| |
Organ (Liver) Transplants
as Larry Kramer quotes his liver transplant surgeon Dr John Fung head of
University of Pittsburg Medical Center Thomas E. Starzl Transplant Institute:
|
| |
| |
Organ and tissue transplants allow the elderly to walk and athletes to run again. Thanks to kidney transplants, patients long chained to dialysis machines are freed, and following corneal transplants, those who have lost their sight are able once more to see a plum tree in bloom.
At the same time, donated skin is used to enhance the lips of fashion models at a cost of $ 1050 per injection. Cadaveric skin helps enlarge penises and smooth wrinkles. In recent years, controversy has mounted over the disparity between the donor family's altruism and the tissue industry's huge profit margins.
Many predict that this area of medicine will be involved in greater and greater controversy, from issues regarding organ shortages and allocation to questions about the marketing of organs and profits made by companies that process tissue. Disputes continue over when death occurs, what the definition of "death" should be and whether religious concerns about when the soul
departs the body should be taken into account in deciding when to remove organs for
transplantation. Because radiologic technologists play an integral role in the process of organ transplantation, it is important that they become familiar with both the successes and the controversies of this area of medicine. As HCV-infected individuals have progressed over the past 20 years the demand for liver transplants is expected to increase. With a shortage of livers available for transplantation this obviously will create a problem. IVDU is the main source of HCV transmission today. Ironically IVDUs and individuals on methadone maintenance are not high on the priority list to receive either treatment for HCV or liver transplants. With the shortage of available organs it appears that under current conditions HIV-infected and IVDUs and individuals on methadone are not likely to be receive high priority.
Today, chronic organ rejection following transplantation remains the greatest limitation of
transplantation. More than 50% of all kidney transplants are rejected within 10 years; one third to one half of heart transplants are rejected after 5 years. This ultimate failure rate results in either death or retransplantation. Even if a proper match is found, the "innate and unrelenting intolerance of individuals to grafts of other people's tissues and organs" remains a biological
deterrent to truly successful organ transplants.
Long-term transplant survivors also are prone to redevelop the same condition that made the transplant necessary in the first place. For example, coronary artery disease in transplanted hearts is a major clinical problem and the foremost cause of death in the first year following surgery. The only solution is to transplant yet another heart, and the chance of redeveloping
coronary artery disease is high.
The growing number of transplants has been limited by a shortage of
donor organs, leading to intense competition among recipients. The organ shortage
has produced innovative transplantation approaches, including reduced size or
segmental liver transplants (a liver lobe from either a cadaveric or live
donor is transplanted into a child recipient who is smaller than the donor) and
split-liver transplants in which the liver is divided between 2 recipients.
Domino-donor procedures are operations in which hearts are removed from
patients with terminal pulmonary disease (these patients receive heart-lung
transplants) and implanted into other individuals with end-stage cardiac disease. In
bridge transplants, damaged cadaveric hearts are surgically repaired and
then function as temporary transplants until suitable donor hearts can be
located.
Presently, kidney transplants are the most successful and
therapeutically advanced of all organ transplant procedures. In the United States, heart,
liver and lung transplants are associated with an overall 85% 1-year success
rate; in some transplantation programs, the success rate approaches 95%. (5) Data
from 1988 to 1995 show that 1-year patient survival rates have increased from
81% to 87% for liver recipients, from 83% to 85% for heart recipients and from 50%
to 77% for those receiving a lung. (8) However, organ transplants generally
are performed on patients with end-stage organ disease who are terminally ill. Others on organ waiting lists might be in better health and have a better chance at extended post-transplant survival, but scarce organs generally go to the patients in the most dire medical straits.
What Organs and Tissues Are Transplanted?
Solid organ transplants include the heart, kidneys, pancreas, lungs and liver. Lungs are used in patients with end-stage lung and pulmonary vascular disease. Renal or kidney transplantation is a common procedure; nearly 11000 transplants are performed each year in the United States. (11) Kidney transplants play a large role in treating end-stage renal disease. (12) and
even with rising transplant costs, they have proven more cost effective than dialysis therapy. (13) Similarly, liver transplantation has become the treatment of choice for patients with end-stage, nonmalignant liver disease. (14) A number of diseases can cause liver failure, including some forms of hepatitis, alcoholic liver disease, drug-induced hepatitis and cancer. (14) Sections of the intestinal system may be transplanted to replace diseased or cancerous
tissue.
Transplanted tissues include cornea, whole eyes, skin, bone marrow, heart valves and veins. (15,16) People blinded by injury, infection, inherited or congenital disease may regain their sight following corneal transplants. Connective tissue such as ligaments, tendons, cartilage and muscle sheaths are used for various purposes, as is bone tissue in the form of ribs and bones
of the arm, leg, shoulder, hip, ankle, spine and jaw. (16,17) Bone has been
used in transplantation longer than any other body part because it has a unique
cellular structure and therefore is not as prone to rejection as other organs or
tissues.
Donated bone and tissue are used for joint transplants, limb preservation and fracture repair, tumor and whole-bone reconstructions, facial reconstruction, heart-valve transplants, correction of birth defects, burn treatment, lengthening legs, and plastic and cosmetic surgery. (16) Bone powder is used by dentists in periodontal surgery. (16)
Some spinal fusions require donor bone matter, and ear reconstruction is accomplished using ear bones or rib cartilage. Rib cartilage also is used in nose reconstruction or plastic surgery, and ligaments throughout the extremities may be replaced or repaired using donated tissue. (16) Dura mater (the tough, outermost layer covering the brain) is used to repair brain aneurysms and hernias, replace the pericardium (the sac that encases the heart), fashion
sheaths for peripheral nerves, perform spinal fusions, and repair cleft palates and lips. (16,17) Dura mater is of such importance that it is even displayed by brand at surgical conventions. (17)
The growing number of transplants has been limited by a shortage of donor
organs, leading to intense competition among recipients. The organ shortage
has produced innovative transplantation approaches, including reduced size or segmental liver transplants (a liver lobe from either a cadaveric or live donor is transplanted into a child recipient who is smaller than the donor) and split- liver transplants in which the liver is divided between 2 recipients. (5,7) Domino-donor procedures are operations in which hearts are removed from patients with terminal pulmonary disease (these patients receive heart-lung
transplants) and implanted into other individuals with end-stage cardiac disease. (8) In bridge transplants, damaged cadaveric hearts are surgically repaired and then function as temporary transplants until suitable donor hearts can be located.
Presently, kidney transplants are the most successful and therapeutically advanced of all organ transplant procedures. In the United States, heart, liver and lung transplants are associated with an overall 85% 1-year success rate; in some transplantation programs, the success rate approaches 95%. (5) Data from 1988 to 1995 show that 1-year patient survival rates have increased from 81% to 87% for liver recipients, from 83% to 85% for heart recipients and from 50%
to 77% for those receiving a lung. (8) However, organ transplants generally are performed on patients with end-stage organ disease who are terminally ill. Others on organ waiting lists might be in better health and have a better chance at extended post-transplant survival, but scarce organs generally go to the patients in the most dire medical straits. (5)
EDITORIAl
by John fung, MD, leading liver transplant surgeon at University of Pittsburgh, and Larry Kramer, liver transplant recipient and long-time AIDS activist
And the other sad thing is that in spite of all the efforts over the past 15 years, the money spent, etc., that the consent rates (consent from person to use their organs for transplant after death)now are the same as it was years ago. There is underlying mistrust of the medical system, including articles designed to infuriate and mislead (see last month Playboy magazine article that was really bad). Anyway, when someone wants to try something different, such as considering payment for organs or putting cannulas into dead on arrival patients in the ER for purposes of non heart beating donation, or presumed consent, etc., the establishment tells us that we are bad guys and just make do with what we are doing. Meanwhile patients are dying and the public still does not understand that saying no to donation means someone will die. No one wants to be so blunt, no one wants to raise the American conscience to make them feel that it is their human obligation to pass along their body to the living, when they die. This is a systematic deficiency in American culture, the idea that you are out only for yourself and have little or no obligation to society as a whole.
| |
| |
|
|
|
