Organ transplant
Overview
 
Organ transplantation is the moving of an organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

 from one body to another or from a donor
Donor
A donor in general is a person who donates something voluntarily. Usually used to represent a form of pure altruism but sometimes used when the payment for a service is recognised by all parties as representing less than the value of the donation and that the motivation is altruistic...

 site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine
Regenerative medicine
Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore orestablish normal function". This field holds the promise of regenerating damaged tissues and organs in the body by replacing damaged tissue and/or by stimulating the body's own repair...

 is allowing scientists and engineers to create organs to be re-grown from the patient's own cells (stem cell
Stem cell
This article is about the cell type. For the medical therapy, see Stem Cell TreatmentsStem cells are biological cells found in all multicellular organisms, that can divide and differentiate into diverse specialized cell types and can self-renew to produce more stem cells...

s, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called autografts.
Encyclopedia
Organ transplantation is the moving of an organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

 from one body to another or from a donor
Donor
A donor in general is a person who donates something voluntarily. Usually used to represent a form of pure altruism but sometimes used when the payment for a service is recognised by all parties as representing less than the value of the donation and that the motivation is altruistic...

 site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine
Regenerative medicine
Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore orestablish normal function". This field holds the promise of regenerating damaged tissues and organs in the body by replacing damaged tissue and/or by stimulating the body's own repair...

 is allowing scientists and engineers to create organs to be re-grown from the patient's own cells (stem cell
Stem cell
This article is about the cell type. For the medical therapy, see Stem Cell TreatmentsStem cells are biological cells found in all multicellular organisms, that can divide and differentiate into diverse specialized cell types and can self-renew to produce more stem cells...

s, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

Organs that can be transplanted are the heart
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

, kidneys
Kidney transplantation
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ...

, eyes, liver
Liver transplantation
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...

, lungs
Lung transplantation
Lung transplantation, or pulmonary transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor...

, pancreas
Pancreas transplantation
A pancreas transplant is an organ transplant that involves implanting a healthy pancreas into a person who usually has diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated...

, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. The cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.

Organ donors may be living, or brain dead. Tissue may be recovered from donors who are cardiac dead – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked". Transplantation raises a number of bioethical issues, including the definition of death, when and how consent should be given for an organ to be transplanted and payment for organs for transplantation. Other ethical issues include transplantation tourism and more broadly the socio-economic context in which organ harvesting or transplantation may occur. A particular problem is organ trafficking. Some organs, such as the brain, cannot be transplanted.

In the United States of America, tissue transplants are regulated by the U.S. Food and Drug Administration (FDA) which sets strict regulations on the safety of the transplants, primarily aimed at the prevention of the spread of communicable disease. Regulations include criteria for donor screening and testing as well as strict regulations on the processing and distribution of tissue grafts. Organ transplants are not regulated by the FDA.

Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...

, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through serotyping
Serotype
Serotype or serovar refers to distinct variations within a subspecies of bacteria or viruses. These microorganisms, viruses, or cells are classified together based on their cell surface antigens...

 to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs.

History

Successful human allotransplants
Allotransplantation
Allotransplantation is the transplantation of cells, tissues, or organs, sourced from a genetically non-identical member of the same species as the recipient. The transplant is called an allograft or allogeneic transplant or homograft...

 have a relatively long history of operative skills were present long before the necessities for post-operative survival were discovered. Rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...

 and the side effects of preventing rejection (especially infection and nephropathy
Nephropathy
Nephropathy refers to damage to or disease of the kidney. An older term for this is nephrosis.-Causes:Causes of nephropathy include administration of analgesics, xanthine oxidase deficiency, and long-term exposure to lead or its salts...

) were, are, and may always be the key problem.

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. Roman Catholic accounts report the 3rd-century saints Damian and Cosmas
Saint Cosmas
Saint Cosmas of Maiuma, also called Cosmas Hagiopolites , Cosmas of Jerusalem, or Cosmas the Melodist, or Cosmas the Poet , was a bishop and hymnographer of the Eastern Orthodox Church.-Life:Saint Cosmas was probably born in Damascus, but he was orphaned at a young age...

 as replacing the gangrenous
Gangrene
Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...

 leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...

. Most accounts have the saints performing the transplant in the 4th 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 2nd century BC, who used autografted skin transplantation in nose reconstruction rhinoplasty
Rhinoplasty
Rhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...

. Success or failure of these procedures is not well documented. Centuries later, the Italian surgeon Gasparo Tagliacozzi
Gasparo Tagliacozzi
Gaspare Tagliacozzi was an Italian surgeon.Tagliacozzi was born in Bologna. He studied at the University of Bologna under Gerolamo Cardano and others, and, at the age of twenty-four, earned his degree in philosophy and medicine. First he was appointed professor of surgery and later was appointed...

 performed successful skin autografts; he also failed consistently with allografts, offering the first suggestion of rejection centuries before that mechanism could possibly be understood. 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
Cornea transplant
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue in its entirety or in part...

 operation, was performed by Eduard Zirm
Eduard Zirm
Eduard Konrad Zirm was an ophthalmologist who performed the first successful human tissue transplant on 7 December 1905....

 at Olomouc Eye Clinic, now Czech Republic
Czech Republic
The Czech Republic is a landlocked country in Central Europe. The country is bordered by Poland to the northeast, Slovakia to the east, Austria to the south, and Germany to the west and northwest....

, in 1905. Pioneering work in the surgical technique of transplantation was made in the early 1900s by the French surgeon Alexis Carrel
Alexis Carrel
Alexis Carrel was a French surgeon and biologist who was awarded the Nobel Prize in Physiology or Medicine in 1912 for pioneering vascular suturing techniques. He invented the first perfusion pump with Charles A. Lindbergh opening the way to organ transplantation...

, with Charles Guthrie
Charles Claude Guthrie
Charles Claude Guthrie was an American physiologist. He was born at Gilmore, St. Charles Co., Mo., and graduated from the University of Missouri in 1901 and from the University of Chicago in 1908; taught physiology while engaged in advanced studies, and was professor of physiology and...

, with the transplantation of arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....

 or vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...

s. Their skilful anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....

 operations, the new suturing techniques, laid the groundwork for later transplant surgery and won Carrel the 1912 Nobel Prize in Physiology or Medicine
Nobel Prize in Physiology or Medicine
The Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...

. From 1902 Carrel performed transplant experiments on dogs. Surgically successful in moving kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

s, heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

s and spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...

s, he was one of the first to identify the problem of rejection
Rejection
The word "rejection" was first used in 1415. The original meaning was "to throw" or "to throw back".Rejection may mean:* Social rejection, in psychology, an interpersonal situation that occurs when a person or group of people exclude an individual from a social relationship* Transplant rejection,...

, which remained insurmountable for decades.

Major steps in skin transplantation occurred during the First World War, notably in the work of Harold Gillies
Harold Gillies
Sir Harold Delf Gillies was a New Zealand-born, and later London based, otolaryngologist who is widely considered as the father of plastic surgery.-Personal life:Gillies was born in Dunedin, New Zealand...

 at Aldershot. 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
Archibald McIndoe
Sir Archibald McIndoe CBE FRCS was a pioneering New Zealand plastic surgeon who worked for the Royal Air Force during World War II. He greatly improved the treatment and rehabilitation of badly burned aircrew.-Background:...

, carried on the work into the Second World War
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

 as reconstructive surgery
Reconstructive surgery
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although Maxillo-Facial Surgeons, Plastic Surgeons and Otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.Other...

. In 1962 the first successful replantation surgery was performed – re-attaching a severed limb and restoring (limited) function and feeling.

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
Joseph Murray
Joseph Edward Murray is a retired American plastic surgeon. He performed the first successful human kidney transplant on identical twins on December 23, 1954....

 and J. Hartwell Harrison, M.D.
J. Hartwell Harrison, M.D.
John Hartwell Harrison was a key member of the pioneer medical team that received the 1961 Amory Prize of the American Academy of Arts and Sciences for bringing kidney transplantation to the world....

 performed the first successful transplant, a kidney transplant between identical twins, in 1954, successful because no immunosuppression was necessary in genetically identical twins.

In the late 1940s Peter Medawar
Peter Medawar
Sir Peter Brian Medawar OM CBE FRS was a British biologist, whose work on graft rejection and the discovery of acquired immune tolerance was fundamental to the practice of tissue and organ transplants...

, working for the National Institute for Medical Research
National Institute for Medical Research
The National Institute for Medical Research, commonly abbreviated to NIMR, is a medical research facility situated in Mill Hill, on the outskirts of London, England. It is mainly funded by the Medical Research Council, or MRC, and is its largest establishment and the only one designated as an...

, improved the understanding of rejection. Identifying the immune reactions in 1951 Medawar suggested that immunosuppressive drugs could be used. Cortisone
Cortisone
Cortisone is a steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally,...

 had been recently discovered and the more effective azathioprine
Azathioprine
Azathioprine is a purine analogue immunosuppressive drug. It is used to prevent organ rejection following organ transplantation and to treat a vast array of autoimmune diseases, including rheumatoid arthritis, pemphigus, inflammatory bowel disease , multiple sclerosis, autoimmune hepatitis, atopic...

 was identified in 1959, but it was not until the discovery of cyclosporine
Ciclosporin
Ciclosporin , cyclosporine , cyclosporin , or cyclosporin A is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the immune system, and therefore the risk of organ rejection...

 in 1970 that transplant surgery found a sufficiently powerful immunosuppressive.

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
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...

 sufferer in June 1963 by James Hardy
James Hardy (surgeon)
Dr. James D. Hardy was an American surgeon, famous for the first human lung transplant and the first animal-to-human heart transplant.- Early life :...

 in Jackson, Mississippi
Jackson, Mississippi
Jackson is the capital and the most populous city of the US state of Mississippi. It is one of two county seats of Hinds County ,. The population of the city declined from 184,256 at the 2000 census to 173,514 at the 2010 census...

. The patient survived for eighteen days before dying of kidney failure. Thomas Starzl
Thomas Starzl
Thomas E. Starzl is an American physician, researcher, and is an expert on organ transplants. He performed the first human liver transplants, and has often been referred to as "the father of modern transplantation."-Life:...

 of Denver attempted a liver transplant in the same year but was not successful until 1967.

The heart was a major prize for transplant surgeons. But over and above 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
Heart-lung machine
Cardiopulmonary bypass is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump"...

 was also needed. Lung pioneer James Hardy
James Hardy (surgeon)
Dr. James D. Hardy was an American surgeon, famous for the first human lung transplant and the first animal-to-human heart transplant.- Early life :...

 attempted a human heart transplant in 1964, but when a premature failure of the recipient's heart caught Hardy with no human donor, he used a chimpanzee heart, which failed very quickly. The first success was achieved on December 3, 1967, by Christiaan Barnard
Christiaan Barnard
Christiaan Neethling Barnard was a South African cardiac surgeon who performed the world's first successful human-to-human heart transplant.- Early life :...

 in Cape Town
Cape Town
Cape Town is the second-most populous city in South Africa, and the provincial capital and primate city of the Western Cape. As the seat of the National Parliament, it is also the legislative capital of the country. It forms part of the City of Cape Town metropolitan municipality...

, South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

. Louis Washkansky
Louis Washkansky
Louis Washkansky was the recipient of the world's first human heart transplant.-Biography:Washkansky was a Lithuanian Jew who migrated with his friends to South Africa in 1922, aged nine, and became a grocer in Cape Town. Washkansky saw active service in World War II in East and North Africa and...

, the recipient, survived for eighteen days amid what many saw as a distasteful publicity circus. 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
Philip Blaiberg
Philip Blaiberg was a Jewish South African dentist and the second person to receive a heart transplant. On January 2, 1968, in Cape Town, Dr...

, lived for 19 months.

It was the advent of cyclosporine that altered transplants from research surgery to life-saving treatment. In 1968 surgical pioneer Denton Cooley
Denton Cooley
Denton Arthur Cooley is an American heart surgeon famous for performing the first implantation of a total artificial heart. Cooley is also founder and surgeon in-chief of the Texas Heart Institute, chief of Cardiovascular Surgery at St...

 performed seventeen transplants, including the first heart-lung transplant. 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 9, 1981, the first successful heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

-lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

 transplant took place at Stanford University Hospital. The head surgeon, Bruce Reitz, credited the patient's recovery to cyclosporine-A
Ciclosporin
Ciclosporin , cyclosporine , cyclosporin , or cyclosporin A is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the immune system, and therefore the risk of organ rejection...

.

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 more common. Additionally, there is substantive research into xenotransplantation
Xenotransplantation
Xenotransplantation , is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenografts or xenotransplants...

, or transgenic organs; although these forms of transplant are not yet being used in humans, clinical trials involving the use of specific cell
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....

 types have been conducted with promising results, such as using porcine islets of Langerhans
Islets of Langerhans
The islets of Langerhans are the regions of the pancreas that contain its endocrine cells. Discovered in 1869 by German pathological anatomist Paul Langerhans at the age of 22, the islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas...

 to treat type 1 diabetes. 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 means of reducing the general burden of immunosuppression. Common approaches include avoidance of steroids, reduced exposure to calcineurin inhibitors, and other means of weaning drugs based on patient outcome and function. While short-term outcomes appear promising, long-term outcomes are still unknown, and in general, reduced immunosuppression increases the risk of rejection and decreases the risk of infection.

Many other new drugs are under development for transplantation.

The emerging field of regenerative medicine
Regenerative medicine
Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore orestablish normal function". This field holds the promise of regenerating damaged tissues and organs in the body by replacing damaged tissue and/or by stimulating the body's own repair...

 promises to solve the problem of organ transplant rejection by regrowing organs in the lab, using the patients' own cells (stem cells or healthy cells extracted from the donor site.)

Timeline of successful transplants

  • 1905: First successful cornea transplant
    Cornea transplant
    Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue in its entirety or in part...

     by Eduard Zirm
    Eduard Zirm
    Eduard Konrad Zirm was an ophthalmologist who performed the first successful human tissue transplant on 7 December 1905....

     (Olomouc Eye Clinic, now Czech Republic
    Czech Republic
    The Czech Republic is a landlocked country in Central Europe. The country is bordered by Poland to the northeast, Slovakia to the east, Austria to the south, and Germany to the west and northwest....

    )
  • 1954: First successful kidney transplant by Joseph Murray
    Joseph Murray
    Joseph Edward Murray is a retired American plastic surgeon. He performed the first successful human kidney transplant on identical twins on December 23, 1954....

     (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 Christian Barnard (Cape Town, South Africa)
  • 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)
  • 1995: First successful laparoscopic live-donor nephrectomy
    Nephrectomy
    Nephrectomy is the surgical removal of a kidney.-History:The first successful nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869 in Heidelberg. Simon practiced the operation beforehand in animal experiments...

     by Lloyd Ratner and Louis Kavoussi (Baltimore, U.S.A.)
  • 1997 First successful allogeneic vascularized transplantation of a fresh and perfused human knee joint by G.O. Hofmann
    Gunther O. Hofmann
    Professor Dr. med. Dr. rer. nat. Gunther O. Hofmann is a german surgeon, physicist and university teacher.- Education and Career :...

  • 1998: First successful live-donor partial pancreas transplant by David Sutherland (Minnesota, U.S.A.)
  • 1998: First successful hand transplant
    Hand transplant
    Hand transplantation is a surgical procedure to transplant a hand from one human to another.The operation is carried out in the following order: bone fixation, tendon repair, artery repair, nerve repair, then vein repair. The operation typically lasts 8 to 12 hours...

     (France)
  • 1999: First successful Tissue Engineered Bladder transplanted by Anthony Atala
    Anthony Atala
    Anthony Atala, M.D., is the W.H. Boyce Professor and Director of the Wake Forest Institute for Regenerative Medicine, and Chair of the Department of Urology at the Wake Forest University School of Medicine in North Carolina...

     (Boston Children's Hospital, U.S.A.)
  • 2005: First successful partial face transplant
    Face transplant
    A face transplant is a still-experimental procedure to replace all or part of a person's face. The world's first full face transplant was completed in Spain in 2010.-Beneficiaries of face transplant:...

     (France)
  • 2006: First jaw
    Jaw
    The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...

     transplant to combine donor jaw with bone marrow
    Bone marrow
    Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...

     from the patient, by Eric M. Genden
    Eric M. Genden
    Eric M. Genden is an American otolaryngologist with the distinction of being the first surgeon to perform a jaw transplant in the United States. It was also the first jaw transplant ever to combine donor jaw with bone marrow from the patient....

     (Mount Sinai Hospital, New York
    Mount Sinai Hospital, New York
    Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...

    )
  • 2008: First successful complete full double arm transplant by Edgar Biemer, Christoph Höhnke and Manfred Stangl (Technical University of Munich, Germany)
  • 2008: First baby born from transplanted ovary.
  • 2008: First transplant of a human windpipe
    Vertebrate trachea
    In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...

     using a patient’s own stem cells, by Paolo Macchiarini
    Paolo Macchiarini
    Paolo Macchiarini, M.D., Ph.D. is head and chairman of the Hospital Clínic de Barcelona, University of Barcelona in Barcelona, Spain, as well as professor of surgery at the University of Barcelona in Spain, and at the Hannover Medical School in Hannover, Germany.Dr. Macchiarini completed his...

     (Barcelona, Spain)
  • 2008: First successful transplantation of near total area (80%) of face
    Face transplant
    A face transplant is a still-experimental procedure to replace all or part of a person's face. The world's first full face transplant was completed in Spain in 2010.-Beneficiaries of face transplant:...

    , (including palate, nose, cheeks, and eyelid by Maria Siemionow
    Maria Siemionow
    Maria Siemionow is a Polish surgeon at the Cleveland Clinic in Cleveland, Ohio. She gained public notice in December, 2008, when she led a team of six surgeons in a 22-hour surgery, performing the first face transplant in the United States on Connie Culp. She is currently Director of Plastic...

     (Cleveland, USA)
  • 2010: First full facial transplant, by Dr Joan Pere Barret and team (Hospital Universitari Vall d'Hebron on July 26, 2010 in Barcelona, Spain.)
  • Valencia's Hospital La Fe has been given permission by Spain's National Transplant Organisation (NTO) to carry out the world's first double leg transplant.. The transplantation has been carried on thursday 27 August 2010.

Autograft

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.) 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
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 in advance of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

). In a rotationplasty
Rotationplasty
Rotationplasty is type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.Typically the ankle joint becomes...

 a distal joint is used to replace a more proximal one, typically a foot and ankle joint is used to replace a knee joint. The a patient's foot is severed and reversed, the knee removed, and the tibia joined with the femur.

Allograft and allotransplantation

An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same species
Species
In biology, a species is one of the basic units of biological classification and a taxonomic rank. A species is often defined as a group of organisms capable of interbreeding and producing fertile offspring. While in many cases this definition is adequate, more precise or differing measures are...

. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...

 will identify the organ as foreign and attempt to destroy it, causing transplant rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...

.

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). Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they do not trigger an immune response
Immunology
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 the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...

.

Xenograft and xenotransplantation

A transplant of organs or tissue from one species to another. An example are porcine heart valve transplants, which are quite common and successful. Another example is attempted piscine-primate (fish to non-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study was intended to pave the way for potential human use, if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue.

Split transplants

Sometimes a deceased-donor organ, usually a 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 performed on patients with cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...

 because both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs at the same time. As the recipient's native heart is usually healthy, it can be transplanted into someone else needing a heart transplant.
This term is also used for a special form of liver transplant in which the recipient suffers from familial amyloidotic polyneuropathy
Amyloid
Amyloids are insoluble fibrous protein aggregates sharing specific structural traits. Abnormal accumulation of amyloid in organs may lead to amyloidosis, and may play a role in various neurodegenerative diseases.-Definition:...

, a disease where the liver slowly produces a protein that damages other organs. This patient's liver can be transplanted into an older patient who is likely to die from other causes before a problem arises.

This term also refers to a series of living donor transplants in which one donor donates to the highest recipient on the waiting list and the transplant center utilizes that donation to facilitate multiple transplants. These other transplants are otherwise impossible due to blood type or antibody barriers to transplantation. The "Good Samaritan" kidney is transplanted into one of the other recipients, whose donor in turn donates his or her kidney to an unrelated recipient. Depending on the patients on the waiting list, this has sometimes been repeated for up to six pairs, with the final donor donating to the patient at the top of the list. This method allows all organ recipients to get a transplant even if their living donor is not a match to them. This further benefits patients below any of these recipients on waiting lists, as they move closer to the top of the list for a deceased-donor organ.
Johns Hopkins Medical Center in Baltimore and Northwestern University's Northwestern Memorial Hospital have received significant attention for pioneering transplants of this kind.

Thoracic organs

  • Heart
    Heart transplantation
    A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...

     (Deceased-donor only)
  • Lung
    Lung transplantation
    Lung transplantation, or pulmonary transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor...

     (Deceased-donor and living-related lung transplantation)
  • Heart/Lung
    Heart-lung transplant
    A heart–lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors, it is a rare procedure; only about a hundred such transplants are performed each year in the USA....

     (Deceased-donor and Domino transplant)

Abdominal organs

  • Kidney
    Kidney transplantation
    Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ...

     (Deceased-donor and Living-Donor)
  • Liver
    Liver transplantation
    Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...

      (Deceased-donor and Living-Donor)
  • Pancreas
    Pancreas transplantation
    A pancreas transplant is an organ transplant that involves implanting a healthy pancreas into a person who usually has diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated...

      (Deceased-donor only)
  • Intestine (Deceased-donor and Living-Donor)
  • Stomach (Deceased-donor only)
  • Testis

Tissues, cells, fluids

  • Hand (Deceased-donor only), see the first recipient Clint Hallam
    Clint Hallam
    Clint Hallam was the first recipient of a human hand transplant.Hallam lost his hand in circular-saw accident at Rolleston prison in 1984, where he was serving time for fraud....

  • Cornea
    Cornea transplant
    Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue in its entirety or in part...

     (Deceased-donor only) see the ophthalmologist Eduard Zirm
    Eduard Zirm
    Eduard Konrad Zirm was an ophthalmologist who performed the first successful human tissue transplant on 7 December 1905....

  • Skin including Face replant (autograft) and Face transplant
    Face transplant
    A face transplant is a still-experimental procedure to replace all or part of a person's face. The world's first full face transplant was completed in Spain in 2010.-Beneficiaries of face transplant:...

     (extremely rare)
  • Islets of Langerhans
    Islets of Langerhans
    The islets of Langerhans are the regions of the pancreas that contain its endocrine cells. Discovered in 1869 by German pathological anatomist Paul Langerhans at the age of 22, the islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas...

     (Pancreas Islet Cells) (Deceased-donor and Living-Donor)
  • Bone marrow
    Bone marrow transplant
    Hematopoietic stem cell transplantation is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood...

    /Adult stem cell
    Stem cell
    This article is about the cell type. For the medical therapy, see Stem Cell TreatmentsStem cells are biological cells found in all multicellular organisms, that can divide and differentiate into diverse specialized cell types and can self-renew to produce more stem cells...

     (Living-Donor and Autograft)
  • Blood transfusion
    Blood transfusion
    Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...

    /Blood Parts Transfusion (Living-Donor and Autograft)
  • Blood vessels (Autograft and Deceased-Donor)
  • Heart valve (Deceased-Donor, Living-Donor and Xenograft[Porcine/bovine])
  • Bone (Deceased-Donor and Living-Donor)

Types of donor

Organ donors may be living, or brain dead. Brain dead means the donor must have received an injury (either traumatic or pathological) to the part of the brain that controls heartbeat and breathing. Breathing is maintained via artificial sources, which, in turn, maintains heartbeat. Once brain death has been declared the person can be considered for organ donation. Criteria for brain death vary. Because less than 3% of all deaths in the U.S. are the result of brain death, the overwhelming majority of deaths are ineligible for organ donation, resulting in severe shortages. Tissue may be recovered from donors who are cardiac dead. That is, their breathing and heartbeat has ceased. They are referred to as cadaveric donors. In general, tissues may be recovered from donors up to 24 hours past the cessation of heartbeat. In contrast to organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked." Also, more than 60 grafts may be obtained from a single tissue donor. Because of these three factors, the ability to recover from a non-heart beating donor, the ability to bank tissue, and the number of grafts available from each donor, tissue transplants are much more common than organ transplants. The American Association of Tissue Banks estimates that more than one million tissue transplants take place in the United States each year.

Living
In "living donors", the donor remains alive and donates a renewable tissue, cell, or fluid (e.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). Regenerative medicine
Regenerative medicine
Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore orestablish normal function". This field holds the promise of regenerating damaged tissues and organs in the body by replacing damaged tissue and/or by stimulating the body's own repair...

 may one day allow for laboratory-grown organs, using patient's own cells via stem cells, or healthy cells extracted from the failing organs.

Deceased
Deceased (formerly cadaveric) are donors who have been declared brain-dead
Brain death
Brain death is the irreversible end of all brain activity due to total necrosis of the cerebral neurons following loss of brain oxygenation. It should not be confused with a persistent vegetative state...

 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 Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. 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.

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 using serotyping
Serotype
Serotype or serovar refers to distinct variations within a subspecies of bacteria or viruses. These microorganisms, viruses, or cells are classified together based on their cell surface antigens...

. For example a spouse may be willing to donate a kidney to their partner but cannot since there is not a biological match. The 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
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...

 article "Ethics of a paired-kidney-exchange program" in 1997 by L.F. Ross. It was also proposed by Felix T. Rapport http://books.google.ca/books?ie=UTF-8&vid=ISBN0521651646&id=hd4HwXJkploC&pg=PA316&lpg=PA316&dq=paired+exchange+transplant&sig=3sO5zmDdSn8Dm9uxFz3n0bdsr20 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. 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 http://www.nepke.org/math.htm. Transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program.".

The first pair exchange transplant in the U.S. was in 2001 at Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...

http://www.hopkinshospital.org/health_info/Bladder/Reading/triple_transplant.html. The first complex multihospital kidney exchange involving 12 patients was performed in February 2009 by The Johns Hopkins Hospital, Barnes-Jewish Hospital
Barnes-Jewish Hospital
Barnes-Jewish Hospital is the largest hospital in the U.S. state of Missouri. It is the adult teaching hospital for Washington University School of Medicine, and is located in St. Louis, Missouri. It is consistently rated one of the top hospitals in the United States by U.S. News & World Report...

 in St. Louis and Integris Baptist Medical Center in Oklahoma City
Oklahoma city
Oklahoma City is the capital and largest city of the U.S. state of Oklahoma.Oklahoma City may also refer to:*Oklahoma City metropolitan area*Downtown Oklahoma City*Uptown Oklahoma City*Oklahoma City bombing*Oklahoma City National Memorial...

. Another 12-patient multihospital kidney exchange was performed four weeks later by Saint Barnabas Medical Center
Saint Barnabas Medical Center
Saint Barnabas Medical Center , an affiliate of the Barnabas Health , is a 597-bed non-profit major teaching hospital located in Livingston, New Jersey...

 in Livingston, New Jersey
Livingston, New Jersey
Livingston is a township in Essex County, New Jersey, United States. As of the United States 2000 Census, the township population was 29,366.Livingston was incorporated as a township by an Act of the New Jersey Legislature on February 5, 1813, from portions of Caldwell Township and Springfield...

, Newark Beth Israel Medical Center
Newark, New Jersey
Newark is the largest city in the American state of New Jersey, and the seat of Essex County. As of the 2010 United States Census, Newark had a population of 277,140, maintaining its status as the largest municipality in New Jersey. It is the 68th largest city in the U.S...

 and New York-Presbyterian Hospital. Surgical teams led by Johns Hopkins continue to pioneer in this field by having more complex chain of exchange such as eight-way multihospital kidney exchange. In December 2009, a 13 organ 13 recipient matched kidney exchange took place, coordinated through Georgetown University Hospital and Washington Hospital Center, Washington DC.

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
Jesus Christians
Jesus Christians is a small Christian group that practices communal living and distributes Bible-based comics and books.-History:The group was started in New South Wales, Australia, by Dave and...

, an Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

n religious group, have donated kidneys in such a fashion.

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
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...

.

In the United States, The National Organ Transplant Act of 1984
The National Organ Transplant Act of 1984
The National Organ Transplant Act , approved October 19, 1984 and amended in 1988 and 1990, outlawed the sale of human organs and provided for the establishment of the Task Force on Organ Transplantation; authorized the Department of Health and Human Services to make grants for the planning,...

 made organ sales illegal. In the United Kingdom, the Human Organ Transplants Act 1989 first made organ sales illegal, and has been superseded by the Human Tissue Act 2004
Human Tissue Act 2004
The Human Tissue Act 2004 is an Act of the Parliament of the United Kingdom which consolidated previous legislation and created the Human Tissue Authority to "regulate the removal, storage, use and disposal of human bodies, organs and tissue."...

.

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

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. Bioethicist Jacob M. Appel has argued that organ solicitation on billboards and the internet may actually increase the overall supply of organs.

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 a 2004 journal article Economist Alex Tabarrok argues that allowing organ sales, and elimination of organ donor lists will increase supply, lower costs and diminish social anxiety towards organ markets.

Iran has had a legal market for kidneys since 1988, and the market price is of the order of US$1,200 for the recipient. The Economist
The Economist
The Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...

http://www.economist.com/opinion/displaystory.cfm?story_id=8173039 and the Ayn Rand Institute
Ayn Rand Institute
The Ayn Rand Institute: The Center for the Advancement of Objectivism is a 501 nonprofit think tank in Irvine, California that promotes Ayn Rand's philosophy, called Objectivism. It was established in 1985, three years after Rand's death, by Leonard Peikoff, Rand's legal heir...

http://www.aynrand.org/site/News2?JServSessionIdr012=e38noczlb2.app7a&page=NewsArticle&id=11517&news_iv_ctrl=1085 approve and advocate a legal market elsewhere. 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
Surrogacy
Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. This woman may be the child's genetic mother , or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship whatsoever, transferred to her uterus...

, which can be done legally for pay in most countries.

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
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami on December 26, 2004. About 100 people, mostly women, sold their kidneys for 40,000–60,000 rupees ($900–$1,350). 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.

In Cyprus in 2010 police closed a fertility clinic under charges of trafficking in human eggs. The Petra Clinic, as it was known locally, imported women from Ukraine and Russia for egg harvesting and sold the genetic material to foreign fertility tourists. This sort of reproductive trafficking violates laws in the European Union. In 2010 the Pulitzer Center on Crisis Reporting
Pulitzer Center on Crisis Reporting
The Pulitzer Center on Crisis Reporting is an American news media organization established in 2006 that sponsors independent reporting that other media outlets are less willing or able to undertake on their own. The Center's goal is to raise the standard of coverage of global affairs, and to do so...

 and the magazine Fast Company
Fast Company (magazine)
Fast Company is a full-color business magazine that releases 10 issues per year and reports on topics including innovation, digital media, technology, change management, leadership, design, and social responsibility...

 explored illicit fertility networks in Spain, the United States and Israel.

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
United Network for Organ Sharing
Located in Richmond, Virginia, the United Network for Organ Sharing is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network in the United States, established by the U.S. Congress in 1984.UNOS was awarded the initial OPTN...

 or UNOS. (UNOS does not handle donor cornea tissue; corneal donor tissue is usually handled by various eye banks.) UNOS 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. 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.

Access to organ transplantation is one reason for the growth of medical tourism
Medical tourism
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...

.

Forced donation

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 . Illegal dissection of corpses is a form of body-snatching
Body-snatching
Body snatching is the secret disinterment of corpses from graveyards. A common purpose of body snatching is to sell the corpses for dissection or anatomy lectures in medical schools...

 and may have taken place to obtain allografts. http://money.cnn.com/2005/10/07/news/midcaps/corpse/?section=money_latest

According to the Chinese Deputy Minister of Health, Huang Jiefu, 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.

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
Medical tourism
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...

 to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical ways (see later). http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/09/MN23UPQ0K.DTL http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/17/MNGHAIA5B51.DTL http://www.independent.co.uk/news/world/asia/japans-rich-buy-organs-from-executed-chinese-prisoners-470719.html.

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

  • All numbers per million population

Source: http://www.transplantation-soc.org/globalalliance.php#6a,http://www.istanbulsaglik.gov.tr/w/sb/tedk/pdf/organ_nakli_genel_istatistikler.pdf

According to the Council of Europe
Council of Europe
The Council of Europe is an international organisation promoting co-operation between all countries of Europe in the areas of legal standards, human rights, democratic development, the rule of law and cultural co-operation...

, Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

 through the Spanish Transplant Organization
Spanish Transplant Organization
The National Transplant Organization is an institution belonging to the Spanish Ministry of Health and Consumption, put in charge of developing the competencies related with provision and clinical utilization of organs, tissues and cells....

 led by Dr Rafael Matesanz shows the highest worldwide rate of 35.1 donors per million population in 2005 and 33.8 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
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

. Donor bases vary in developing nations.

Traditionally, Muslims believe body desecration in life or death to be forbidden, and thus many reject organ transplant. However most Muslim authorities nowadays accept the practice if another life will be saved.

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.

Organ transplantation in China has taken place since the 1960s, and China has one of the largest transplant programmes in the world, peaking at over 13,000 transplants a year by 2004. Organ donation, however, is against Chinese tradition and culture, and involuntary organ donation is illegal under Chinese law. China
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...

's transplant programme attracted the attention of international news media
News media
The news media are those elements of the mass media that focus on delivering news to the general public or a target public.These include print media , broadcast news , and more recently the Internet .-Etymology:A medium is a carrier of something...

 in the 1990s due to ethical concerns about the organs
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

 and tissue
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

 removed from the corpses of executed criminals being commercially traded for transplants
Organ transplant
Organ transplantation is the moving of an 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 absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...

.

With regard to organ transplantation in Israel, there is a severe organ shortage due to religious objections by some rabbis who oppose all organ donations and others who advocate that a rabbi participate in all decision making regarding a particular donor. One third of all heart transplants performed on Israelis are 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. The organization HODS (Halachic Organ Donor Society) is working to increase knowledge and participation in organ donation among Jews throughout the world.

Transplantation rates also differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list. For example, different groups express definite interest and complete pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.

Comparative costs

One of the driving forces for illegal organ trafficking and for “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 http://organharvestinvestigation.net/report20070131.htm#_Toc160145122. Although these prices are still unattainable to the 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.

In India, a kidney transplant operation runs for around as low as $5000.

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 did not show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies would not have existed in high enough numbers to detect. The crisis has caused many to call for more sensitive screening tests, which could pick up antibodies sooner. Currently, the screens cannot pick up on the small number of antibodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18–21 days before a donation is made.

NAT (nucleic acid testing) is now being done by many organ procurement organizations and is able to detect antibodies for HIV and Hepatitis C within seven to ten days of exposure to the virus.

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, France, Italy, Poland and Spain have ruled all adults potential donors with the “opting out” policy, unless they attain cards specifying not to be. 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.

On June 27, 2008, Indonesian, Sulaiman Damanik, 26, pleaded guilty in Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...

 court for sale of his kidney to CK Tang's executive chair, Mr Tang Wee Sung, 55, for 150 million rupiah (S$ 22,200). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks." Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (20,200 US). Upon sentence, both would suffer each, 12 months in jail or 10,000 Singapore dollars (7,600 US) fine.

In an article appearing in the Econ Journal Watch, April 2004. Economist Alex Tabarrok examined the impact of direct consent laws on transplant organ availability. Tabarrok found that social pressures resisting the use of transplant organs decreased over time as the opportunity of individual decisions increased. Tabarrok concluded his study suggesting that gradual elimination of organ donation restrictions and move to a free market in organ sales will increase supply of organs and encourage broader social acceptance of organ donation as a practice.

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. 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
Distributive justice concerns what some consider to be socially just allocation of goods in a society. A society in which incidental inequalities in outcome do not arise would be considered a society guided by the principles of distributive justice...

. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 argues that transplantations promote health, but the notion of “transplantation tourism” has the potential to violate human rights
Human rights
Human rights are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being." Human rights are thus conceived as universal and egalitarian . These rights may exist as natural rights or as legal rights, in both national...

 or exploit the poor, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. 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
Universal Declaration of Human Rights
The Universal Declaration of Human Rights is a declaration adopted by the United Nations General Assembly . The Declaration arose directly from the experience of the Second World War and represents the first global expression of rights to which all human beings are inherently entitled...

. 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
Universal Declaration of Human Rights
The Universal Declaration of Human Rights is a declaration adopted by the United Nations General Assembly . The Declaration arose directly from the experience of the Second World War and represents the first global expression of rights to which all human beings are inherently entitled...

.

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
Legal death
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. The specific criteria used to pronounce legal death are variable and often depend on certain circumstances in order to pronounce a...

 cannot be adequately defined and can easily change with changing technology.

Artificial organ transplantation

Surgeons in Sweden performed the first implantation of a synthetic trachea in July 2011, for a 36-year-old patient who was suffering from cancer. Stem cells taken from the patient's hip were treated with growth factors and incubated on a plastic replica of his natural trachea.

Sources and bibliography

  • Köchler, Hans
    Hans Köchler
    Hans Köchler is a professor of philosophy at the University of Innsbruck, Austria, and president of the International Progress Organization, a non-governmental organization in consultative status with the United Nations...

    , ed. (2001). Transplantationsmedizin und personale Identität. Medizinische, ethische, rechtliche und theologische Aspekte der Organverpflanzung. (Transplantation Medicine and Personal Identity. Medical, Ethical, Legal and Theological Aspects of Organ Transplantation / German) Frankfurt a. M. etc.: Peter Lang. ISBN 3-631-38363-0

Further reading

  • Gerritsen, T
    Tess Gerritsen
    Tess Gerritsen, M.D., is a Chinese-American novelist and retired physician. Her first name is really Terry; she decided to feminize it when she was a writer of romance novels.-Early life:...

    . (1996). Harvest. New York: Pocket Books.
  • Gutkind, L
    Lee Gutkind
    Lee Gutkind is an American writer.Gurkind is the founder of the literary magazine Creative Nonfiction and the author or editor of over a dozen books. He started the first ever MFA program in creative nonfiction at the University of Pittsburgh in Pittsburgh...

    . (1990). Many Sleepless Nights: The World of Organ Transplantation. New York: W. W. Norton & Company, Inc.
  • Picoult, J.
    Jodi Picoult
    Jodi Lynn Picoult is an American author. She was awarded the New England Bookseller Award for fiction in 2003. Picoult currently has some 14 million copies of her books in print worldwide.-Early life and education:...

    . (2008). Change of Heart. New York: Simon & Schuster, Inc.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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