ORGAN
DONATION & TRANSPLANTATION
Transplantation is transference of
tissues or organs from one individual to another. In December 1967, Christiaan
Barnard performed the first human heart transplant in South Africa on Louis
Washkansky, a 55-year-old man, using the heart of a 25-year-old woman;
Washkansky died 18 days later. The first kidney transplant was carried out in
the
Registered letter with Organ
Donation stamps from
Organ Transplants
Heart and liver transplants are used
when a person's own organs are irreparably damaged, such as by a heart attack
or cirrhosis of the liver. The cornea is transplanted to cure blindness.
Pancreas transplants have been attempted in persons with diabetes mellitus.
Bone marrow is transplanted to persons with cancer of the blood-forming organs
or leukemia. The most successful and widely practiced transplants are those of
kidneys and corneas, which are accepted medical procedures, but pancreas and
liver transplants are also becoming increasingly common. Transplants of hearts
and bone marrow are done 
with some success, but they are only
performed at medical centers that are able to handle such surgery. Grafting
involves the transplanting or implanting of living tissue from one part of the
body to another in order to make the tissue adhere and grow to supply a missing
part. Skin and bone grafting, which involves advanced plastic surgery
techniques, are prime examples of self-grafts; in cases of severe burns,
however, the patient will receive donor skin tissue which, although selected
for its genetic compatibility, may eventually be rejected by the patient's
immune system.
Problems of Organ Rejection 
In most types of transplants the
difficulties that arise are not ones of surgical technique. Instead, they are
due to rejection of the new organ by the recipient's immune system. This occurs
because each person's tissues bear a unique set of substances called antigens.
Some of these substances are considered to be foreign bodies by the recipient's
immune system, which mounts an attack against them. Successful transplants have
been due largely to the development of ways of temporarily suppressing this
immune attack until the organ establishes itself in its new host.
Immunosuppressive drugs, in particular cyclosporine, are used; cyclosporine
inhibits replication of immune cells known as lymphocytes, without depressing
bone marrow function. It is therefore particularly helpful in bone marrow
transplants.
Suppressing the immune system,
however, leaves the transplant recipient susceptible to viral and fungal
infections. Such infections cause many transplants to fail and sometimes cause
the death of the recipient. The problem of immune rejection is greatly lessened
when the organ comes from a close relative, who is more likely to have the same
tissue antigens as the recipient. In the case of liver and pancreas
transplants, failures also occur because of the difficulty of reconnecting the
many ducts and blood vessels leading into and out of the transplanted organ. As
transplantation depends greatly on donor organs, people who have decided to
become donors carry special donor cards on them which indicate which of their
organs may be used in the event of their death.
Blood Transfusion
The procedure of introducing the
blood of a donor or blood pre-donated by the recipient (autologous transfusion)
into the bloodstream. It is a highly effective form of therapy and has saved
the lives of incalculable numbers of people suffering from shock, hemorrhage,
or blood diseases. Blood transfusion is 
employed routinely in cases of
surgery, trauma, gastrointestinal bleeding and in childbirth involving great
loss of blood.
During the 17th century
the French doctor Jean-Baptiste Denis
performed the first recorded transfusion by infusing sheep's blood into a human
being. Later attempts were also unsuccessful. Even when human blood was used
the majority of recipients died because of blood incompatibility. With the
discovery of the major blood groups and the introduction of blood typing in the
20th century, transfusion became routinely successful.
Transfusions still tend to cause the
development of sensitivity and increase the possibility that the recipient will
react to any later transfusions. Transmission of viral hepatitis was a major
risk until a method of screening blood for infectivity was developed in the
1960’s; some other forms of hepatitis, however, are not detected by this test.
In 1985 a test was introduced that screens donated blood for an antigen
associated with AIDS.
For most of this century transfusion
was accomplished with whole blood. Methods of separating blood into its
components were devised during the 1960’s. Between 1970 and 1980 the use of
these blood components became more frequent than the use of whole blood.
Replacement with packed red blood cells (concentrated blood cells that have
been separated from the blood plasma) is now the preferred treatment for most
blood loss caused by injury or surgery.
In some instances the circulating
blood volume can be depleted by loss of fluid but little or no loss of red
cells. For example, this can occur soon after a severe burn, during peritonitis
and after a limb has suffered a crush injury. The purpose of transfusion in
these instances is to bring the amount of circulating fluid back to or towards
normal. For such transfusions red blood
cells are not necessary; plasma or,
better, serum albumin, a plasma derivative, is more appropriate. Fresh-frozen
plasma can be stored for as long as a year, but it still has the potential for
transmitting hepatitis and is best used only when blood-clotting factors
(proteins in the plasma that assist in the clotting process) are needed.
Albumin solution, on the other hand, is heat-treated to destroy hepatitis
infectivity. It is used in the management of shock and burns, and for some
patients with kidney and liver disease. A less pure fraction of plasma called
plasma protein fraction can be used for many of the same purposes.
Clotting factors isolated from blood
are used to treat some hereditary bleeding disorders such as hemophilia.
Patients undergoing chemotherapy for cancer may have too few platelets, small
blood components that help prevent or stop bleeding, both separate from and as
part of the clotting process; they may be given an infusion of platelets to
speed clotting.
Various synthetic plasma
substitutes, such as the carbohydrate compound dextran, as well as various
saline solutions, have been used in recent years to replenish the blood-fluid
level that often falls dangerously low in cases of sudden shock. These
substances, called plasma volume expanders, are more readily available than
blood products. During the late 1970’s, a synthetic blood-carrying substance
called Fluosol-DA, a fluorinated hydrocarbon, was successfully used in several
patients who could not or, for religious reasons, would not receive
transfusions of natural blood products. Research is also being conducted into
ways of converting one blood type into another; if developed, this process
would help increase the availability of blood products to all patients.
Albert Hustin 1882 –
1967
A test for
blood type and prescription of anticoagulant are necessary when a blood
transfusion is conducted. The use of citric acid for anticoagulant was reported
by Hustin in 1914.
Although blood can be transferred
directly, the usual practice for hospitals is to use blood that has been collected earlier and stored in blood banks. The use of
stored blood began during World War I, but the first large-scale blood bank was
not created until 1940’s. Many health-care centers now maintain their own blood
banks, using more than 98% volunteer donors. A donor supplies about 1 pint each
time and samples are also taken for typing and screening.
