005). "Pro/con ethics debate: when is dead really dead?". Critical Care (London, England) 9 (6): 538-42. PMID 16356234.  

Sources and bibliography

External links

Scientific/academic societies

Journalism

Patented technology

Philanthropy and support

Websites about Illegal Organ Procurement

United States Federally Contracted Services

Websites avocating sale of organs

Procedural descriptions

Islamic opposition to organ transplantation



The Christian Science Monitor (CSM is an international Newspaper published daily Monday through Friday Children's Hospital of Pittsburgh of UPMC, a hospital of the University of Pittsburgh Medical Center, is the only hospital is southwestern Pennsylvania dedicated

Dictionary

organ transplant

-noun

  1. A surgical operation in which an organ is moved from a donor to a recipient
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