Medical Technology: organ harvesting and Transplants

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Figure 1. Donor Card (Source: OrganDonor.Gov) http://organdonor.gov/donor/index.htm Signing up to be an organ and tissue donor is easy and may save and improve the lives of many. You may register online with your state donor registry through http://organdonor.gov/donor/registry.shtm or designate your desire to be an organ donor on your driver’s license. You may also fill out and carry an organ donor card with you, ftp://ftp.hrsa.gov/organdonor/newdonorcard.pdf, until you have the chance to register online or designate it on your driver’s license. of a driver’s license application) that permits medical teams to harvest organs or tissues when you are about to die or very shortly after death. Few medical exclusions exist, with the exception of HIV, active cancer, and systemic infections being the only absolute exclusions. Organs and tissues from individuals with other medical conditions will be evaluated by doctors to determine if they are suitable for donation. The key in organ donation is the condition of the organ, not the age. Even though it takes little effort to become an organ donor, many people spend years on the waiting list due to the shortage of organs. Although physicians from earlier times attempted human limb transplants, successful transplants began with the eye cornea and were first reported in 1906 by Edward Zirm, MD (www.ulleb.org/history_of_corneal_transplan. htm). The major drawbacks to early transplants were organ rejections and infections. Research during the 1940s gave scientists a better understanding of the role the immune system played in organ donation. Their discoveries led to the development and use of the first immunosuppressive drugs in the hopes that by suppressing the normal immune reaction, the chances of organ rejection would decrease. However, the first drugs used also killed the patient’s bone marrow cells, leaving patients, “vulnerable to all kinds of infections” (Grace, 296, p. 61). As a result, survival rates were very low. During the 1970s though, transplant success greatly improved as the discovery of the immunosuppressive drug, cyclosporine, solved this problem and transformed the world of organ donation. Produced by a fungus that actually lives in soil, cyclosporine works by only inactivating a person’s T-cells, a type of white blood cell involved in the immune response, leaving the remainder of the immune system intact. Few side effects are associated with taking cyclosporine, and those that do occur go away when the patient stops taking the medication. Since the first use of cyclosporine in humans in 1978, survival rates for liver and kidney transplants have doubled, and rejection of heart transplants has been virtually eliminated (Grace, 2006). The increased survival rates due to the use of cyclosporine, however, brought about a new problem with organ donations—lack of organ supply. This Resources in Technology piece will explain organ and tissue transplants currently being performed throughout the medical community. What is Organ Harvesting? Organ harvesting is the taking of a healthy organ from a human body that is dying or clinically dead (Reference.MD, 2007, www.reference.md/files/D019/ mD019737.html). Organs and tissue are usually harvested from people who volunteer as organ donors upon their death. The person must be breathing and their heart must be beating; however, they have been medically determined to be brain dead. Organs that can be donated by an individual who has died include the kidneys, liver, heart, lungs, pancreas, and intestines. Not all transplants are made from donors who are brain dead. Some organs or tissue can be harvested and transplanted from the living, such as a kidney, part of the intestines, lungs, and liver. You might have heard of a family member donating a kidney to keep another family member from dying. Various types of tissues can be donated as well and include corneas, skin, bone, heart valves, cartilage, tendons, ligaments, and even tissue from the middle ear. These tissues have been successfully used to restore a person’s sight, repair a damaged heart, fix tendons and ligaments, replace veins, and help in the healing process for burn patients. Multiple organs can also be transplanted at the same time. While kidney/pancreas transplants and heart/ lung transplants are the most common multiple-organ transplants, other combinations of organ transplants have also been performed. In addition to organs and tissues, healthy adults aged 18-60 may donate stem cells, which may be obtained from the bone marrow or peripheral blood (Who Can Donate, http://organdonor.gov/donation/ who_donate.htm). Stem cells from the cord blood of an infant may also be harvested and donated to a public cord blood bank to be placed on a national registry list. New parents can opt to have their child’s cord blood stored by a private company in the event that it is needed later to help 6 • The Technology Teacher • April 2010
healthy organ. A video on the processing of tissue can be viewed at LifeNet Health at www.accesslifenet.org/home/ virtual_tour_video/. Organ and Tissue Transplants Figure 2. Medical helicopter. (Source: Sentara Hospitals) From its base at Sentara Norfolk General Hospital, the Nightingale Regional Air Ambulance has reached out to more than 16,000 patients since its inception in February 1982. The Sentara service provides rapid transport of the critically ill or injured from a scene of an accident or incident, or from one medical facility to another with more specialized critical care capabilities. save that child or the child’s sibling. Stem cells have been used to treat many diseases including various cancers and leukemia. Timing is very critical to harvesting organs. Prior to the organs being removed from the donor, they are flushed with an ice-cold preservative solution that removes all of the blood from the organs and begins the preservation process. Once the organs are removed, they are packaged in wet ice, placed in a sterile container, and transported to the designated transplant center. It is imperative that organs be transported as quickly as possible as each organ is only viable for a specified amount of time. Medical helicopters are frequently used to transport organs from donor locations to a transplant center like the one shown in Figure 2. When the organs no longer receive oxygen and blood, they lose their ability to regenerate and function. Hearts and lungs must be transported within 4-6 hours, livers between 18-24 hours, and intestines within 8 hours (Organ Donation Process, www.donatelifeny.org). Kidneys have the longest transport time of 24-48 hours (Organ Donation Process, www.donatelifeny.org). Corneas must be removed within 12 hours following the donor’s death in order to be viable for transplant. The intent is to transplant the healthy organ into a living human with a damaged or failing organ, thus replacing it with the As stated above, a major problem of organ and tissue transplanting is the lack of needed organs for transplant. Individuals in need of an organ transplant may spend many years on the waiting list, and some may die before an organ becomes available. During 2009 (UNOS, 2009), there were 104,296 U.S. residents awaiting transplants. These numbers show that only 27% of the U.S. population was able to get needed transplants. The number continues to grow, as every 11 minutes another name gets added to the national waiting list. (See Table 1.) About 18 deaths occur each day due to lack of an available organ(s). These percentages increase as one moves around the globe because of a lack of information and medical resources. Additionally, more detailed data both at the national and state level can be accessed through the UNOS website at www.unos.org. How We Harvest Transplant Numbers Waiting list candidates 105,327 as of 01/12/2010 Transplants January - October 2009 23,846 as of 01/08/2010 Donors January - October 2009 12,180 as of 01/08/2010 Table 1 Many hospitals and companies specialize in surgery, storage, and transplant of organs and tissues. The process is complex, as patients need to be diagnosed and subsequently put onto waiting lists, donors have to be identified, organs must be harvested, stored, and transported, and then the transplant surgery must take place. Before the organs and tissues may be harvested for future transplant, the patient and family must complete the appropriate paperwork, approving the procedures and usage of the donated organs and/or tissues. Therefore, the procurement of organs and tissues takes the coordination and cooperation of many individuals including nurses, hospital staff, the donor’s family, transplant coordinator, and the surgery team performing the transplant. Figure 3 shows a surgical team operating 7 • The Technology Teacher • April 2010
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Medical Technology: organ harvesting and Transplants

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