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Organ transplantsOrgan Transplants

We have come a long way since the first kidney transplant was performed almost 60 years ago. Doctors now have the expertise to replace many parts of our bodies with success, saving thousands of lives every year.

Transplantation began at the turn of the century, shortly after blood groups were identified and the first successful blood transfusions between unrelated individuals had been made. Sadly, the first transplants were fraught with failure because they used organs from donors who were unrelated to the recipients.

The key to the success of later transplants was the introduction of drugs such as cyclosporin which suppress the immune system and help to prevent rejection.

NEW DISCOVERIES

In addition, tissue typing was developed for some transplants. Just as people's blood groups can vary, it was discovered that their tissue does too. Kidneys and bone marrow grafts are tissue typed to match recipients when they come from unrelated donors. A donor's tissue type is established by screening their white blood cells, or lymphocytes. Experience has shown that this substantially improves the success rate of transplants in these cases. Other organs are matched to recipients by size and blood group.

And most recently, newer, more effective drugs derived from fungal extracts, such as cyclosporin, have made new organ transplants like the small bowel possible.

Kidneys are the most commonly transplanted organs with around 1,700 transplants performed every year in the UK. But hearts, lungs and livers are being transplanted in ever increasing numbers.

SUCCESS RATES

Nowadays, 75 per cent of heart transplant patients have a working graft one year after their operation and, for kidney transplant patients, that figure rises to 85 per cent. More than 80 per cent of liver transplant patients ahve a working graft after one year and more than 60 per cent of heart and lung transplant patients.

The first heart transplant was carried out in Capetown, South Africa in 1967 by world-famous surgeon Dr Christiaan Barnard. And in 1987, the so-called 'domino' heart-long transplant was first carried out in the UK by transplant surgeon Sir Magdi Yacoub at Harefield Hospital. This is where a patient with unhealthy lungs gets a new heart and lungs from the same donor, and in turn their own heart is donated to another patient. this has proved more successful than simply replacing a diseased lung.

MAKING HISTORY

In 1990, a heart and lung transplant patient made history by racing against the recipient of his own donated heart at the British Transplant Games which were held at London's Crystal Palace.

The domino operation is now helping victims of the genetic condition, cystic fibrosis. Sufferers develop enlarged hearts because the disease interferes with blood flow from the lungs to the brain.

In the domino operation, the new heart and lungs are transplanted to replace one of the sufferer's sick longs. The enlarged heart must be replaced because it would be too powerful for the new lungs. The heart is still healthy, however, even though it's enlarged, so it can be donated to someone who needs a bigger heart.

Liver transplants were first performed in the UK in 1968. Following early disappointments, the development of new drugs and surgery means that more than 500 liver transplants are now performed every year and approximately 70 of them are on children.

NEW SIGHT

Corneal grafts are used to restore and improve the sight of approximately 2,000 patients every year in the UK. the cornea -- the transparent 'window' over the front of the eye -- can cause blindness if it is damaged or diseased. Corneas are now stored in 'eye banks' ready for use. Over 90 per cent of these grafts are functioning successfully a year after they were transplanted.

A wide range of other tissues can be 'recycled' within our bodies or donated to other patients. These include bone marrow, saving the lives of those with leukaemia, aplastic anaemia and other diseases; skin, which provides burns victims with a live dressing; bone to prevent people with bone cancer from having limbs amputated; plus cartilage, hair (with skin), veins and arteries.

The main danger following transplantation is organ rejection, either by the recipient of the organ or by the donated organ itself. To reduce this risk, cyclosporin and other drugs that suppress the body's immune responses are given. The downside of immunosuppressive therapy is that it makes the body more susceptible to infections.

Those who undergo an organ transplant operation will need to take immunosuppressant drugs indefinitely, and this also puts them at increased risk of developing certain types of cancer.

SAVING MANY LIVES

Able to provide two kidneys, two lungs, a heart, liver, pancreas and two corneas, one person has the potential to save seven lives and restore the sight of two people. This number may soon increase to nine if small bowel transplants become more successful.

 

Though organs are normally taken from dead people, bone marrow, a slice of liver and a kidney can be taken from live donors. A kidney from a live donor is best taken from a blood relation as this tissue is inherited from the parents. Although there is only a slight risk to a kidney donor's health, he may actually take longer to recover than the patient.

 

The condition of the organs taken from a dead donor is more important than how old the donor is. Kidneys and corneas from people who die at the age of 70 or over can still be used and the heart, lungs and liver of donors up to about 50 can be transplanted.


Most organs from dead donors, apart from corneas, are taken from patients who have died in intensive care. This is because, despite the fact they are 'brain-stem dead', which means there is no activity in the brain, the body needs to be kept ventilated to prevent the organs from deteriorating.

MEDICAL ETHICS
There are very strict ethical guidelines laid down by the medical profession to determine whether a brain death has occurred. These involve two sets of tests for brain activity which legally must be carried out by different specialists, whose work is totally separate from the transplant surgery team, between one and 12 hours apart. The first set of results indicating brain death must be confirmed by the second.


Getting donated organs to patients quickly is vital, especially for heart and lung transplants which must be transplanted within four to five hours of death. A liver can wait up to 18 hours and a kidney up to 36 hours. Organs are placed in plastic bags, packed with ice and transported in chilled boxes kept at between 0-4C. Corneas can be preserved for up to a month in special nutrient-rich fluid.

NEW SKIN GRAFTS
A new technique allowing modified skin to be grown in the laboratory from a square centimetre of donor skin and stored under liquid nitrogen has opened the possibility for skin banks to provide emergency skin grafts for serious burns patients.


This is a breakthrough because normal donor skin is rejected by the recipient and can only be used as a temporary dressing. The modified skin contains no hair follicles, sweat glands or blood vessels and seems to be tolerated without the use of drugs.

FUTURE HOPES
A possibility in years to come is brain tissue transplants. to treat Parkinson's disease, where the brain fails to produce enough of the chemical, dopamine, to control muscle action. Scientists are hoping that the transplanted brain tissue could produce enough of the chemical to cure the disorder.


Eventually, limb, hand, feet and face transplants may be possible for those who have been severely disfigured in accidents. The donor parts would outperform even the most sophisticated artificial spare parts.

DONOR SHORTAGE
There are almost 5,000 patients awaiting donor organs in the UK and Ireland and the situation is getting worse. Kidney patients are lucky in that they can usually be kept going with regular life-saving dialysis. For others, like heart and liver patients, time is running out and, tragically, many die because a donor cannot be found in time.


In a bid to meet the demand, doctors are now working towards xenografting -- using animal organs as spare parts. Pig heart valves have been used successfully in heart surgery for several years. Experts in the field predict that animal organ transplants will be introduced within the next decade.

     
     

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