Final Thoughts

Over the past ten weeks of this blog we have examine the topic about organ transplant thoroughly. I hope that this blog was informative and helpful . Thank you for giving me the opportunity to share with you guys about this topic and thank you for giving me feedback to further improve my work. After writing this blog, I am truly amaze at some of the stuff that I have learn. I hope you guys learned as much as I learn about organ transplant from writing this blog. 

Over the past ten weeks we have covered... 

• The basic of organ transplant
• Anti-rejection drugs
• A test that can save future kidney recipients
• The debate about organ market
• Myths or Facts 
• FAQ
• A possible solution to organ transplant problem
• The history
• A patient who got rabies through organ transplant

If there are any future questions, don't hesitate, just comment below as the blog is linked to my email. Again thank you for giving me the opportunity to write this blog and I hope you guys have learned as much as I did about organ transplant.

Chapter 9: Rabies from an organ transplant

As we should all know by now, getting an organ transplant should be a life saving procedure. Organ transplant has been done in the United States since the 1950s. The procedure is always improving and transplants are more successful than ever today. There are many protocols that the doctors have to go through for both the patient and donor before an organ transplant can be preformed.

In this unfortunate case, a Maryland man died from rabies because of an organ transplant after 18 months. The patient who is an army veteran received a kidney and contracted rabies. Rabies can be very fatal if it is left untreated. Globally an estimate of 55,000 people die of rabies every year and approximately 2 human rabies death are reported in the United State every year. However, the death are usually related to bats and not raccoon.  The CDC conducted a study and found out that the donor and the recipients both detected "rabies virus antigens, rabies virus neutralizing antibodies, rabies virus". Later, after an interview with the donor's family, it was concluded that the donor had a significant amount of wildlife exposure. The donor is a 20 year old who got sick from a fishing trip in Florida where he was undergoing Air Force Training. The donor also had two raccoon bites but did not seek medical treatment for it. There was three other recipients who also received organ from this donor but there are no signs or symptoms of rabies. They are also being monitored and being treated.

Reference:

• http://www.foxnews.com/health/2013/07/24/organs-from-man-with-rabies-transplanted-into-four-people/
• http://www.sciencedaily.com/releases/2013/07/130723180606.htm

Chapter 8: A brief history

Transplantation has been performed since 1869 with the first skin transplant being the first transplant. However, the first organ transplant was performed in 1954 with the first organ transplant being the kidney. Lets memorize these amazing doctors who has lead this world into a better life by saving patients who were on the edge of their life.



In 1954 on December 23, the first successful living related kidney transplant was led by Dr. Joseph Murray and Dr. David Hume at Brigham Hospital in Boston, MA. A kidney was transplanted from Ronald Herrick into his identical twin. On the right you will see a picture of the transplant team and the Herrick twins.

In 1966, the first successful pancreas and kidney transplant was led by Dr. Richard Lillehei and Dr. William Kelly at the University of Minnesota in Minneapolis, MN. The transplant was done to a 28 year old woman who was diagnosed with diabetes at age 9. On the left you will find a picture of Dr. Richard Lillehei and Dr. William Kelly.






In 1967, the first successful liver transplant was led by Dr. Thomas Starzl at the University of Colorado in Denver, CO. Also, the first successful heart transplant was led by Dr. Christiaan Barnard at Groote Schuur Hospital in Cape Town, South Africa. On the right, you will see a picture of Dr. Christiaan Barnard illustrating and addressing a group of journalist in Cape Town. The first successful heat transplant in the United States was done in 1968 led by Dr. Norman Shumway at Stanford University Hospital, CA.





In 1983, the first successful lung transplant was led by Dr. Joel Cooper from the Toronto Lung Transplant Group at Toronto General Hospital in Canada. Later on in 1986, Dr. Joel Cooper successfully led the first double-lung transplant from the Toronto Lung Transplant Group at Toronto General Hospital in Canada. On the left you will find a picture of Dr. Joel Cooper.

Reference:
http://www.cuteandweird.com/2009/05/photos-of-first-successful-transplants/
http://www.donatelifeny.org/all-about-transplantation/organ-transplant-history/
http://www.organdonor.gov/legislation/timeline.html

Chapter 7: Possible solution?

Every day 17 people die because they are unable to receive an organ transplant. In the diagram on your right, it shows just how big the gap is between people who are in the waiting list, people who are getting transplant, and donors. Everyone including the government and health services are constantly finding ways to deal with this matter. In this article "Stop families from overriding donor consent" talks about one way health services are trying to help fill in that gap.


This article can either open your eyes and think of this as a great way of filling in the gap or this can disgust you because of how outrageous this idea is. In our society, we try to honor and respect our dead ones. So what happen when our dead ones wish was to donate their organs? Do you want to respect them by not having their body touch or do you respect them by honoring their wishes? In this article the National Health Service Blood and Transplant wants to prevent families from overriding the consent of people who wishes to have their organ donated when they pass away.

"The aims of the strategy are to:

• Improve consent rates from relatives to above 80% (currently 57%) in all cases (families are asked to give consent whether their relatives has signed the organ donor register or not)
• Bring the deceased donor rate up to 26 per million of the population (currently 19 pmp)
• Increase the number of patients recieveing a transplant to 74 per million of the population (currently 49pmp) "

This article is really engaging and really easy to read. It was also very information and they also have a section for "serious debate" where they mention if there should be a system like Singapore. In Singapore, people who are register gets higher priority on the waiting list if they ever need a transplant. Finding ways to lessen the gap between people on the waiting list and enlisted donor has been a huge problem world wide. As the year goes by, the waiting list goes up but the amount of donor remain slightly steady but goes up only minimal. What do you guys think? Should they be able to stop families from overriding donor consent? 

Reference:
http://www.bbc.co.uk/news/health-23260057

Chapter 6: Frequently Ask Questions

Is there a difference between tissue and organ donation?

Organ donors must be brain dead which is defined as the irreversible end of all brain activity (including involuntary activity necessary to sustain life). While the patient is on life support, organs must be carefully matched to the waiting recipients. Matching of the organs are done base on blood type, medical status and size of the recipient. Tissue donation can occur patient who suffer from brain dead or suffered from cardiac death. Tissue recipients do not have to matched to their donors because rejection is not a concern.

What tissues can be donated?

Tissues that can be donated are bone, tendons, ligaments, heart valves, skin, veins, and cartilage.

Where are these tissues used?

• Long bones maybe used to replace bones that have been by cancer. Smaller sections of bone are used to strengthen areas of a deformed spine or to fill areas where bones has been lost.
• Skin can be life-saving for patients who have been critically burned.
• Heart valves are use to replace damage heart valves.

Is there a cost to donate tissue?

There are no cost to donate tissue and to donate organ

Can I specify who receives my donation?

Yes, you are allow to make a donation to an individual. The organ must be a match for the person who is waiting for the transplant.

How do I get on the waiting list?

• Receive a referral from your physician
• Contact a transplant hospital
• Schedule an appointment for evaluation
• The hospital transplant team will decide weather you are a good transplant candidate
• If you are determine a good transplant candidate, you will be added to the national waiting list

How are organs distributed?

Organs are distributed locally first and if there are no matched then then will look regionally, then nationally until every attempt in made to place donor organs.

Why should minorities be concerned about organ donation?

Some diseases of the kidney, heart, lung, pancreas, and liver are found more frequently in racial and ethnic minority populations that in general population. 

Citations:

http://www.mtf.org/donor_faq.html?gclid=CKKqg6G0nLoCFUqk4AodQTAAgQ

http://www.health.ny.gov/professionals/patients/donation/organ/frequently_asked_questions.htm

http://www.transplantliving.org/community/patient-resources/frequently-asked-questions/#matchWL

 

Myths or Facts???

1) If I am in an accident and the hospital knows that I am designated as a donor, the doctors won't try to save my life.

Truth: 

This is a false misconception that people always have. Doctors, nurse, paramedics will do everything they can to save your life. In order to be able to donate an organ, you have to be on a ventilator and are declared brain dead. Transplant team will not take your organ out until they have receive permission from the deceased family.

2) I am too old to be an organ donor

Truth:

This is false, there are not age limit as to when you can become an organ donor. At the time of death, medical professionals will evaluate you and determine which organ and tissue is suitable for donation.

3) I have a history of medical illness, no one will benefit from my organs

Truth:

This is false, a person's organ and tissue are always determine at the time of death. Clinical professionals from the organ and tissue donor program will review medical and social histories of the donor to determine its eligibility.

4) If I say I only want one of my organs to be donated, they will take all my organs

Truth:

This is false, your wishes will be followed. 

5) Being an organ donor means my body will be disfigured and my family will not be able to have an open casket funeral for me

Truth:

This is false, donated organs are removed surgically in a routine operation similar to regular surgery. Donation will not interfere with traditional funeral arrangement.

Reference:

http://www.mayoclinic.com/health/organ-donation/FL00077

http://www.transweb.org/myths/myths.shtml

http://www.americantransplantfoundation.org/about-transplant/facts-and-myths/

Should there be an organ market?

In this essay called "Payment for donor kidney: Pros/cons" by EA Friedman and Al Friedman, talks about potentially selling organs.The argument about whether there should be an organ market has been going back and forth for many years. People are still doing illegal organ transplant around the world like India, China, Turkey, and Russia so how come we can not have an organ market? What is stopping us from going further? For this blog I will be talking mainly about the kidney organ. Considering you have two kidneys, you are able to give away one of your kidneys and still be functional. In 2005, 65,000 people were waiting for a kidney from deceased donor in order to survive. About 3000 of the people on the wait list will die yearly just waiting for the kidney. Each day 74 people receive an organ transplant but about 17 people die each day because they could not receive a transplant. So why isn't there an organ market?

What's stopping us?

 The Medical associations consider that an organ transaction is "morally and ethically irresponsible" and "inhumane and unacceptable". Pope John Paul II said that "buying and selling an organ violates the dignity of the human person". The National Organ Transplant Act states that "it shall be unlawful" and punishment for doing illegal transplant can face up to $50,000 and or 5 years in prison.

What is the view now?

 Over the years, there are more and more people favoring for kidney sales. Everyone has a choice to engage in risky behaviors such as sky diving, military services, and smoking cigarettes, so what is the difference? Also how is it worse that selling a person's egg and sperm is legal compare to an organ market? A sperm and egg will create an entirely new human being, is that the same as human trafficking? If the government steps in and introduce a system that can manage the sales of kidney appropriately, there will be less death from end stage renal diseases. By having an organ market, it will eliminate black markets.What do you think? Should we have an organ market?

References:

EA Friedman and AL Friedman. (2006). Payment for donor kidney: Pros/cons

https://www.hods.org/pdf/fried.pdf

New Test May Protect Future Kidney Organ

http://www.sciencenews.org/view/generic/id/352937/description/Test_could_warn_of_problems_for_kidney_transplant_recipients


In this article it talks about a potential test that can tell if a patient who had received a kidney organ will potentially have an organ failure. The test would involve checking your urine for for a specific immune protein CXCL9. In a research, they found that patients who show high levels of CXCL9 have a higher chance of organ failure. By doing this test there is no harm to the patient but only beneficial. Standard procedure would be a kidney biopsy where they would have to surgically remove a small piece of the tissue. If the biopsy shows signs of damage tissue, it means that the immune system is attacking the organ and the organ has stop filtering the blood. Rejection can be gradual or sudden but its usually treated by immune suppressant drugs. By having a test that does not involve dangerous invasive procedure, doctors are able to adjust immune suppressant drugs base on the result of their urine.

I really like this article, and the tittle of the article says it all. The article was well written and the information was right on the spot with little to no complication of reading it. There was another article link to this article in the second paragraph but you have to be a member to be able to read it. I was sad to find that out because I was hoping the link could lead to some charts or data. I really wish that this article would have some data regarding to the research but overall was a great article. This is great news to hear for both doctors and patients who had just received a new kidney.

Anti-rejection Drug

After an organ transplant the first thing that should come across your mind is that you want to take care of the new organ that you just received!!!!!!

What is the purpose of anti-rejection drug?

Anti-rejection drugs also known as immunosuppressants, helps suppresses the immune system so the body can accept the new organ. When a new organ is implanted into the patient's body, the patient's immune system may recognize the new organ as foreign and will reject it.  

What kind of anti-rejection drugs are out there?

Anti-rejection drugs have two categories

• Induction agents: These are powerful anti-rejection medication that is used at the time of the transplant.
• Maintenance agents: These are the anti-rejection medications that is used for long term.
• Calcineurin Inhibitors:

• Tacrolimus
• Cyclosporine
• Antiproliferative Agents:
• Mycophenolate Mofetil
• Mycophenolate Sodium 
• Azathioprine
• mTOR Inhibitor:
• Sirolimus
• Steroids:
• Prednison

Are there side effects with these drugs?

• Tacrolimus causes: tremor, hair loss, headaches and increase chance of developing diabetes
• Cycloporine causes: hair growth, gum enlargement, and tremors. Sadly if you are bald, this will not help you grow hair.
• Sirolimus causes: rash, bone marrow problem (low platelets, low white count), swelling of ankle, bubbly urine
• Prednison causes: weight gain, water retention, diabetes, acne and bone thinning

Is anti-rejection the only thing you need to do after transplantation?

This is a both yes and no. After an organ transplant you have to take your anti-rejection drug daily to prevent your body from rejecting the new organ. However, after 6 months to a year, the anti-rejection drug doses are generally lowered and this will also make the side effect lowered. It is also recommended that you exercise and adopt to a healthy diet and lifestyle. Lastly, you should go to the doctors for check ups and vaccination.

Reference:

http://www.webmd.com/a-to-z-guides/life-after-transplant-tips-managing-health

http://www.cpmc.org/advanced/kidney/news/newsletter/kidneytransplant_medication_sideeffects.html

Chapter 1. Introduction

What is organ transplantation?

An organ transplant is an operation that involve moving an organ
from a donor organism to the recipient organism. You would want to do an organ transplant when you have a failing organ or an organ has stopped working and is in need of a replacement organ in order to survive.

What kind of organs are commonly transplanted?

• Kidney 
• Liver
• Heart
• Pancreas
• Lung
• Intestine

How do you prepare for an organ transplant?

Before anything is done, you need to have blood and tissue tested to make sure that eveything matches with the donor. This is because of your immune system. If your immune system detects that the new organ as foreign and will reject it. 

What happens after an organ transplant?

After an organ transplant, you may feel better than ever. What you are capable of doing physically and mentally depends on what kind of organ transplant you did. You do however need to take anti-rejection medication for the rest of your life to prevent the immune system from rejecting the new organ. You will also be required to do regular check ups and blood test to see if the new organ is functioning properly. Because of the anti-rejection drug, your immune system is weaken and you have to stay away from people who maybe sick.

Who can and can not be on the organ transplant list?

• You must get a referral from your physician in order to be on the transplant list.
• Many transplant center will not accept anyone who does not have insurance
• Some transplant center will not accept patients with mental retardation, HIV, history of addiction and people with criminal record
• Transplant center will reject anyone who is at the age of 75 and up
• Transplant center do accept illegal aliens but usually are only children. 

How long does it usually take to get an organ if accepted into the list?

Organ	Median national waiting time
Hearts	113 days
Lungs	141 days
Livers	361 days
Kidneys	1,219 days
Pancreas	260 days
Intestine	159 days

Reference:

http://organdonor.gov/about/transplantationprocess.html