Transplantation – a second life

Proven content

Specialists predict that in just 10 years every tenth operation performed in the world will be a transplant. There is a chance for this, because laboratories and medical clinics are still intensively working on new applications of transplantation methods.

When prof. Christian Barnard transplanted a heart for the first time – the world stopped in surprise, but it was said that it was just an experiment. Today, heart, kidney, liver and lung transplants do not surprise anyone, because they have been considered one of the many methods of treatment. Thanks to transplants, some patients can be cured and others can significantly extend their lives. Progress has made the transplantation of human organs a safe, effective and relatively cheap (compared to long-term use of drugs and frequent hospital stays) method of treatment. The effects of the treatments are more and more promising, because 80 percent of patients survive 5 years or more after transplantation with properly functioning organs. Record holders live 20 or even 40 years, leading a normal professional and family life. More and more women after kidney or heart transplants give birth to healthy children.

Hopes and emotions

Aging societies want to remain efficient and independent as long as possible. This is one of the reasons why scientists are constantly looking for new areas in the use of transplantation methods. Successful implantation of foreign nerves, muscles or face transplants raise hopes in all of us. We want to believe that soon, thanks to the use of the properties of stem cells, it will be possible to grow replacement organs or lead to biological regeneration of damaged ones. Perhaps to a greater extent it will be possible to produce (grow) spare parts that will perform as well as currently popular prostheses of hip joints, blood vessels, heart valves or bones. But it’s still a dream. Currently, the necessary organ cannot be manufactured or purchased. The donor may be a deceased person or, in the case of kidney and liver fragment, a person living and close to the patient (husband, brother, life partner).

Many of us wonder what such costly operations do. The answer is simple – a healthy life for people. They can start work, continue their education. Moreover, kidney recipients free up places at dialysis stations for other patients who will die without this type of treatment. It is also important that the results of kidney transplantation, compared to dialysis treatment, are incomparably better and twice cheaper.

New possibilities

Heart, kidney or liver transplantation no longer arouses emotions. Although they are still complex and lasting hours, they are treated like any other surgical procedure. However, from time to time the medical world boasts of new successes in the field of transplantation.

One of such events was the first penis transplant in 2005, performed by doctors from the urology department of the Guangzhou city hospital, led by Dr. Weilie Hu. The recipient was a 44-year-old man who lost his organ in an accident. The victim had a one-centimeter long stump, which prevented him from urinating and having intercourse normally. The organ was taken from a 22-year-old man who was in a state of cerebral death. The operation lasted 15 hours, during which nerves and blood vessels were connected. The recipient’s organism, supported by immunosuppressive drugs, did not reject the transplant. After 10 days, the patient was able to urinate normally. The organ was well supplied with blood and could also fulfill other functions. Unfortunately, the new penis was swollen. It caused serious mental problems in the recipient and his wife. The patient requested that the male symbol be removed. The surgeons complied with his request.

Someone like my own

On August 25, 1998, the world heard about the first successful hand transplant. It was a great success for the doctors from Lyon. They took a forearm from a patient whose brain had stopped functioning. In order not to make a mistake when fusing corresponding muscles, tendons, nerves and blood vessels, doctors marked them with colored threads both on the patient’s stump and on the amputated arm. The operation was started by joining the bones with metal plates. During the 13-hour operation, two teams of surgeons precisely joined together tendons, nerves, and vessels. Finally, the skin was sewn together. The patient to whom medicine offered a new arm was a 48-year-old man who lost his own forearm in a chainsaw accident.

The first in Poland and 26th successful hand transplant surgery was performed in 2006 by surgeons from Trzebnica. The recipient was a 34-year-old carpenter who lost his arm in an accident 12 years earlier. Another Polish hero of the transplant chronicles was a 28-year-old man from Mysłowice, whose hand was torn off by a threshing machine at the elbow level in his childhood. After XNUMX years, he regained his hand, which – although it comes from a different human – is similar to his own in size and even in the shape of nails. Surgeons claim that transplanting a hand from a foreign donor is an easier procedure than replantation, i.e. sewing on your own hand. This is because the donor’s hand is surgically removed, so there are no damaged fragments. A hand lost in an accident usually has muscles, ligaments and vessels damaged over a large part of it.

new face

The first face transplant was performed in France in 2005. The recipient was a woman whose face had been bitten by a dog. In 2006, in China, a part of the face was transplanted from a forest worker who was attacked by a bear. The next operation was performed by the surgeons and in March this year – again in France. The most spectacular, however, was the face transplant, which was performed in 2008 with her team by Prof. Maria Siemionow, a Pole who has been working in the USA for many years in a hospital in Cleveland. It was considered a great success that 80 percent of the face surface was replaced during the operation. She was left with her own forehead, upper eyelids, lower lip and chin. Transplanting such a large area of ​​the face is an unimaginable undertaking, because only the facial muscles that need to be precisely connected are 70.

But in the spring of 2010, another remarkable scientific piece of information arrived from Barcelona. Spanish surgeons performed the first full face transplant. The recipient was a man who had been shot 5 years earlier. As a result, he could not breathe or eat on his own. He also had trouble speaking. His situation was not changed by numerous plastic surgeries. A new face took 22 hours to form on the operating table. During the procedure, the man’s skin, muscles, teeth and some facial bones were transplanted from an anonymous donor. Doctors also made sure that the new face resembled the lost one as much as possible. The operation was successful.

Nerves from my mother

2005 American doctors transplanted a young man with nerves taken from his mother. As a result of the accident, the recipient had torn two of the three main nerves in his left hand: the ulnar and the medial. In order to limit the possibility of rejection of the transplant, donors were searched for among the closest men. His mother turned out to be the most genetically compatible. A few days before the surgery, fragments of the tissue innervating her arms and legs were collected from the boy’s mother. For a week they were kept in a special solution which acts on the cells in such a way that the probability of their later recognition as foreign by the recipient’s organism is less than normal. So far, about 12 such treatments have been carried out in the world.

I am selling a kidney

When a few years ago, after the arrest of a well-known transplantologist, the number of transplants in Poland dropped dramatically, the discussion about the idea of ​​organ transplantation flared up again. One of the threads became the problem of organ trafficking. Polish law strongly rejects such a possibility. For the collection of cells, tissues or organs from a living donor or from a human corpse, it is not allowed to demand payment or other material benefits, but only reimbursement of costs incurred, e.g. travel costs to the clinic. Persons who traffick cells or organs are subject to imprisonment.

Legal solutions for transplantation in Poland are the same as in Austria, Belgium, France, Luxembourg, Spain and Portugal, and in some cantons in Switzerland, where organ donation is allowed if the deceased did not object to it during his lifetime. Finland, Denmark, the United Kingdom and Germany have a legal solution known as the extended explicit consent model. This means that if the deceased did not express consent or objection to organ donation after his death, the consent of his relatives is required – in the following order: husband, wife, adult children, adult siblings. Similar law applies in the United States.

But organ trafficking is getting louder and louder, especially in Asian countries. The sale of organs is common here. Clinics are established in China and the Philippines, where Japanese, Korean and Asian Americans come to transplant. Many volunteers are recruited in Madras, where there are villages where whoever could have sold a kidney. Organ trafficking is unofficial even in the United States, almost in accordance with the law. Moreover, the UK and the US are considering the possibility of establishing government agencies that would buy organs from living donors. A government agency has already been created in Iran, which registers and examines people who want to donate one kidney for a fee. The price of the organ obtained in this way is around PLN 2,5 thousand. dollars. Official transplantation of a purchased kidney is also possible in Egypt and India. But you don’t have to look for sale offers that far. In Ukraine and Moldova three years ago, 2,5 thousand jobs were offered. euro for a kidney. However, Polish doctors and ethicists strongly reject such solutions.

I agree, but …

When we are healthy, we accept the idea of ​​transplantation without reservations, and even declare that our organs should be used after death to save other people. We also have no moral resistance when, in the face of a disease that shortens our lives, we wait for a transplant. But at the time of the trial, the earlier declarations do not transfer to our attitudes. When we are asked for consent to donate organs after the death of a loved one, we often say no. Why is this happening? Are we driven by fear of the profanation of the body or do we believe that we have to be complete in that world? There are certainly many reasons.

The most important obstacle in harvesting organs from the deceased is the – it seems – widespread lack of knowledge on the subject. About 50 percent. Polish society does not know anything about organ transplantation, and stories about some types of transplants can color more than one film script. Many of us also have a false idea of ​​ u30b uXNUMXblife after transplantation. Fools keep repeating that a man who receives a woman’s heart will no longer be one, that his character and, over time, even his gender will change. Some people are concerned about contact with the donor’s family, who may claim compensation. These are unfounded fears. Hospitals strictly protect the anonymity of donors. All you can find out is, for example, you have the heart of a XNUMX-year-old woman. Nobody gives addresses or other data allowing the identification of the donor.

Who can donate

The criteria that a potential donor (or rather his body) must meet are strictly defined and depend on the type of donated organ and the so-called physiological parameters. Organs are not collected from people who have been infected with bacteria, fungi or viruses, especially hepatitis and HIV, have had malignant tumors, generalized atherosclerosis or diseases that have damaged individual organs. Contraindication to the donation is also the age over 70, hypertension, diabetes, alcohol abuse, pharmacological agents destroying organs and the donor’s origin from the group with an increased risk of HIV infection (e.g. drug addicts, prostitutes). Appropriate tests are performed to make sure that the donor was not a carrier of dangerous viruses. The most common transplants are: kidneys, skin, liver, intestines, heart, lungs, bone marrow, pancreas.

Leave a will

If we want our organs to save the life or health of other people, let us clearly tell our relatives and family about it. Thanks to this, after our death, they will not have to make difficult decisions. They will be left to respect our will.

Expressing consent or objection to organ donation (while still alive) may be oral or written. An oral statement should be made in the presence of two witnesses, e.g. after being admitted to a hospital. Objections may be submitted to Poltransplanta in the Central Register of Objections (02-005 Warsaw, ul. Lindleya 4 [email protected]). If you agree, you can contact the Association “Life after transplant” (address [email protected]) we will receive a declaration form free of charge, which must be completed and returned. The law also honors the traditional form of a will that will express our will. The declaration of will must contain our personal data (name, surname, date of birth, PESEL number) and the address of residence.

In the churches of the world

The position of the Catholic Church is unequivocal. Pope John Paul II presented them very clearly during the XVIII International Transplantology Congress in 2000. “Each organ transplant has its source in a decision of great ethical value: a decision to selflessly donate a part of your own body for the health and well-being of another human being. This is the nobility of this act, which is an authentic act of love. “

Judaism allows organ donation to save or improve the quality of one’s life. Many rabbis consider organ donation to be a great merit in God’s eyes. However, they emphasize that their donation must take place after the donor’s death, however that may be defined. All medical procedures must respect the body of the deceased, and any unused parts of the organs must be buried with the donor’s body.

Islam allows organ donation for transplantation if the recipient’s life is in danger, there is a chance to perform the operation, and the donor or his family have agreed to it. Views on brain death are divided, but the Islamic Fik Assembly considers brain death definitive as long as brain functions have ceased and medical equipment has confirmed this, and experts have ruled that it is irreversible.

Protestants base their attitude towards organ transplantation on the provisions of the scripture, which prescribe the protection of life from conception to natural death. Life is a gift from God that is also to serve other people. If the earthly life of seriously ill people can be saved by removing healthy organs from the deceased – it must be accepted. Whoever gives consent to organ donation acts responsibly because it helps other people. A family that gives consent to such an action shows no disrespect for the deceased. It acts ethically and responsibly, because on behalf of the deceased, it saves the lives of other people.

The followers of the Evangelical Methodist Church consider donating organs for transplantation as an act of self-donation. It is an expression of love and service for the good of those in need.

Christian churches (including Evangelical-Augsburg, Evangelical Reform, Pentecostal) have not issued an official position expressing their attitude to organ transplantation. Nevertheless, the faithful are encouraged to help other people.

Only Japanese Shintoism is strongly opposed to organ harvesting and transplantation.

Life list

In accordance with the law in force in Poland, the National List of Recipients (KLB) collects information about people waiting for a kidney or kidney and pancreas, and liver, heart and lung transplant. The list includes people reported by dialysis centers for kidney patients and transplant centers. The list of recipients is constantly updated.

In accordance with international transplant law, organs removed from a cadaver may only be transplanted to persons placed on an official waiting list. Patients who receive an organ from a living donor must also be included in this list due to the possible need to perform a cadaver transplant. A recipient can only be registered on one list (regional lists are only subsets of KLB). The fate of the harvested organs is closely followed by transplant centers. Such action is to prevent any attempts to trade in organs that are prosecuted by law.

Without shame

Polish transplantologists, or doctors dealing with organ transplants, have nothing to be ashamed of. Their skills and techniques are at the same level as doctors from other European countries and even the USA. If there were more money in the clinics, we could also carry out innovative operations. Unfortunately, there is not only money, but organs for transplantation. However, it is worth applying for them.

Currently, about 15 people with transplanted organs live in Poland. The most common are the kidneys, followed by the liver, heart and pancreas. Patients ‘survival times do not differ from patients’ survival times in the West. This is because everyone is given immunosuppressive drugs (the same everywhere) that protect against transplant rejection. The ever-longer life after transplantation is a great success for medics, in which Polish doctors play a large part.

The invention of cyclosporine in the 70s was a huge success of modern transplantology. The drug turned out to be so effective that it became widely used. It weakened the patient’s body vigilance enough so that the foreign organ would treat it as its own and would not reject the transplant, but not so much that the patient would die of a runny nose.

Text: Anna Jarosz

Consultation: prof. Wojciech Rowiński, Polish Union of Transplantation Medicine