Organ-Transplantation-Unit-Part-1.presentation

Organ Transplantation
• Organ transplantation is a medical procedure in which an
organ is removed from one body and placed in the body of
the recipient
• This is for replacing a damaged or missing organ
• The donor and the recipient may be at the same location, or
• Organs may be transported from a donor site to another location
2

• Autograft
• Organs and / or tissues that are transplanted within the same
person’s body are called autograft
• Allografts
• Transplants that are recently performed between two subjects of
the same species are called allografts
3

• Xenotransplantation
• Even with creative ways to utilise more living and deceased
donors, another source of kidneys is most likely
necessary
• Transplantation between an animal source and human recipient is
called xenotransplantation
• This has already occurred from non-human primate donors such
as chimpanzees, monkeys and baboons
4

• These are endangered species and the size and blood type
differences are great
– Moreover, there is a concern of transmission of infectious
diseases
– These type transplantation is currently banned in USA by the
FDA
• Most research in this field is currently centered on the pig
– As the donor, pigs has certain desirable characteristics
• They have multiple offspring, rapid maturity to adult age, lower risk of
transmissible infectious deisease and appropriate size
5

• Transplant tourism
• With the short supply of organs patients are travelling from one
country to another to receive a transplant
• Commercialisation and poor regulation can undermine the true
nature of transplantation and put patient’s life at risk
6

• History of kidney Transplantation
• Alexis Carrel was awarded the Nobel Prize in 1912 for his pioneering
work.
• First case of kidney transplantation was reported in 1902 by a
Hungarian surgeon Emerich Ullmann
• The report was submitted at the Vienna Medical Society
Meeting
• A dog’s kidney was transplanted into another Dog’s neck
• In the same year another French surgeon also published a paper on
operating technique for organ transplantation 7

• First Animal to human transplant
• In 1906, a French surgeon transplanted left kidney of a pig into the
left elbow of a woman suffering from nephrotic syndrome
• The graft failed because of early vascular thrombosis
• First unsuccessful kidney transplant between humans
• In 1936, Voronoy in Russia reported transplant between humans
using cadeveric kidney
8

• 1943-1944 Madawar gave an explanation of graft destruction
due to biological incompatibility – as described by carrel
• This ‘biological incompatibility’ was now explained as rejection due to
an immunologic response
• 1947-1953: Initial unsuccessful allotransplants
• This was in Peter Bent Brigham Hospital in Boston USA on a young
woman
• Due to objection by hospital administration to perform such operation
in OT, it was done in a difficult situation in a small room in the
night by using two lamps
9

• 1959: First successful kidney transplant between non-
identical twins
• This was done in the same hospital (PBB Hospital) between
dizygotic twins
• 1960: First successful kidney transplant between non-twin
sioblings
• In January 1960, the first successful kidney transplant was done
at the Foch Hospital in France
10

• 1960-61: First successful kidney transplant
– A transplant was done at Foch Hospital two kidney transplants was
performed between two non-siblings
– An episode of rejection occurred at 5 weeks
– It was treated with low doses of total body irradiation, steroids and
administration of an immunosuppressive drug – 6-
mercaptopurine
• 1961-1962: First kidney transplants using azathioprine
– Experimentation with 6-mercaptopurine began in 1959 in London,
• Roy Calne demonstrated prolonged kidney graft survival in dogs
– The drug was first used in humans in 1960
11

• 1962: First successful cadeveric kidney transplant using
immunosuppressant
– In April 1962, at the Peter Bent Brigham Hospital, Murray
performed the first successful human cadaveric kidney transplant,
– They used an immunosuppressive regimen of azathioprine and
actinomycin C
– The graft functioned for more than one year
– This was a record for a cadaveric kidney at that time.
12

Organ Donation Standards for living Donors
• These standards are published by Accreditation Canada
• These standards for living donors apply to acute care organisations
that have a living donation team and program
• This standards pertain to living donation for kidney, liver,
lung, intestine, and pancreas donation
13

WHO – Draft Guiding Principles on Human Organ
Transplantation
• Guiding Principle (GP) 1
• Organs may be removed from the bodies of deceased persons for
the purpose of transplantation if:
• any consents required by law are obtained; and
• there is no reason to believe that the deceased person objected to such
removal, in the absence of any formal consent given during the
person's lifetime.
14

Transplantation
• Guiding principle 2
• Physicians determining that the death of a potential donor has
occurred
• should not be directly involved in organ removal from the donor and
• subsequent transplantation procedures, or
• be responsible for the care of potential recipients of such organs.
15

Transplantation
• Organs for transplantation should be removed preferably from
the bodies of deceased persons.
• However, adult living persons may donate organs, but in general
such donors should be genetically related to the recipients.
• Exceptions may be made in the case of transplantation of bone
marrow and other acceptable regenerative tissues
16

Transplantation
– An organ may be removed from the body of an adult living donor for the
purpose of transplantation if the donor gives free consent.
– The donor should be free of
• any undue influence and pressure and
• sufficiently informed to be able to understand and weigh the risks, benefits and
consequences of consent
– No organ should be removed from the body of a living minor for the purpose
of transplantation.
– Exceptions may be made under national law in the case of regenerative
tissues
17

Transplantation
– The human body and its parts cannot be the subject of
commercial transactions.
– Accordingly, giving or receiving payment (including any other
compensation or reward) for organs should be prohibited.
– Advertising the need for or availability of organs, with a view to
offering or seeking payment, should be prohibited.
18

Transplantation
– It should be prohibited for physicians and other health professionals to
engage in organ transplantation procedures, if
• they have reason to believe that the organs concerned have been the subject of
commercial transactions.
– It should be prohibited for any person or facility involved in organ
transplantation procedures
• to receive any payment that exceeds a justifiable fee for the services
rendered.
19

Transplantation
• In the light of the principles of distributive justice and equity,
• donated organs should be made available to patients on the basis
of medical need
• and not on the basis of financial or other considerations.
20

Need
In India there is a growing need of organ and tissue transplant. The estimated
number of organs required every year is as under:
Type of organ Number
Kidney 250000
Heart 50000
Liver 80000
Cornea 100000
21

Status of Organ / Tissue Donation and
Transplantation in India
• The organ donation rate in India is currently less than 1 per
million
• In comparison, Spain is having 35 donation per million
• The deceased donation is insignificant in India
• Govt. of India enacted the Transplantation of Human Organ
Act, 1994
• The Act provide for removal, storage and transplantation of human
organs for therapeutic purposes
22

Status of Organ / Tissue Donation and
Transplantation in India
• The Act envisaged prevention of commercial dealings in
human organs
• A committee was constituted by the Hon’ble High Court of
Delhi to review the provisions of the Act, 1994 and the Rule,
1995 amended in 2008
• The G of I amended the Act in 2011
23

Organ Donation
• What are the Organs that can be donated ?
• The organs that can be donated are:
• Liver, Kidney, Pancreas, Heart, Lung, Intestine.
• What are the tissues that can be donated?
• The tissues that can be donated are:
• Cornea, Bone, Skin, Heart Valve, blood vessels, nerves and tendon etc.
24

Organ Donation
• How does whole body donation differ from organ donation?
• Organ donation for therapeutic purposes is covered under the
Transplantation of Human Organs Act (THOA 1994).
• Whole body donation is covered by the Anatomy Act 1984.
• Body donation is defined as the act of giving one’s body after death for
medical research and education.
• Those donated cadavers remain a principal teaching tool for anatomists
and medical educators teaching gross anatomy.
25

Organ Donation
• What are the different types of Organ Donation?
• There are two types of organ donation:-
1. Living Donor Organ Donation:
• A person during his life can donate
• one kidney (the other kidney is capable of maintaining the body
functions adequately for the donor),
• a portion of pancreas (half of the pancreas is adequate for sustaining pancreatic
functions) and
• a part of the liver (the segments of liver will regenerate after a period of time in
both recipient and donor).
26

Organ Donation
• Deceased Donor Organ Donation:
• A person can donate multiple organ and tissues after (brain-
stem/cardiac) death.
• His/her organ continues to live in another person’s body..
• What are the different types of living organ donation?
• Living Near Related Donors:
• Only immediate blood relations are accepted usually as donors viz., parents,
siblings, children, grandparents and grand children (THOA Rules 2014).
• Spouse is also accepted as a living donor in the category of near relative and is
permitted to be a donor.
27

Organ Donation
• Living Non-near relative Donors:
• They are other than near relative of recipient or patient.
• They can donate only for the reason of affection and attachment towards the
recipient or for any other special reason.
• SWAP Donors:
• In some cases the living near-relative donor is incompatible with the recipient,
• Provision for swapping of donors between two such pairs exists,
• In this, the donor of first pair matches with the second recipient and donor of second
pair matches with the first recipient
• This is permissible only for near relatives as donors.
28

Organ Donation
• What is Brain-stem Death?
• Brain stem death is cessation of function of the brain stem due to
irreversible damage.
• It is an irreversible condition and the person has died.
• It is also called Brain Death in India.
• A brain stem dead person cannot breathe on his own
• The heart has an inbuilt mechanism for pumping as long as it has a supply of
oxygen and blood.
29

Organ Donation
• A ventilator continues to blow air into lungs of brain stem dead persons
• Their heart continues to receive oxygenated blood and medicine may be given to
maintain their blood pressure.
• The heart will continue to beat for a period of time after brain stem death
• this does not mean that the person is alive, or that there is any chance of recovery.
• The declaration of brain stem death is made with accepted
medical standards.
• The parameters emphasize the 3 clinical findings necessary to
confirm irreversible cessation of all functions of the entire brain,
including the brain stem:
30

Organ Donation
• coma (loss of consciousness) with a known cause,
• absence of brainstem reflexes, and
• apnea (absence of spontaneous breathing).
• These tests are carried out twice at the interval of at-least 6-
12 hours by the team of Medical Experts.
• Brain-stem Death is accepted under the Transplant Human
Organ Act since 1994.
31

Organ Donation
• Who will certify the Brain-stem Death?
• As per THOA Board of Medical Experts Consisting of following will certify
Brain-stem Death:
1. Doctor in charge of the hospital (medical superintendent)
2. Doctor nominated from a panel of Doctors appointed by the Appropriate
Authority
3. Neurologist/neurosurgeon/intensivist nominated from a panel appointed by the
Appropriate Authority.
4. Doctor treating the patient.
• The panel of four doctors carries out the tests together to certify brain
death. 32

Organ-Transplantation-Unit-Part-1.presentation

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Organ-Transplantation-Unit-Part-1.presentation