Medical Technology: organ harvesting and Transplants

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Figure 3. Operating room. Doctors and support staff are shown here preparing a patient for delicate hand surgery. Similar to complex organ transplants, OR surgeons and support staff function as a team using sophisticated surgical tools and monitoring equipment. (Photo Credit: www.randysmithphoto.com) on a patient’s hand using precision surgical techniques and sophisticated equipment in an operating room environment similar to what we may expect see in a transplant OR room. The donation process begins with a representative from the hospital where the patient donor has died contacting the designated organ donor network and providing the information needed to determine if the patient is a viable donor. A transplant coordinator from the OPO (organ procurement organization) then travels to the site, at which time he or she will evaluate the potential donor by obtaining detailed medical information and will, at that time, determine whether the organs are suitable for donation. The transplant coordinator also meets with the patient’s next of kin to explain the donation process and obtain consent for which organs and/or tissues they wish to be donated. All needed information about the donor, including blood type and body size, are entered into a national computerized network maintained by UNOS (United Network for Organ Sharing) located in Richmond, VA (Organ Donation Process, www.donatelifeny.org). UNOS serves as the link between all of the organ procurement organizations (OPOs) and the local transplant centers. Using this information, the system will match the medical characteristics of the donor to the characteristics of individuals on the waiting list. Many factors are taken into consideration when determining how the donated organs are to be distributed. Age, medical urgency, time spent on the waiting list, geographical distance between donor and recipient, blood type, size of the organ relative to the potential recipient, and type of organ needed are just a few of the factors that are looked at prior to the dissemination of the organ. Based on these factors, a ranked list of potential recipients, called a “match run” is generated (About Organ Allocation, www.transplantliving. org/beforethetransplant/allocation/matchingOrgans.aspx). The available organ is first offered to the top candidate on the waiting list. However, this patient is not always the one to receive the organ as several things must fall into place for a transplant to occur. The patient must be available, willing to have the transplant right away, and healthy enough for the surgery to be performed. If any one of these does not occur, the organ will then be offered to the next person on the waiting list. Once a viable recipient is identified, the transplant center in the area where the potential recipient resides is then contacted by the transplant coordinator. The transplant coordinator provides the transplant center with the needed information about the donor. The final decision as to whether the donor and recipient are a good match is ultimately made by the transplant surgeon. Information regarding donated tissues is sent to the tissue bank affiliated with the hospital. The tissue bank evaluates the information to determine the viability of the tissues being donated. Most tissues can be stored frozen for extended time periods. Each U.S. state has one or more regional tissue banks for the storage and retrieval of tissues. Recovery of donated organs and/or tissues occurs in the hospital where the potential donor is located. Surgeons, nurses, the transplant coordinator, and an organ preservation technician all have an important role in ensuring that the recovery process occurs smoothly and efficiently. Identification of potential recipients for a heart, lung, or liver transplant occurs before the organs are removed from the donor. In cases of kidney and pancreas transplants, compatibility testing between the donor and the potential recipient must be performed after the organs are removed. For the testing to be performed, a tube of blood is drawn and the sample is tested to determine which human leukocyte antigens (HLA), genetic markers found on a person’s white blood cells, are present. The results are analyzed to determine how close the donor’s HLA matches those of the recipient. Matching six or more antigens increases the chance that the transplant will be a success and greatly 8 • The Technology Teacher • April 2010
educes the chance for rejection (The Kidney Transplant Process, www.utmb.edu/renaltx/process.htm). However, successful transplants have occurred with lesser matches between antigens. Other compatibility testing is performed, along with the HLA testing, in order to lessen the likelihood that the organ will be rejected. Types of Transplants There are three types of transplants that can be performed between donor and recipient. Autologous transplants involve donations in which the donor is the same as the recipient, e.g., blood donations or vein transplants. Homologous donations or allografts are donations from a genetically identical twin, a living person, or deceased donor unrelated to the recipient or a parent or sibling genetically similar to the recipient. Xenotransplants are transplants in which the donor is from a different species than the recipient, i.e., pig valves and baboon hearts being transplanted in humans. Heart transplants in adults are most often required in patients with coronary artery disease, cardiomyopathy, and congestive heart failure. In infants and young children, the need for a new heart most often occurs in cases of congenital heart disease, which is the most common lethal birth defect. Lung transplants are often needed in individuals suffering from such diseases as Cystic Fibrosis, emphysema, and pulmonary hypertension. Cirrhosis of the liver is the most common cause of liver failure, which subsequently results in the need for a new liver. Intestinal transplants may be required in patients with irreversible intestinal failure due to twisted and/or blocked intestines. Diabetes is the leading cause of both kidney and pancreatic failure and is therefore the reason why a patient with the disease may need a kidney/pancreas transplant in order to survive. Kidney failure also occurs with other diseases that directly damage the kidney and are unrelated to the pancreas. Ethical Considerations In developed countries, the harvesting of organs and tissue is highly regulated, and ethical practices are followed. At times the ethics are questioned, such as when a celebrity moves up on a list and gets a transplant before others. News media will often bring these issues to the attention of the public and raise ethical questions. Different people with different beliefs sometimes question organ and tissue transplants. They argue that this is not a natural process, and speak out against such practices. However, there are positive sides of organ and tissue transplants. Although they do not cure a condition that exists in the human, the transplant enables the person to live more years. This is why there is a waiting list for organ transplants. In some parts of the world, the selling of organs is practiced. According to new reports (Vaknin, 2007), it is illegal to sell organs, but cases have been reported in India, Ukraine, and China. One village in India has many residents who have sold kidneys because their fishing livelihood was destroyed by a tsunami. Reports of organ snatching have also been documented. Some countries take organs of convicted prisoners and use them for transplants. There have also been reports of captured soldiers who have had their organs snatched and used for transplants (BBC, 2009) among the citizens of the country that captured them. To reduce the organ deficit supply for transplant use and meet the transplant need, medical researchers are experimenting with the growth of replacement organs— regenerative medicine. Medical researchers take the stem cells from the patient and cultivate them in petri dishes. As they grow, the researchers layer the cell growth and then grow the cells in a mold the shape of the organ. As the replacement organ matures, it is implanted back into the person (Wake Forest University Baptist Medical Center, 2006). These organs, because they were made from the recipient’s own cells, will not require the use of immunosuppressive drug therapy, and that greatly reduces the likelihood of organ rejection. Through the use of stem cells, researchers may be able to find a solution to the shortage of organs and tissues available for transplant. Activities As this Resources in Technology has shown, medical surgery has made it possible to keep humans alive as a result of organ and tissue transplants. As an activity, select an organ or tissue transplant that you feel would be vital to keep a friend alive. Do web research to find answers to the following questions. • How many people are on the waiting list from your nation or state for the organ/tissue you have selected? • What is the time your friend will likely have to wait for the transplant? • Determine the steps that your friend will have to go through during the donation process. • What are the potential complications for the transplant? • What is life expectancy after the transplant? • What would be the projected costs of the transplant surgery? 9 • The Technology Teacher • April 2010
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