Pulmo Sleep Center Eliksir

Organ transplantation is a medical procedure that involves replacing a nonfunctional (diseased) organ with a new one through an invasive surgical intervention.

It is common practice to perform such complex and demanding procedures on life-threatening patients, but they are also used to improve the basic quality of life and life functions in people suffering from chronic diseases that can be treated and managed in this way.

What does organ transplantation involve?

Organ transplantation is a method of treating patients by grafting tissues and organs (“graft” or transplant) considering the successful formation of a zygote (after implantation or introduction of foreign genetic material, symbiosis, and acceptance must be confirmed). Therefore, a successful transplantation largely depends on understanding the immunogenetic constitution of both the donor and the recipient.

What is the best indicator of rejected tissue in a patient's body?

The best indicator of how a patient’s (or a healthy person’s) body can react to “foreign tissue” is tumors. Tumors are cancerous, diseased formations in their host’s tissue. They disrupt the integrity of the whole organism and are “out of control” and non-compliant with the body.

Categories of organ transplantation

No two organ transplants are identical; they are not performed in the same way and are not carried out by the same surgeons. In fact, in medical practice, there are several forms and scopes of transplantation. They can be categorized into four basic types.

1. Autotransplantation

Autotransplantation involves transferring tissues from one part of the body to another part of the same person. This type of organ and tissue transplantation is usually used for chronic wounds resulting from peripheral vascular disease, burns, diabetes, and skin trauma.

The most common types of autotransplantation are skin, bone, and blood vessels. The product of this procedure is called an autograft.

1. Isotransplantation

Isotransplantation involves transplanting tissue between genetically identical organisms (monozygotic twins). The product of this procedure is called an isograft.

1. Allotransplantation

Allotransplantation occurs between genetically (un)related (or less related) individuals of the same species. For example, this is the most common type of organ transplantation – from one human to another, who may or may not be related. The product of this procedure is called an allograft.

1. Xenotransplantation

Xenotransplantation is an operation in which tissue or organs from one biological species are transplanted into a member of another species. The product of this procedure is called a xenograft. Currently, transplantation between different species is still a hypothesis, as many scientists consider it unethical to use animals as factories for growing human organs.

Genetically modified pig organs with “inserted” human genes could potentially be transplanted into humans, since organ donation wait times for human donors are often years long. This is particularly relevant for heart, kidney, and liver transplants.

What are the potential moral issues?

Some scientists argue that creating “chimeras,” i.e., organisms that are not of a single species (in this case, pigs with human organs), violates human dignity. Furthermore, creating chimeras could potentially lead to the creation of animals with human-like consciousness, which may have unpredictable consequences if such chimeras were to enter the wild.

1. Domino Transplantation

Domino transplantation is performed on patients with severe health problems, where it is necessary to replace an entire organ (e.g., both lungs in cases of cystic fibrosis). Another characteristic of domino transplantation is that the donors in this case are mostly deceased individuals (with or without a donor card).

How does organ transplantation work?

Organs must be removed shortly after the patient is opened (or shortly after brain death is declared) and must be “transplanted” very quickly. However, thanks to advanced technology, all organs can survive much longer under special conditions, such as:

• heart and lungs up to 6 hours
• pancreas 12 hours
• liver less than 24 hours
• corneas several days
• heart valves, veins, bones, skin, and several months

What does preparation for organ transplantation involve?

Preparation for an organ transplantation involves pre-transplant evaluations or tissue processing. The following text will provide answers to some of the most frequently asked questions regarding the preparation for organ transplantation.

The goal of all pre-transplant evaluations is to identify risk factors that may represent relative contraindications and could jeopardize the short-term and long-term outcomes of the transplantation.

What are the prerequisites for transplantation?

Probably one of the biggest prerequisites for performing a transplantation is the waiting list, in addition to finding a suitable donor. Organ transplantation is a form of therapy that must be available to all patients in the terminal stage of the disease.

Selection and evaluation of candidates for transplantation is a time-consuming process that requires dedication and persistence from both medical staff and patients. Patient education is a key driver in this process, so it is advised not to skip or avoid regular check-ups and documentation as legally required.

What are the obstacles to transplantation?

Organ transplantation cannot be performed in cases where there are absolute contraindications, and in such cases, the patient is referred for further management of the issues:

1. Active ischemic heart disease,
2. Severe cardiomyopathy,
3. Severe respiratory insufficiency,
4. Active infection,
5. Diagnosed cancer,
6. Cirrhosis and advanced liver fibrosis,
7. Substance abuse,
8. Active psychosis or other severe psychiatric disorders that may hinder cooperation with the patient (dementia).

What diagnostic or therapeutic procedures must be performed before transplantation?

Before organ transplantation, basic laboratory tests and evaluations must be performed, such as:

1. Blood type (tested in two laboratories),
2. Complete blood count (CBC) and biochemistry,
3. Prothrombin time (PT), partial thromboplastin time (PTT), INR, and bleeding time,
4. Serological tests for hepatitis B and C and HIV virus,
5. Serological tests for CMV, EBV, VZV, and HSV,
6. HLA typing and PRA tests for testing diseased tissue are done every 3 months. If the scheduled period is not adhered to, the patient is temporarily removed from the list,
7. ECG and chest X-ray,
8. Cardiovascular evaluation,
9. Abdominal ultrasound,
10. Echo and Doppler examination of blood vessels or MSCT angiography,
11. Gastroscopy (with possible biopsy),
12. Parathyroid hormone.

Additional evaluations for individuals in the reproductive period and later:

1. Gynecological examination and pap smear (cervical cells),
2. Testicular examination,
3. Obstetric-gynecological evaluation for women of reproductive age.

What must be done after the transplantation?

After the transplantation, immunosuppressive therapy is started to suppress the body’s immune response to the transplanted organ. The prescribed drugs must be used in prescribed doses and frequencies to prevent complications and ensure the success of the transplantation.

Regular medical follow-ups, diagnostic tests, and other health care practices are essential for maintaining good health and monitoring the condition of the transplanted organ.