Introduction
Transplantation – The transfer of cells, tissues, or organs from an area of the body to another of from one organism to another.
Transplantation, allogeneic (allograft) – Transplantation between genetically different members of the same species. Nearly all organ and bone marrow transplants are allografts. These may be between brothers and sisters, parents and children, or between donors and recipients who are not related to each other.
Transplantation, autologous – Transplantation of an organism’s own cell or tissues; autologous transplantation may be used to repair or replace damaged tissue; autologous bone marrow transplantation permits the usage of more severe and toxic cancer therapies by replacing bone marrow damaged by the treatment with marrow that was removed and stored prior to treatment.
Transplantation, xenogeneic (xenograft) – Transplantation between members of different species; for example, the transplantation of animal organs into humans.
Living Donors – Are persons who donate a kidney, part of a lung or part of a liver while they are still alive
Donation – Is the act of giving one’s organs or tissue to someone else.
End-Stage Organ Disease – A disease that leads, ultimately, to functional failure of an organ. Some examples are emphysema (lungs), cardiomyopathy (heart), and polycystic kidney disease (kidneys).HISTORY
Thirty-five years ago today, surgeon Christiaan Barnard performed the first human heart transplant on a human being at the Groote Schuur Hospital in Cape Town, South Africa.
Barnard, who studied medicine at the University of Cape Town and pursued further heart training in the U.S., employed transplantation techniques initially developed by American researchers in the 1950s. American surgeon Norman Shumway achieved the first successful heart transplant, in a dog, at Stanford University in California in 1958.
On December 3, 1967, Barnard transplanted a heart from a 25-year-old woman fatally injured in a car accident into Lewis Washkansky, a 53-year-old South African grocer dying from chronic heart disease.
Lung infection and pneumonia claimed Washkansky’s life 18 days later. The patient’s new heart, however, continued to function normally until his death.
In the three decades since the performance of the first human heart transplant in December 1967, the procedure has changed from an experimental operation to an established treatment for advanced heart disease. During the next 25 years, improved drugs such as cyclosporine dramatically reduced organ rejection by suppressing the human immune system, and increased survival rates for transplants.
There have been two main barriers to increasing the number of successful operations. In 1983, the first barrier to successful transplantations–rejection of the donor organ by the patient–was overcome. The drug cyclosporine was introduced to suppress rejection of a donor heart or heart-lung by the patient’s body. Cyclosporine and other medications to control rejection have significantly improved the survival of transplant patients. About 80 percent of heart transplant patients survive 1 year or more. About 60 percent of heart-lung transplants live at least 1 year after surgery. Research is under way to develop even better ways to control transplant rejection and improve survival.
Organ availability is the second barrier to increasing the number of successful transplantations. Hospitals and organizations nationwide are trying to increase public awareness of this problem and improve organ distribution.
Approximately 2,300 heart transplants are performed each year in the United States.
In 1981, combined heart and lung transplants began to be used to treat patients with conditions that severely damage both these organs. As of 1995, about 500 people in the United States and 2,000 worldwide have received heart-lung transplants. Today, more than 30,000 heart transplants have been performed in the United States and more than 50,000 have been done worldwide. While heart transplantation has become very successful, finding appropriate donors is extremely difficult. More than 80,000 people in the United States currently await transplants; nearly 4,000 of those require a heart transplant.
Why are transplants done?
A transplant is considered when the organ is failing and does not respond to all other therapies, but health is otherwise good. The leading reasons why people receive heart transplants are:
• Cardiomyopathy–a weakening of the heart muscle.
• Severe coronary artery disease–in which the heart’s blood vessels become blocked and the heart muscle is damaged.
• Birth defects of the heart.
Heart-lung transplants are performed on patients who will die from end-stage lung disease that also involves the heart. Alternative therapies for these patients have been tried or considered. Leading reasons people receive heart-lung transplants are:
• Severe pulmonary hypertension–a large increase in blood pressure in the vessels of the lungs that limits blood flow and delivery of oxygen to the rest of the body.
• A birth defect of the heart that results in Eisenmenger’s complex–another name for acquired pulmonary hypertension.
What happens during a heart or heart-lung transplant?
A transplant is the replacement of a patient’s diseased heart or heart and lungs with a normal organ(s) from someone–called a donor–who has died. The donor’s organ(s) is completely removed and
quickly transported to the patient, who may be located across the country. Organs are cooled and kept in a special solution while being taken to the patient.