healthytransplant.com | The Basics | Before Transplantation
In the past 20 years, transplantation has become a treatment option for otherwise incurable diseases of several types of solid organs. Here are some of the transplants that can be made:
This is the most common type of organ transplantation. In 2008, over 16,500 kidney transplants were performed in the US
The liver was the second most common type of organ transplant in 2008, with over 6,300 transplants performed
In 2008, almost 2,200 heart transplants were performed in the US
DECEASED DONORS AND LIVING DONORS
In the United States and around the globe, there is a shortage of organs for transplantation…and the shortage is growing.
- Almost 103,000 people are waiting today for solid organ transplant surgeries according to the US Department of Health and Human Services and (DHHS) and the Organ Procurement and Transplantation Network (OPTN)
The good news is that transplantation of organs from deceased donors has increased and medical advances have raised the profile of transplants from living donors.
Figure. US transplants by donor type by year. Based on OPTN data as of August 9, 2009.
Partly as a result of these advances, the number of living donors in the United States climbed to more than 6,200 in 2008 — 44% of all organ donations.
Figure. US Donors by Donor Type (2008) Based on OPTN data as of August 9, 2009.
MATCHING ORGANS FROM A DECEASED DONOR
To match organs between deceased donors and potential recipients there is a centralized computer network — called UNetSM — available 24 hours a day, seven days a week. The network – run by the United Network for Organ Sharing (UNOS) — links all transplant hospitals and organ procurement organizations using a secure passwords.
Medical information about the deceased donor is matched against transplant candidates. This "match run" automatically creates a ranked list of suitable candidates for each organ based on several factors which may include some of the following, depending on the type of organ:
- Time on the waiting list
- Blood type
- Tissue match
- Immune status
- Distance between the potential recipient and the donor
- Degree of medical urgency (for heart, liver, lung and intestines)
There several ways to increase the pool of organs from deceased donors including accepting organs from "extended criteria donors" (ECD). Although there is no universally accepted definition of ECD, some of the criteria are advanced donor age; longer time that the donated organ is without blood supply; need for medications to increase blood pressure in the donor; and donation after the donor’s heart stops.
Transplant doctors continue to evaluate the risks to the recipient associated with ECD organ transplantation.
FINDING A LIVING DONOR
Finding a living donor involves a different process than matching organs from a deceased donor. Some living donors are related to the organ recipient — genetically and/or emotionally — whereas others are not. Some individuals donate an organ explicitly for a single recipient, but "exchanging" organs among multiple donors and recipients is also an option. You can learn more about living donation at Healthy-Donor.com
The types of living organ donations are described below:
Blood relatives of transplant candidates are considered related living donors. These include:
- Other blood relatives
Individuals not related by blood but with an emotional bond to the transplant candidates are considered unrelated living donors are. These include:
- Wife or husband
- In-law relatives
- Friends, neighbors, co-workers
Non-directed donation refers to donation by altruistic or "good Samaritan" donors who are anonymous to the recipient.
Paired donation consists of two incompatible donor/recipient pairs (they may have the wrong blood type, or the recipient may have antibody to the proteins on the surface of the donor's cells). The donor and recipient are matched with another incompatible donor/recipient pair and the organs are exchanged between the pairs.
Figure. Two-way exchange.
Figure. Three-way exchange.
RISKS OF "TRANSPLANT TOURISM"
In recent years, practices such as organ trafficking, transplant commercialism, and transplant tourism have become serious problems. Such practices are illegal in the United States and many countries and can pose serious health problems for donors and recipients.
Efforts to Discourage Organ Trafficking, Transplant Commercialism, and Transplant Tourism
Within the United States, the National Organ Transplant Act (NOTA) of 1972 states, "It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation." Recently, the Institute of Medicine has published a report that affirms legal opposition to organ sales.
Internationally, there have stepped up efforts to discourage organ trafficking, transplant commercialism, and "transplant tourism."
For example, in 2004, the World Health Organization (WHO) called on member states "to take measures to protect the poorest and vulnerable groups from transplant tourism and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs."
In 2008, an International Summit on Transplant Tourism and Organ Trafficking was convened in Istanbul, Turkey by The Transplantation Society and International Society of Nephrology. The Istanbul Declaration proclaimed that the poor who sell their organs are being exploited, and transplant tourists risk physical harm by unregulated and illegal transplantation.