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Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called
autograft Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogen ...
s. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source. Organs that have been successfully transplanted include the
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
,
kidneys The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...
,
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...
,
lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side ...
,
pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...
, intestine,
thymus The thymus is a specialized primary lymphoid organ of the immune system. Within the thymus, thymus cell lymphocytes or ''T cells'' mature. T cells are critical to the adaptive immune system, where the body adapts to specific foreign invaders. ...
and
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
. Tissues include
bones A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, a ...
, tendons (both referred to as musculoskeletal grafts), corneae,
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...
,
heart valves A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart v ...
, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart. Corneae and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold. Organ donors may be living,
brain dead Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...
, or dead via circulatory death. Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of
cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...
s) can be preserved and stored for up to five years, meaning they can be "banked". Transplantation raises a number of
bioethical Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, m ...
issues, including the definition of death, when and how consent should be given for an organ to be transplanted, and payment for organs for transplantation. Other ethical issues include transplantation tourism (medical tourism) and more broadly the socio-economic context in which organ procurement or transplantation may occur. A particular problem is
organ trafficking Organ trade (also known as Red market) is the trading of human organs, tissues, or other body products, usually for transplantation.(Carney, Scott. 2011. "The Red Market." Wired 19, no. 2: 112–1. Internet and Personal Computing Abstracts.) Acco ...
. There is also the ethical issue of not holding out false hope to patients. Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of
transplant rejection Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient ...
, during which the body has an
immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, parasites, and fungi which could ...
to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through serotyping to determine the most appropriate donor-recipient match and through the use of
immunosuppressant drugs Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system. Classification Immunosuppressive drugs can be classified into ...
.


Types of transplant


Autograft

Autografts are the transplant of tissue to the same person. Sometimes this is done with surplus tissue, tissue that can regenerate, or tissues more desperately needed elsewhere (examples include skin grafts, vein extraction for CABG, etc.). Sometimes an autograft is done to remove the tissue and then treat it or the person before returning it (examples include stem cell autograft and storing blood in advance of surgery). In a
rotationplasty Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a ...
, a distal joint is used to replace a more proximal one; typically a foot or ankle joint is used to replace a knee joint. The person's foot is severed and reversed, the knee removed, and the
tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...
joined with the
femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates wit ...
.


Allograft and allotransplantation

An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same
species In biology, a species is the basic unit of classification and a taxonomic rank of an organism, as well as a unit of biodiversity. A species is often defined as the largest group of organisms in which any two individuals of the appropriate s ...
. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splint ...
will identify the organ as foreign and attempt to destroy it, causing transplant rejection. The risk of transplant rejection can be estimated by measuring the panel-reactive antibody level.


Isograft

An isograft is a subset of allograft in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin). Isografts are differentiated from other types of transplants because while they are anatomically identical to autografts, they do not trigger an
immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, parasites, and fungi which could ...
.


Xenograft and xenotransplantation

A xenograft is a transplant of organs or tissue from one species to another. An example is porcine heart valve transplant, which is quite common and successful. Another example is attempted piscine
primate Primates are a diverse order of mammals. They are divided into the strepsirrhines, which include the lemurs, galagos, and lorisids, and the haplorhines, which include the tarsiers and the simians ( monkeys and apes, the latter including ...
(
fish Fish are aquatic, craniate, gill-bearing animals that lack limbs with digits. Included in this definition are the living hagfish, lampreys, and cartilaginous and bony fish as well as various extinct related groups. Approximately 95% of ...
to non-human primate) transplant of pancreatic islets. The latter research study was intended to pave the way for potential human use if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-functional compatibility, rejection, and disease carried in the tissue. In the opposite direction, attempts are being made devise a way to transplant human fetal hearts and kidneys into animals for future transplantation into human patients to address the shortage of donor organs.


Domino transplants

In people with cystic fibrosis (CF), where both lungs need to be replaced, it is a technically easier operation with a higher rate of success to replace both the heart and lungs of the recipient with those of the donor. As the recipient's original heart is usually healthy, it can then be transplanted into a second recipient in need of a heart transplant, thus making the person with CF a living heart donor. In a 2016 case at Stanford Medical Center, a woman who was needing a heart-lung transplant had cystic fibrosis which had led to one lung expanding and the other shrinking, thereby displacing her heart. The second patient who in turn received her heart was a woman with right ventricular dysplasia which had led to a dangerously abnormal rhythm. The dual operations required three surgical teams, including one to remove the heart and lungs from a recently deceased initial donor. The two living recipients did well and had an opportunity to meet six weeks after their simultaneous operations. Another example of this situation occurs with a special form of liver transplant in which the recipient has familial amyloidotic polyneuropathy, a disease where the liver slowly produces a
protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, res ...
that damages other organs. The recipient's liver can then be transplanted into an older person for whom the effects of the disease will not necessarily contribute significantly to mortality. This term also refers to a series of living donor transplants in which one donor donates to the highest recipient on the waiting list and the transplant center utilizes that donation to facilitate multiple transplants. These other transplants are otherwise impossible due to blood type or antibody barriers to transplantation. The " Good Samaritan" kidney is transplanted into one of the other recipients, whose donor in turn donates his or her kidney to an unrelated recipient. This method allows all organ recipients to get a transplant even if their living donor is not a match to them. This further benefits people below any of these recipients on waiting lists, as they move closer to the top of the list for a deceased-donor organ. Johns Hopkins Medical Center in Baltimore and
Northwestern University Northwestern University is a private research university in Evanston, Illinois. Founded in 1851, Northwestern is the oldest chartered university in Illinois and is ranked among the most prestigious academic institutions in the world. Charte ...
's
Northwestern Memorial Hospital Northwestern Memorial Hospital (NMH) is a nationally ranked academic medical center located on Northwestern University’s Chicago campus in Streeterville, Chicago, Illinois. It is the flagship campus for Northwestern Medicine and the primary ...
have received significant attention for pioneering transplants of this kind. In February 2012, the last link in a record 60-person domino chain of 30 kidney transplants was completed.


ABO-incompatible transplants

Because very young children (generally under 12 months, but often as old as 24 months) do not have a well-developed immune system, it is possible for them to receive organs from otherwise incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. Graft survival and people's mortality is approximately the same between ABOi and ABO-compatible (ABOc) recipients. While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation. The most important factors are that the recipient not have produced isohemagglutinins, and that they have low levels of T cell-independent
antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune respons ...
s.
United Network for Organ Sharing The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...
(UNOS) regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below, and if there is no matching ABOc recipient. Studies have shown that the period under which a recipient may undergo ABOi transplantation may be prolonged by exposure to nonself A and B antigens. Furthermore, should the recipient (for example, type B-positive with a type AB-positive graft) require eventual retransplantation, the recipient may receive a new organ of either blood type. Limited success has been achieved in ABO-incompatible heart transplants in adults, though this requires that the adult recipients have low levels of anti-A or anti-B antibodies. Renal transplantation is more successful, with similar long-term graft survival rates to ABOc transplants.


Transplantation in obese individuals

Until recently, people with
obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
were not considered appropriate candidate donors for renal transplantation. In 2009, the physicians at the University of Illinois Medical Center performed the first robotic renal transplantation in an obese recipient and have continued to transplant people with a body mass index over 35 using
robotic surgery Robotic surgery are types of surgical procedures that are done using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabi ...
. As of January 2014, over 100 people who would otherwise have been turned down because of their weight have successfully been transplanted.


Organs and tissues transplanted


Chest

*
Heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
(deceased-donor only; porcine xenograft attempted) * Lung (deceased-donor and living-related lung transplantation) *
Thymus The thymus is a specialized primary lymphoid organ of the immune system. Within the thymus, thymus cell lymphocytes or ''T cells'' mature. T cells are critical to the adaptive immune system, where the body adapts to specific foreign invaders. ...


Abdomen

*
Kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
(deceased-donor and living-donor; porcine xenograft attempted) *
Liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...
(deceased-donor, which enables donation of a whole liver; and living-donor, where each donor can provide up to 70% of a liver) *
Pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...
(deceased-donor only; a very severe type of diabetes ensues if a live person's entire pancreas is removed) * Intestine (deceased-donor and living-donor; normally refers to the small intestine) *
Stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
(deceased-donor only) *
Uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
(deceased-donor only) *
Testis A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testostero ...
(deceased-donor and living-donor) *
Penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...
(deceased-donor only)


Tissues, cells and fluids

* Hand (deceased-donor only), see first recipient Clint Hallam *
Cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...
(deceased-donor only) see the ophthalmologist Eduard Zirm *
Skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...
, including face replant (autograft) and
face transplant A face transplant is a medical procedure to replace all or part of a person's face using tissue from a donor. Part of a field called "Vascularized Composite Tissue Allotransplantation" (VCA) it involves the transplantation of facial skin, the ...
(extremely rare) *
Islets of Langerhans The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...
(pancreas islet cells) (deceased-donor and living-donor) * Bone marrow or adult stem cell (living-donor and autograft) *
Blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...
, whole blood or fractionated
blood product A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in transfusion medicine. Blood components include: red blood cell conc ...
s (living-donor and autograft) * Blood vessels (autograft and deceased-donor) * Heart valve (deceased-donor, living-donor and xenograft
bovine Bovines (subfamily Bovinae) comprise a diverse group of 10 genera of medium to large-sized ungulates, including cattle, bison, African buffalo, water buffalos, and the four-horned and spiral-horned antelopes. The evolutionary relationship betwe ...
]) * Bone transplant, Bone (deceased-donor and living-donor)


Types of donor

Organ donors may be living or may have died of brain death or circulatory death. Most deceased donors are those who have been pronounced brain dead. Brain dead means the cessation of brain function, typically after receiving an injury (either traumatic or pathological) to the brain, or otherwise cutting off blood circulation to the brain (
drowning Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer as ...
, suffocation, etc.). Breathing is maintained via artificial sources, which, in turn, maintains heartbeat. Once brain death has been declared, the person can be considered for organ donation. Criteria for brain death vary. Because less than 3% of all deaths in the US are the result of brain death, the overwhelming majority of deaths are ineligible for organ donation, resulting in severe shortages. Organ donation is possible after cardiac death in some situations, primarily when the person is severely brain-injured and not expected to survive without artificial breathing and mechanical support. Independent of any decision to donate, a person's next-of-kin may decide to end artificial support. If the person is expected to expire within a short period of time after support is withdrawn, arrangements can be made to withdraw that support in an operating room to allow quick recovery of the organs after circulatory death has occurred. Tissues may be recovered from donors who die of either brain or circulatory death. In general, tissues may be recovered from donors up to 24 hours past the cessation of heartbeat. In contrast to organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked." Also, more than 60 grafts may be obtained from a single tissue donor. Because of these three factorsthe ability to recover from a non-heart-beating donor, the ability to bank tissue, and the number of grafts available from each donortissue transplants are much more common than organ transplants. The American Association of Tissue Banks estimates that more than one million tissue transplants take place in the United States each year.


Living donor

In living donors, the donor remains alive and donates a renewable tissue, cell, or fluid (e.g., blood, skin), or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, lung lobe, small bowel). Regenerative medicine may one day allow for laboratory-grown organs, using person's own cells via stem cells, or healthy cells extracted from the failing organs.


Deceased donor

Deceased donors (formerly cadaveric) are people who have been declared brain-dead and whose organs are kept viable by
ventilators A ventilator is a piece of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators ...
or other mechanical mechanisms until they can be excised for transplantation. Apart from brainstem-dead donors, who have formed the majority of deceased donors for the last 20 years, there is increasing use of after-circulatory-death donors (formerly non-heart-beating donors) to increase the potential pool of donors as demand for transplants continues to grow. Prior to the legal recognition of brain death in the 1980s, all deceased organ donors had died of circulatory death. These organs have inferior outcomes to organs from a brain-dead donor. For instance, patients who underwent liver transplantation using donation-after-circulatory-death allografts have been shown to have significantly lower graft survival than those from donation-after-brain-death allografts due to biliary complications and primary nonfunction in liver transplantation. However, given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered. Jurisdictions with medically assisted suicide may co-ordinate organ donations from that source.


Allocation of organs

In most countries there is a shortage of suitable organs for transplantation. Countries often have formal systems in place to manage the process of determining who is an organ donor and in what order organ recipients receive available organs. The overwhelming majority of deceased-donor organs in the United States are allocated by federal contract to the
Organ Procurement and Transplantation Network The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...
, held since it was created by the Organ Transplant Act of 1984 by the
United Network for Organ Sharing The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...
, or UNOS. (UNOS does not handle donor cornea tissue; corneal donor tissue is usually handled by various eye banks.) Individual regional
organ procurement organization In the United States, an organ procurement organization (OPO) is a non-profit organization that is responsible for the evaluation and procurement of deceased-donor organs for organ transplantation. There are 57 such organizations in the United Sta ...
s, all members of the Organ Procurement and Transplantation Network, are responsible for the identification of suitable donors and collection of the donated organs. UNOS then allocates organs based on the method considered most fair by the leadership in the field. The allocation methodology varies somewhat by organ, and changes periodically. For example, liver allocation is based partially on MELD score (Model of End-Stage Liver Disease), an empirical score based on lab values indicative of the sickness of the person from liver disease. In 1984, the National Organ Transplant Act (NOTA) was passed; it gave way to the Organ Procurement and Transplantation Network, which maintains the organ registry and ensures equitable allocation of organs. The Scientific Registry of Transplant Recipients was also established to conduct ongoing studies into the evaluation and clinical status of organ transplants. In 2000 the Children's Health Act passed and required NOTA to consider special issues around pediatric patients and organ allocation. An example of "line jumping" occurred in 2003 at Duke University when doctors attempted to correct an initially incorrect transplant. An American teenager received a heart-lung donation with the wrong blood type for her. She then received a second transplant even though she was then in such poor physical shape that she normally would not be considered a good candidate for a transplant. In an April 2008 article in ''The Guardian'', Steven Tsui, the head of the transplant team at Papworth Hospital in the UK, is quoted in raising the ethical issue of not holding out false hope. He stated, "Conventionally we would say if people's life expectancy was a year or less we would consider them a candidate for a heart transplant. But we also have to manage expectations. If we know that in an average year we will do 30 heart transplants, there is no point putting 60 people on our waiting list, because we know half of them will die and it's not right to give them false hope."Heart of the matter
''The Guardian'' K Simon Garfield, 6 April 2008.
Experiencing somewhat increased popularity, but still very rare, is directed or targeted donation, in which the family of a deceased donor (often honoring the wishes of the deceased) requests an organ be given to a specific person, subverting the allocation system. In the United States, there are various lengths of waiting times due to the different availabilities of organs in different UNOS regions. In other countries such as the UK, only medical factors and the position on the waiting list can affect who receives the organ. One of the more publicized cases of this type was the 1994 Chester and Patti Szuber transplant. This was the first time that a parent had received a heart donated by one of their own children. Although the decision to accept the heart from his recently killed child was not an easy decision, the Szuber family agreed that giving Patti's heart to her father would have been something that she would have wanted. Access to organ transplantation is one reason for the growth of
medical tourism Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable a ...
.


Reasons for donation and ethical issues


Living related donors

Living related donors donate to family members or friends in whom they have an emotional investment. The risk of surgery is offset by the psychological benefit of not losing someone related to them, or not seeing them suffer the ill effects of waiting on a list.


Paired exchange

A "paired-exchange" is a technique of matching willing living donors to compatible recipients using serotyping. For example, a spouse may be willing to donate a kidney to their partner but cannot since there is not a biological match. The willing spouse's kidney is donated to a matching recipient who also has an incompatible but willing spouse. The second donor must match the first recipient to complete the pair exchange. Typically the surgeries are scheduled simultaneously in case one of the donors decides to back out and the couples are kept anonymous from each other until after the transplant. Paired-donor exchange, led by work in th
New England Program for Kidney Exchange
as well as at Johns Hopkins University and the Ohio organ procurement organizations, may more efficiently allocate organs and lead to more transplants. Paired exchange programs were popularized in the ''
New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one. His ...
'' article "Ethics of a paired-kidney-exchange program" in 1997 by L.F. Ross. It was also proposed by Felix T. Rapport in 1986 as part of his initial proposals for live-donor transplants "The case for a living emotionally related international kidney donor exchange registry" in ''Transplant Proceedings''. A paired exchange is the simplest case of a much larger exchange registry program where willing donors are matched with any number of compatible recipients. Transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program." The first pair exchange transplant in the US was in 2001 at
Johns Hopkins Hospital The Johns Hopkins Hospital (JHH) is the teaching hospital and biomedical research facility of the Johns Hopkins School of Medicine, located in Baltimore, Maryland, U.S. It was founded in 1889 using money from a bequest of over $7 million (1873 m ...
. The first complex multihospital kidney exchange involving 12 people was performed in February 2009 by The Johns Hopkins Hospital,
Barnes-Jewish Hospital Barnes-Jewish Hospital is the largest hospital in the U.S. state of Missouri. Located in the Central West End neighborhood of St. Louis, it is the adult teaching hospital for the Washington University School of Medicine and a major component of ...
in
St. Louis St. Louis () is the second-largest city in Missouri, United States. It sits near the confluence of the Mississippi and the Missouri Rivers. In 2020, the city proper had a population of 301,578, while the bi-state metropolitan area, which e ...
and Integris Baptist Medical Center in
Oklahoma City Oklahoma City (), officially the City of Oklahoma City, and often shortened to OKC, is the capital and largest city of the U.S. state of Oklahoma. The county seat of Oklahoma County, it ranks 20th among United States cities in population, a ...
. Another 12-person multihospital kidney exchange was performed four weeks later by Saint Barnabas Medical Center in
Livingston, New Jersey Livingston is a township in Essex County, New Jersey. As of the 2010 U.S. census, the township's population was 29,366, reflecting an increase of 1,975 (+7.2%) from the 27,391 counted in the 2000 Census. In 2019, the Population Estimates Prog ...
,
Newark Beth Israel Medical Center Newark Beth Israel Medical Center (NBIMC), previously Newark Beth Israel Hospital, is a 665-bed quaternary care, teaching hospital located in Newark, New Jersey serving the healthcare needs for Newark and the Northern Jersey area. The hospital i ...
and
New York-Presbyterian Hospital The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New ...
. Surgical teams led by Johns Hopkins continue to pioneer this field with more complex chains of exchange, such as an eight-way multihospital kidney exchange. In December 2009, a 13 organ 13 recipient matched kidney exchange took place, coordinated through Georgetown University Hospital and Washington Hospital Center, Washington DC.


Good Samaritan

Good Samaritan or "altruistic" donation is giving a donation to someone that has no prior affiliation with the donor. The idea of altruistic donation is to give with no interest of personal gain, it is out of pure selflessness. On the other hand, the current allocation system doesn't assess a donor's motive, so altruistic donation isn't a requirement. Some people choose to do this out of a personal need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them. Web sites are being developed that facilitate such donation. Over half of the members of the Jesus Christians, an Australian religious group, have donated kidneys in such a fashion.


Financial compensation

Monetary compensation for organ donors, in the form of reimbursement for out-of-pocket expenses, has been legalised in Australia, and strictly only in the case of kidney transplant in the case of
Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
(minimal reimbursement is offered in the case of other forms of organ harvesting by Singapore). Kidney disease organizations in both countries have expressed their support.Live donors to get financial support
Rashida Yosufzai, AAP, 7 April 2013
In compensated donation, donors get money or other compensation in exchange for their organs. This practice is common in some parts of the world, whether legal or not, and is one of the many factors driving
medical tourism Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable a ...
. In the illegal black market the donors may not get sufficient after-operation care,The Meat Market
, The Wall Street Journal, 8 January 2010.
the price of a kidney may be above $160,000, middlemen take most of the money, the operation is more dangerous to both the donor and receiver, and the receiver often gets
hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes ( jaundice), poor appetite, vomiting, tiredness, abdominal ...
or
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
. In legal markets of Iran the price of a kidney is $2,000 to $4,000. An article by
Gary Becker Gary Stanley Becker (; December 2, 1930 – May 3, 2014) was an American economist who received the 1992 Nobel Memorial Prize in Economic Sciences. He was a professor of economics and sociology at the University of Chicago, and was a leader of ...
and Julio Elias on "Introducing Incentives in the market for Live and Cadaveric Organ Donations" said that a
free market In economics, a free market is an economic system in which the prices of goods and services are determined by supply and demand expressed by sellers and buyers. Such markets, as modeled, operate without the intervention of government or any ot ...
could help solve the problem of a scarcity in organ transplants. Their economic modeling was able to estimate the price tag for human kidneys ($15,000) and human livers ($32,000). In the United States, The National Organ Transplant Act of 1984 made organ sales illegal. In the United Kingdom, the Human Organ Transplants Act 1989 first made organ sales illegal, and has been superseded by the
Human Tissue Act 2004 The Human Tissue Act 2004 is an Act of the Parliament of the United Kingdom, that applied to England, Northern Ireland and Wales, which consolidated previous legislation and created the Human Tissue Authority to "regulate the removal, storage, u ...
. In 2007, two major European conferences recommended against the sale of organs. Recent development of web sites and personal advertisements for organs among listed candidates has raised the stakes when it comes to the selling of organs, and have also sparked significant ethical debates over directed donation, "good-Samaritan" donation, and the current US organ allocation policy. Bioethicist Jacob M. Appel has argued that organ solicitation on billboards and the internet may actually increase the overall supply of organs. In an experimental survey, Elias, Lacetera and Macis (2019) find that preferences for compensation for kidney donors have strong moral foundations; participants in the experiment especially reject direct payments by patients, which they find would violate principles of fairness. Many countries have different approaches to organ donation such as: the opt-out approach and many advertisements of organ donors, encouraging people to donate. Although these laws have been implemented into a certain country they are not forced upon very one as it is an individual decision. Two books, ''Kidney for Sale By Owner'' by Mark Cherry (Georgetown University Press, 2005) and ''Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative'' by James Stacey Taylor: (Ashgate Press, 2005), advocate using markets to increase the supply of organs available for transplantation. In a 2004 journal article economist Alex Tabarrok argues that allowing organ sales, and elimination of organ donor lists will increase supply, lower costs and diminish social anxiety towards organ markets. Iran has had a legal market for kidneys since 1988. The donor is paid approximately US$1200 by the government and also usually receives additional funds from either the recipient or local charities. ''
The Economist ''The Economist'' is a British weekly newspaper printed in demitab format and published digitally. It focuses on current affairs, international business, politics, technology, and culture. Based in London, the newspaper is owned by The Eco ...
'' and the
Ayn Rand Institute The Ayn Rand Institute: The Center for the Advancement of Objectivism, commonly known as the Ayn Rand Institute (ARI), is a 501(c)(3) nonprofit think tank in Santa Ana, California, that promotes Objectivism, the philosophy developed by Ayn Rand ...
approve and advocate a legal market elsewhere. They argued that if 0.06% of Americans between 19 and 65 were to sell one kidney, the national waiting list would disappear (which, the Economist wrote, happened in Iran). The Economist argued that donating kidneys is no more risky than surrogate motherhood, which can be done legally for pay in most countries. In Pakistan, 40 percent to 50 percent of the residents of some villages have only one kidney because they have sold the other for a transplant into a wealthy person, probably from another country, said Dr. Farhat Moazam of Pakistan, at a
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami on 26 December 2004. About 100 people, mostly women, sold their kidneys for 40,000–60,000 rupees ($900–1,350). Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, "I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work." Most kidney sellers say that selling their kidney was a mistake. In Cyprus in 2010 police closed a fertility clinic under charges of trafficking in human eggs. The Petra Clinic, as it was known locally, brought in women from Ukraine and Russia for egg harvesting and sold the genetic material to foreign fertility tourists. This sort of reproductive trafficking violates laws in the European Union. In 2010
Scott Carney Scott Carney (born July 9, 1978) is an American investigative journalist, author and anthropologist. He's the author of five books: ''The Red Market, The Enlightenment Trap, What Doesn't Kill Us', The Wedge'' and'' The Vortex. ''Carney contributes ...
reported for the
Pulitzer Center on Crisis Reporting The Pulitzer Center on Crisis Reporting is an American news media organization established in 2006 that sponsors independent reporting on global issues that other media outlets are less willing or able to undertake on their own. The center's goal ...
and the magazine
Fast Company ''Fast Company'' is a monthly American business magazine published in print and online that focuses on technology, business, and design. It publishes six print issues per year. History ''Fast Company'' was launched in November 1995 by Alan Web ...
explored illicit fertility networks in Spain, the United States and Israel.


Forced donation

There have been concerns that certain authorities are harvesting organs from people deemed undesirable, such as prison populations. The World Medical Association stated that prisoners and other individuals in custody are not in a position to give consent freely, and therefore their organs must not be used for transplantation. According to former Chinese Deputy Minister of Health, Huang Jiefu, the practice of transplanting organs from executed prisoners is still occurring . World Journal reported Huang had admitted approximately 95% of all organs used for transplantation are from executed prisoners. The lack of a public organ donation program in China is used as a justification for this practice. In July 2006, the Kilgour-Matas report David Kilgour,
David Matas David Matas (born 29 August 1943) is the senior legal counsel of B'nai Brith Canada who currently resides in Winnipeg, Manitoba. He has maintained a private practice in refugee, immigration, and human rights law since 1979, and has published vario ...
(6 July 2006, revised 31 January 2007
An Independent Investigation into Allegations of Organ Harvesting of Falun Gong Practitioners in China
(free in 22 languages) organharvestinvestigation.net
stated, "the source of 41,500 transplants for the six-year period 2000 to 2005 is unexplained" and "we believe that there has been and continues today to be large scale organ seizures from unwilling
Falun Gong Falun Gong (, ) or Falun Dafa (; literally, "Dharma Wheel Practice" or "Law Wheel Practice") is a new religious movement.Junker, Andrew. 2019. ''Becoming Activists in Global China: Social Movements in the Chinese Diaspora'', pp. 23–24, 33, 119 ...
practitioners". Investigative journalist
Ethan Gutmann Ethan Gutmann is an American writer, researcher, author, and a senior research fellow in China Studies at the Victims of Communism Memorial Foundation whose work has investigated surveillance and organ harvesting in China. Education Gutmann earn ...
estimates 65,000 Falun Gong practitioners were killed for their organs from 2000 to 2008.
Jay Nordlinger Jay Nordlinger (born November 21, 1963) is an American journalist. He is a senior editor of ''National Review'', and a book fellow of the National Review Institute. He is also a music critic for ''The New Criterion'' and ''The Conservative''. In ...
(25 August 2014
"Face The Slaughter: The Slaughter: Mass Killings, Organ Harvesting, and China's Secret Solution to Its Dissident Problem, by Ethan Gutmann"
, National Review
Ethan Gutmann (August 2014
The Slaughter: Mass Killings, Organ Harvesting and China's Secret Solution to Its Dissident Problem
"Average number of Falun Gong in Laogai System at any given time" Low estimate 450,000, High estimate 1,000,000 p. 320. "Best estimate of Falun Gong harvested 2000 to 2008" 65,000 p. 322.
However 2016 reports updated the death toll of the 15-year period since the persecution of Falun Gong began putting the death toll at 150,000 to 1.5 million. In December 2006, after not getting assurances from the Chinese government about allegations relating to Chinese prisoners, the two major organ transplant hospitals in Queensland, Australia stopped transplantation training for Chinese surgeons and banned joint research programs into organ transplantation with China. In May 2008, two United Nations Special Rapporteurs reiterated their requests for "the Chinese government to fully explain the allegation of taking vital organs from Falun Gong practitioners and the source of organs for the sudden increase in organ transplants that has been going on in China since the year 2000".Market Wired (8 May 2008

Retrieved 26 October 2014
People in other parts of the world are responding to this availability of organs, and a number of individuals (including US and Japanese citizens) have elected to travel to China or India as medical tourists to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical manner.


Organ transplantation by region

Some estimates of the number of transplants performed in various regions of the world have been derived from the
Global Burden of Disease Study The Global Burden of Disease Study (GBD) is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors. GBD is a collaboration of over 3600 research ...
. According to the Council of Europe, Spain through the Spanish Transplant Organization shows the highest worldwide rate of 35.1 donors per million population in 2005 and 33.8 in 2006. In 2011, it was 35.3. In addition to the citizens waiting for organ transplants in the US and other developed nations, there are long waiting lists in the rest of the world. More than 2 million people need organ transplants in China, 50,000 waiting in Latin America (90% of whom are waiting for kidneys), as well as thousands more in the less documented continent of Africa. Donor bases vary in developing nations. In Latin America the donor rate is 40–100 per million per year, similar to that of developed countries. However, in Uruguay, Cuba, and Chile, 90% of organ transplants came from cadaveric donors. Cadaveric donors represent 35% of donors in Saudi Arabia. There is continuous effort to increase the utilization of cadaveric donors in Asia; however, the popularity of living, single kidney donors in India yields a cadaveric donor prevalence of less than 1 per million population. Traditionally, Muslims believe body desecration in life or death to be forbidden, and thus many reject organ transplant. However most Muslim authorities nowadays accept the practice if another life will be saved. As an example, it may be assumed in countries such as
Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
with a cosmopolitan populace that includes
Muslims Muslims ( ar, المسلمون, , ) are people who adhere to Islam, a monotheistic religion belonging to the Abrahamic tradition. They consider the Quran, the foundational religious text of Islam, to be the verbatim word of the God of Abrah ...
, a special
Majlis Ugama Islam Singapura The Majlis Ugama Islam Singapura (MUIS), also known as the Islamic Religious Council of Singapore (IRCS), is a statutory board of the Ministry of Culture, Community and Youth of the Government of Singapore. As a majlis, its role is to look af ...
governing body is formed to look after the interests of Singapore's Muslim community over issues that includes their burial arrangements. Organ transplantation in Singapore is generally overseen by the National Organ Transplant Unit of the
Ministry of Health (Singapore) The Ministry of Health (MOH; ms, Kementerian Kesihatan; zh, 卫生部; ta, சுகாதார அமைச்சு) is a ministry of the Government of Singapore responsible for managing the public healthcare system in Singapore. Statuto ...
. Due to a diversity in mindsets and religious viewpoints, while Muslims on this island are generally not expected to donate their organs even upon death, youth in Singapore are educated on the Human Organ Transplant Act at the age of 18, which is around the age of military conscription. The Organ Donor Registry maintains two types of information, firstly people of Singapore that donate their organs or bodies for transplantation, research or education upon their death, under the Medical (Therapy, Education and Research) Act (MTERA), and secondly people that object to the removal of kidneys, liver, heart and corneas upon death for the purpose of transplantation, under the Human Organ Transplant Act (HOTA). The Live On social awareness movement is also formed to educate Singaporeans on organ donation. Organ transplantation in China has taken place since the 1960s, and China has one of the largest transplant programmes in the world, peaking at over 13,000 transplants a year by 2004. Organ donation, however, is against Chinese tradition and culture, and involuntary organ donation is illegal under Chinese law. China's transplant programme attracted the attention of international
news media The news media or news industry are forms of mass media that focus on delivering news to the general public or a target public. These include news agencies, print media (newspapers, news magazines), broadcast news (radio and television), and ...
in the 1990s due to ethical concerns about the
organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...
and tissue removed from the corpses of executed criminals being commercially traded. In 2006 it became clear that about 41,500 organs had been sourced from Falun Gong practitioners in China since 2000. With regard to organ transplantation in Israel, there is a severe organ shortage due to religious objections by some rabbis who oppose all organ donations and others who advocate that a rabbi participate in all decision making regarding a particular donor. One-third of all heart transplants performed on Israelis are done in China; others are done in Europe. Dr. Jacob Lavee, head of the heart-transplant unit, Sheba Medical Center, Tel Aviv, believes that "transplant tourism" is unethical and Israeli insurers should not pay for it. The organization HODS (Halachic Organ Donor Society) is working to increase knowledge and participation in organ donation among Jews throughout the world. Transplantation rates also differ based on race, sex, and income. A study done with people beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list. For example, different groups express definite interest and complete pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on people currently on the transplantation waiting list. In the United States, nearly 35,000 organ transplants were done in 2017, a 3.4 percent increase over 2016. About 18 percent of these were from living donors – people who gave one kidney or a part of their liver to someone else. But 115,000 Americans remain on waiting lists for organ transplants. By September 2022, the US had reached one million organ transplants overall.


History

Successful human allotransplants have a relatively long history of operative skills that were present long before the necessities for post-operative survival were discovered. Rejection and the side effects of preventing rejection (especially infection and nephropathy) were, are, and may always be the key problem. Several apocryphal accounts of transplants exist well prior to the scientific understanding and advancements that would be necessary for them to have actually occurred. The Chinese physician Pien Chi'ao reportedly exchanged
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
s between a man of strong spirit but weak will with one of a man of weak spirit but strong will in an attempt to achieve balance in each man.
Roman Catholic Roman or Romans most often refers to: *Rome, the capital city of Italy * Ancient Rome, Roman civilization from 8th century BC to 5th century AD * Roman people, the people of ancient Rome *'' Epistle to the Romans'', shortened to ''Romans'', a let ...
accounts report the 3rd-century saints
Damian Damian ( la, links=no, Damianus) may refer to: *Damian (given name) *Damian (surname) *Damian Subdistrict, in Longquanyi District, Chengdu, Sichuan, China See also *Damiani, an Italian surname *Damiano (disambiguation) *Damien (disambiguation) *Dam ...
and Cosmas as replacing the gangrenous or
cancerous Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bl ...
leg of the Roman deacon
Justinian Justinian I (; la, Iustinianus, ; grc-gre, Ἰουστινιανός ; 48214 November 565), also known as Justinian the Great, was the Byzantine emperor from 527 to 565. His reign is marked by the ambitious but only partly realized ''renovat ...
with the leg of a recently deceased
Ethiopia Ethiopia, , om, Itiyoophiyaa, so, Itoobiya, ti, ኢትዮጵያ, Ítiyop'iya, aa, Itiyoppiya officially the Federal Democratic Republic of Ethiopia, is a landlocked country in the Horn of Africa. It shares borders with Eritrea to the ...
n. Most accounts have the saints performing the transplant in the 4th century, many decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure. The more likely accounts of early transplants deal with skin transplantation. The first reasonable account is of the Indian surgeon Sushruta in the 2nd century BC, who used autografted skin transplantation in nose reconstruction, a
rhinoplasty Rhinoplasty ( grc, ῥίς, rhī́s, nose + grc, πλάσσειν, plássein, to shape), commonly called nose job, medically called nasal reconstruction is a plastic surgery procedure for altering and reconstructing the nose. There are two typ ...
. Success or failure of these procedures is not well documented. Centuries later, the
Italian Italian(s) may refer to: * Anything of, from, or related to the people of Italy over the centuries ** Italians, an ethnic group or simply a citizen of the Italian Republic or Italian Kingdom ** Italian language, a Romance language *** Regional Ita ...
surgeon Gasparo Tagliacozzi performed successful skin autografts; he also failed consistently with allografts, offering the first suggestion of rejection centuries before that mechanism could possibly be understood. He attributed it to the "force and power of individuality" in his 1596 work ''De Curtorum Chirurgia per Insitionem''. The first successful corneal allograft transplant was performed in 1837 in a
gazelle A gazelle is one of many antelope species in the genus ''Gazella'' . This article also deals with the seven species included in two further genera, '' Eudorcas'' and '' Nanger'', which were formerly considered subgenera of ''Gazella''. A third ...
model; the first successful human corneal transplant, a keratoplastic operation, was performed by Eduard Zirm at Olomouc Eye Clinic, now in the Czech Republic, in 1905. The first transplant in the modern sense – the implantation of organ tissue in order to replace an organ function – was a
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thy ...
transplant in 1883. It was performed by the Swiss surgeon and later Nobel laureate Theodor Kocher. In the preceding decades Kocher had perfected the removal of excess thyroid tissue in cases of
goiter A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
to an extent that he was able to remove the whole organ without the person dying from the operation. Kocher carried out the total removal of the organ in some cases as a measure to prevent recurrent goiter. By 1883, the surgeon noticed that the complete removal of the organ leads to a complex of particular symptoms that we today have learned to associate with a lack of thyroid hormone. Kocher reversed these symptoms by implanting thyroid tissue to these people and thus performed the first organ transplant. In the following years Kocher and other surgeons used thyroid transplantation also to treat thyroid deficiency that appeared spontaneously, without a preceding organ removal. Thyroid transplantation became the model for a whole new therapeutic strategy: organ transplantation. After the example of the thyroid, other organs were transplanted in the decades around 1900. Some of these transplants were done in animals for purposes of research, where organ removal and transplantation became a successful strategy of investigating the function of organs. Kocher was awarded his
Nobel Prize The Nobel Prizes ( ; sv, Nobelpriset ; no, Nobelprisen ) are five separate prizes that, according to Alfred Nobel's will of 1895, are awarded to "those who, during the preceding year, have conferred the greatest benefit to humankind." Alfr ...
in 1909 for the discovery of the function of the thyroid gland. At the same time, organs were also transplanted for treating diseases in humans. The thyroid gland became the model for transplants of
adrenal The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer cortex whic ...
and
parathyroid gland Parathyroid glands are small endocrine glands in the neck of humans and other tetrapods. Humans usually have four parathyroid glands, located on the back of the thyroid gland in variable locations. The parathyroid gland produces and secretes pa ...
s, pancreas, ovary,
testicle A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testoste ...
s and kidney. By 1900, the idea that one can successfully treat internal diseases by replacing a failed organ through transplantation had been generally accepted. Pioneering work in the surgical technique of transplantation was made in the early 1900s by the French surgeon
Alexis Carrel Alexis Carrel (; 28 June 1873 – 5 November 1944) was a French surgeon and biologist who was awarded the Nobel Prize in Physiology or Medicine in 1912 for pioneering vascular suturing techniques. He invented the first perfusion pump with Charl ...
, with Charles Guthrie, with the transplantation of
arteries An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...
or
vein Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenat ...
s. Their skillful anastomosis operations and the new suturing techniques laid the groundwork for later transplant surgery and won Carrel the 1912
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accord ...
. From 1902, Carrel performed transplant experiments on
dog The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...
s. Surgically successful in moving
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
s,
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
s, and
spleen The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes .
s, he was one of the first to identify the problem of rejection, which remained insurmountable for decades. The discovery of transplant immunity by the German surgeon Georg Schöne, various strategies of matching donor and recipient, and the use of different agents for immune suppression did not result in substantial improvement so that organ transplantation was largely abandoned after
WWI World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
. In 1954, the first ever successful transplant of any organ was done at the Brigham & Women's Hospital in Boston, Ma. The surgery was performed by Dr. Joseph Murray, who received the Nobel Prize in Medicine for his work. The success of this transplant was mostly due to the family relation between the recipient, a Richard Herrick of Maine, and his donor and identical twin brother Ronald. Richard Herrick was in the Navy and became severely ill with acute renal failure. His brother Ronald donated his kidney to Richard, and Richard lived on for another eight years. Prior to this case, transplant recipients did not survive for more than thirty days. Their close family relation meant there was no need for anti-rejection medications, which was not known until this time, so the case shed light on the cause of rejection and of possible anti-rejection medicine. Major steps in skin transplantation occurred during the First World War, notably in the work of
Harold Gillies Sir Harold Delf Gillies (17 June 1882 – 10 September 1960) was a New Zealand otolaryngologist and father of modern plastic surgery. Early life Gillies was born in Dunedin, New Zealand, the son of Member of Parliament in Otago, Robert Gillies ...
at
Aldershot Aldershot () is a town in Hampshire, England. It lies on heathland in the extreme northeast corner of the county, southwest of London. The area is administered by Rushmoor Borough Council. The town has a population of 37,131, while the Alder ...
. Among his advances was the tubed pedicle graft, which maintained a flesh connection from the donor site until the graft established its own
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
flow. Gillies' assistant, Archibald McIndoe, carried on the work into
the Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...
as
reconstructive surgery Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition. Description Reconstructive surgery is a term with training, clinical, and reimbursement implicat ...
. In 1962, the first successful replantation surgery was performed – re-attaching a severed limb and restoring (limited) function and feeling. Transplant of a single gonad (testis) from a living donor was carried out in early July 1926 in
Zaječar Zaječar ( sr-Cyrl, Зајечар, ; ro, Zaicear or ) is a city and the administrative center of the Zaječar District in eastern Serbia. According to the 2011 census, the city administrative area has a population of 59,461 inhabitants. Zaječa ...
,
Serbia Serbia (, ; Serbian: , , ), officially the Republic of Serbia (Serbian: , , ), is a landlocked country in Southeastern and Central Europe, situated at the crossroads of the Pannonian Basin and the Balkans. It shares land borders with Hungar ...
, by a
Russian Russian(s) refers to anything related to Russia, including: *Russians (, ''russkiye''), an ethnic group of the East Slavic peoples, primarily living in Russia and neighboring countries *Rossiyane (), Russian language term for all citizens and peo ...
émigré An ''émigré'' () is a person who has emigrated, often with a connotation of political or social self-exile. The word is the past participle of the French ''émigrer'', "to emigrate". French Huguenots Many French Huguenots fled France followin ...
surgeon Dr. Peter Vasil'evič Kolesnikov. The donor was a convicted murderer, one Ilija Krajan, whose death sentence was commuted to 20 years imprisonment, and he was led to believe that it was done because he had donated his testis to an elderly medical doctor. Both the donor and the receiver survived, but charges were brought in a court of law by the public prosecutor against Dr. Kolesnikov, not for performing the operation, but for lying to the donor. The first attempted human deceased-donor transplant was performed by the Ukrainian surgeon Yurii Voronoy in the 1930s; but failed due to ischemia.
Joseph Murray Joseph Edward Murray (April 1, 1919 – November 26, 2012) was an American plastic surgeon who performed the first successful human kidney transplant on identical twins Richard and Ronald Herrick on December 23, 1954. Murray shared the ...
and J. Hartwell Harrison performed the first successful transplant, a kidney transplant between identical
twin Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
s, in 1954, because no
immunosuppression Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reacti ...
was necessary for genetically identical individuals. In the late 1940s
Peter Medawar Sir Peter Brian Medawar (; 28 February 1915 – 2 October 1987) was a Brazilian-British biologist and writer, whose works on graft rejection and the discovery of acquired immune tolerance have been fundamental to the medical practice of tissu ...
, working for the
National Institute for Medical Research The National Institute for Medical Research (commonly abbreviated to NIMR), was a medical research institute based in Mill Hill, on the outskirts of north London, England. It was funded by the Medical Research Council (MRC); In 2016, the NIMR b ...
, improved the understanding of rejection. Identifying the immune reactions in 1951, Medawar suggested that immunosuppressive drugs could be used.
Cortisone Cortisone is a pregnene (21-carbon) steroid hormone. It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of the enz ...
had been recently discovered and the more effective
azathioprine Azathioprine (AZA), sold under the brand name Imuran, among others, is an immunosuppressive medication. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus, ...
was identified in 1959, but it was not until the discovery of
cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...
in 1970 that transplant surgery found a sufficiently powerful immunosuppressive. There was a successful deceased-donor lung transplant into an emphysema and
lung cancer Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, malign ...
patient in June 1963 by James Hardy at the
University of Mississippi Medical Center University of Mississippi Medical Center (UMMC) is the health sciences campus of the University of Mississippi (Ole Miss) and is located in Jackson, Mississippi, United States. UMMC, also referred to as the Medical Center, is the state's only aca ...
in
Jackson, Mississippi Jackson, officially the City of Jackson, is the capital of and the most populous city in the U.S. state of Mississippi. The city is also one of two county seats of Hinds County, along with Raymond. The city had a population of 153,701 at t ...
. The patient John Russell survived for eighteen days before dying of
kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
.Lung Homotransplantation in Man: Report of the Initial Case
JAMA (Journal of the American Medical Association), James D. Hardy, MD; Watts R. Webb, MD; Martin L. Dalton Jr., MD; George R. Walker Jr., MD, 1963;186(12):1065–74 21 Dec. 1963. See als
Lung Transplantation
in same issue.
Anesthesia for Transplant Surgery
Jayashree Sood, Vijay Vohra, New Delhi, London, Panama City, Philadelphia: Jaypee Brothers Medical Publishing, 2014, page 4, "Lung Transplant."
Second Wind: Oral Histories of Lung Transplant Survivors
Mary Jo Festle, Palgrave MacMillan, 2012.
Medical Center marks 50th anniversary of momentous surgical achievement
University of Mississippi Medical Center, Bruce Coleman, 13 May 2013. " ... Rowland Medical Library ... restored film in canister No. 97 ... footage of Hardy's initial lung transplant follows – in vivid color. . "
Thomas Starzl of
Denver Denver () is a consolidated city and county, the capital, and most populous city of the U.S. state of Colorado. Its population was 715,522 at the 2020 census, a 19.22% increase since 2010. It is the 19th-most populous city in the Unit ...
attempted a liver transplant in the same year, but he was not successful until 1967. In the early 1960s and prior to long-term dialysis becoming available, Keith Reemtsma and his colleagues at Tulane University in New Orleans attempted transplants of chimpanzee kidneys into 13 human patients. Most of these patients only lived one to two months. However, in 1964, a 23-year-old woman lived for nine months and even returned to her job as a school teacher until she suddenly collapsed and died. It was assumed that she died from an acute electrolyte disturbance. At autopsy, the kidneys had not been rejected nor was there any other obvious cause of death.Xenotransplantation: The Transplantation of Organs and Tissues Between Species
edited and with chapters by David K.C. Cooper, Ejvind Kemp, Keith Reemtsma, and D.J.G. White; Berlin, Heidelberg, New York: Springer-Verlag, 1991. Please see Case 2 on page 19 for discussion of the 1964 case of the 23-year-old school teacher who lived nine months after receiving a transplant of chimpanzee kidneys, which was written by her surgeon Keith Reemtsma.
One source states this patient died from pneumonia.Kidney Transplantation, Bioengineering, and Regeneration: Kidney Transplantation in the Regenerative Medicine Era
edited by Giuseppe Orlando, Giuseppe Remuzzi, David F. Williams, "Ch. 84.5 Xenotransplantation" by Kazuhiko Yamada, Masayuki Tasaki, Adam Griesemar, Jigesh Shah, London: Academic Press, 2017.
Tom Starzl and his team in Colorado used baboon kidneys with six human patients who lived one or two months, but with no longer term survivors. Others in the United States and France had limited experiences. The heart was a major prize for transplant surgeons. But over and above rejection issues, the heart deteriorates within minutes of death, so any operation would have to be performed at great speed. The development of the
heart-lung machine Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...
was also needed. Lung pioneer James Hardy was prepared to attempt a human heart transplant in 1964, but when a premature failure of comatose Boyd Rush's heart caught Hardy with no human donor, he used a chimpanzee heart, which beat in his patient's chest for approximately one hour and then failed.''Every Second Counts: The Race to Transplant the First Human Heart'', Donald McRae, New York: Penguin (Berkley/Putnam), 2006, see Chapter 7 "Mississippi Gambling,
pages 122 through 127
' egarding Hardy's 1964 transplant of chimpanzee heart into comatose patient, with a close relative signing the consent form. . made no mention of the fact that an animal heart might be used for the procedure. Such was the medicolegal situation at that time that this "informed" consent was not considered in any way inadequate. . . ' The first partial success was achieved on 3 December 1967, when
Christiaan Barnard Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...
of
Cape Town Cape Town ( af, Kaapstad; , xh, iKapa) is one of South Africa's three capital cities, serving as the seat of the Parliament of South Africa. It is the legislative capital of the country, the oldest city in the country, and the second largest ...
, South Africa, performed the world's first human-to-human heart transplant with patient
Louis Washkansky Louis Joshua Washkansky (12 April 1912 – 21 December 1967) was a South African man who was the recipient of the world's first human-to-human heart transplant, and the first patient to regain consciousness following the operation. Washkansky ...
as the recipient. Washkansky survived for eighteen days amid what many saw as a distasteful publicity circus. The media interest prompted a spate of heart transplants. Over a hundred were performed in 1968–1969, but almost all the people died within 60 days. Barnard's second patient, Philip Blaiberg, lived for 19 months. It was the advent of
cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...
that altered transplants from research surgery to life-saving treatment. In 1968 surgical pioneer Denton Cooley performed 17 transplants, including the first heart-lung transplant. Fourteen of his patients were dead within six months. By 1984 two-thirds of all heart transplant patients survived for five years or more. With organ transplants becoming commonplace, limited only by donors, surgeons moved on to riskier fields, including multiple-organ transplants on humans and whole-body transplant research on animals. On 9 March 1981, the first successful heart-lung transplant took place at Stanford University Hospital. The head surgeon, Bruce Reitz, credited the patient's recovery to
cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...
. As the rising success rate of transplants and modern
immunosuppression Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reacti ...
make transplants more common, the need for more organs has become critical. Transplants from living donors, especially relatives, have become increasingly common. Additionally, there is substantive research into
xenotransplantation Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograft ...
, or transgenic organs; although these forms of transplant are not yet being used in humans, clinical trials involving the use of specific
cell Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Locations * Monastic cell, a small room, hut, or cave in which a religious recluse lives, alternatively the small precursor of a monastery ...
types have been conducted with promising results, such as using
porcine The pig (''Sus domesticus''), often called swine, hog, or domestic pig when distinguishing from other members of the genus '' Sus'', is an omnivorous, domesticated, even-toed, hoofed mammal. It is variously considered a subspecies of ''Sus ...
islets of Langerhans The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...
to treat type 1 diabetes. However, there are still many problems that would need to be solved before they would be feasible options in people requiring transplants. Recently, researchers have been looking into means of reducing the general burden of immunosuppression. Common approaches include avoidance of steroids, reduced exposure to
calcineurin Calcineurin (CaN) is a calcium and calmodulin dependent serine/threonine protein phosphatase (also known as protein phosphatase 3, and calcium-dependent serine-threonine phosphatase). It activates the T cells of the immune system and can be block ...
inhibitors, and other means of weaning drugs based on patient outcome and function. While short-term outcomes appear promising, long-term outcomes are still unknown, and in general, reduced immunosuppression increases the risk of rejection and decreases the risk of infection. The risk of early rejection is increased if corticosteroid immunosuppression are avoided or withdrawn after renal transplantation. Many other new drugs are under development for transplantation. The emerging field of
regenerative medicine Regenerative medicine deals with the "process of replacing, engineering or regenerating human or animal cells, tissues or organs to restore or establish normal function". This field holds the promise of engineering damaged tissues and organs by st ...
promises to solve the problem of organ transplant rejection by regrowing organs in the lab, using person's own cells (stem cells or healthy cells extracted from the donor site).


Timeline of transplants

* 1869: First skin autograft-transplantation by Carl Bunger, who documented the first modern successful
skin graft Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft. Surgeons may use skin grafting to treat: * extensive wounding or trauma * burns * areas of extensive skin loss du ...
on a person. Bunger repaired a person's nose destroyed by syphilis by grafting flesh from the inner thigh to the nose, in a method reminiscent of the '' Sushrutha''. * 1905: First successful cornea transplant by Eduard Zirm (Czech Republic) * 1908: First skin allograft-transplantation of skin from a donor to a recipient (Switzerland) * 1931: First uterus transplantation (
Lili Elbe Lili Ilse Elvenes (28 December 1882 – 13 September 1931), better known as Lili Elbe, was a Danish painter and transgender woman, and among the early recipients of sex reassignment surgery. She was a successful painter under her birth name Ein ...
). * 1950: First successful kidney transplant by Dr.
Richard H. Lawler Richard H. Lawler, M.D. (August 12, 1895 — July 24, 1982) led a surgical team at Little Company of Mary Hospital in Evergreen Park, Illinois, that performed on June 17, 1950, what ''Time'' magazine described as "the first human kidney transplan ...
(
Chicago (''City in a Garden''); I Will , image_map = , map_caption = Interactive Map of Chicago , coordinates = , coordinates_footnotes = , subdivision_type = Country , subdivision_name ...
, US) * 1954: First living related kidney transplant (
identical twins Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
) (US) * 1954: Brazil's first successful corneal transplant, the first liver (Brazil) * 1955: First
heart valve A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart ...
allograft into descending
aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes o ...
(Canada) * 1963: First successful lung transplant by James D. Hardy with patient living 18 days (US) * 1964: James D. Hardy attempts heart transplant using chimpanzee heart (US) * 1964: Human patient lived nine months with chimpanzee kidneys, twelve other human patients only lived one to two months, Keith Reemtsma and team (New Orleans, US) * 1965:
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's first successful kidney transplant at Hospital Clinic de
Barcelona Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within ci ...
,
Catalonia Catalonia (; ca, Catalunya ; Aranese Occitan: ''Catalonha'' ; es, Cataluña ) is an autonomous community of Spain, designated as a '' nationality'' by its Statute of Autonomy. Most of the territory (except the Val d'Aran) lies on the nort ...
,
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, by a surgeon team lead by Josep Maria Gil-Vernet and Antoni Caralps. The patient, a woman, had a very long life since the procedure. * 1965: Australia's first successful (living) kidney transplant ( Queen Elizabeth Hospital, SA, Australia) * 1966: First successful pancreas transplant by Richard C. Lillehei and William Kelly (
Minnesota Minnesota () is a state in the upper midwestern region of the United States. It is the 12th largest U.S. state in area and the 22nd most populous, with over 5.75 million residents. Minnesota is home to western prairies, now given over to ...
, US) * 1967: First successful liver transplant by Thomas Starzl (Denver, US) * 1967: First successful heart transplant by Christian Barnard (Cape Town, South Africa) * 1981: First successful heart/lung transplant by Bruce Reitz (Stanford, US) * 1983: First successful lung lobe transplant by Joel Cooper at the
Toronto General Hospital The Toronto General Hospital (TGH) is a major teaching hospital in Toronto, Ontario, Canada and the flagship campus of University Health Network (UHN). It is located in the Discovery District of Downtown Toronto along University Avenue's Hospital ...
(
Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the anch ...
, Canada) * 1984: First successful double organ transplant by Thomas Starzl and Henry T. Bahnson (
Pittsburgh Pittsburgh ( ) is a city in the Commonwealth of Pennsylvania, United States, and the county seat of Allegheny County. It is the most populous city in both Allegheny County and Western Pennsylvania, the second-most populous city in Pennsylva ...
, US) * 1986: First successful double-lung transplant ( Ann Harrison) by Joel Cooper at the
Toronto General Hospital The Toronto General Hospital (TGH) is a major teaching hospital in Toronto, Ontario, Canada and the flagship campus of University Health Network (UHN). It is located in the Discovery District of Downtown Toronto along University Avenue's Hospital ...
(Toronto, Canada) * 1990: First successful adult segmental living-related liver transplant by Mehmet Haberal (Ankara, Turkey) * 1992: First successful combined liver-kidney transplantation from a living-related donor by Mehmet Haberal (Ankara, Turkey) * 1995: First successful
laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medlin ...
live-donor nephrectomy by Lloyd Ratner and Louis Kavoussi (
Baltimore Baltimore ( , locally: or ) is the List of municipalities in Maryland, most populous city in the U.S. state of Maryland, fourth most populous city in the Mid-Atlantic (United States), Mid-Atlantic, and List of United States cities by popula ...
, US) * 1997: First successful allogeneic vascularized transplantation of a fresh and perfused human knee joint by Gunther O. Hofmann * 1997: Illinois' first living donor kidney-pancreas transplant and first robotic living donor pancreatectomy in the US. University of Illinois Medical Center * 1998: First successful live-donor partial
pancreas transplant A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes. Overview Because the pancreas is a vital organ, performing functions necessary in the ...
by David Sutherland (Minnesota, US) * 1998: First successful hand transplant by Dr.
Jean-Michel Dubernard Jean-Michel Dubernard (; 17 May 1941 – 10 July 2021) was a French medical doctor specializing in Organ transplant, transplant surgery who served as a Deputies of the 12th French National Assembly#D, Deputy in the French National Assembly. He ...
(
Lyon Lyon,, ; Occitan language, Occitan: ''Lion'', hist. ''Lionés'' also spelled in English as Lyons, is the List of communes in France with over 20,000 inhabitants, third-largest city and Urban area (France), second-largest metropolitan area of F ...
, France) * 1998: United States' first adult-to-adult living donor liver transplant University of Illinois Medical Center * 1999: First successful tissue engineered
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
transplanted by Anthony Atala (
Boston Children's Hospital Boston Children's Hospital formerly known as Children's Hospital Boston until 2012 is a nationally ranked, freestanding acute care children's hospital located in Boston, Massachusetts, adjacent both to its teaching affiliate, Harvard Medical Scho ...
, US) * 2000: First robotic donor nephrectomy for a living-donor kidney transplant in the world University of Illinois Medical Center * 2004: First liver and small bowel transplants from same living donor into same recipient in the world University of Illinois Medical Center * 2005: First successful ovarian transplant by Dr. P. N. Mhatre (Wadia Hospital,
Mumbai Mumbai (, ; also known as Bombay — List of renamed Indian cities and states#Maharashtra, the official name until 1995) is the capital city of the Indian States and union territories of India, state of Maharashtra and the ''de facto'' fin ...
, India) * 2005: First successful partial
face transplant A face transplant is a medical procedure to replace all or part of a person's face using tissue from a donor. Part of a field called "Vascularized Composite Tissue Allotransplantation" (VCA) it involves the transplantation of facial skin, the ...
(France) * 2005: First robotic hepatectomy in the United States University of Illinois Medical Center * 2006: Illinois' first paired donation for ABO incompatible kidney transplant University of Illinois Medical Center * 2006: First
jaw The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term ''jaws'' is also broadly applied to the whole of the structures constituting the vault of the mouth and serv ...
transplant to combine donor
jaw The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term ''jaws'' is also broadly applied to the whole of the structures constituting the vault of the mouth and serv ...
with bone marrow from the patient, by
Eric M. Genden Eric M. Genden, MD, MHCA, FACS is a United States head and neck cancer surgeon at the Icahn School of Medicine at Mount Sinai and Mount Sinai Health System in New York City. where he serves as the Isidore Friesner Professor and Chairman of Otorhi ...
( Mount Sinai Hospital,
New York City New York, often called New York City or NYC, is the most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the most densely populated major city in the Un ...
, US) * 2006: First successful human
penis transplant Penis transplantation is a surgical transplant procedure in which a penis is transplanted to a patient. The penis may be an allograft from a human donor, or it may be grown artificially, though the latter has not yet been transplanted onto a hu ...
(later reversed after 15 days due to 44-year-old recipient's wife's psychological rejection) (
Guangzhou Guangzhou (, ; ; or ; ), also known as Canton () and alternatively romanized as Kwongchow or Kwangchow, is the capital and largest city of Guangdong province in southern China. Located on the Pearl River about north-northwest of Hong Kon ...
, China) * 2008: First successful complete full double
arm In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint (shoulder joint) and the elbow joint. The distal part of the upper limb between th ...
transplant by Edgar Biemer, Christoph Höhnke and Manfred Stangl (
Technical University of Munich The Technical University of Munich (TUM or TU Munich; german: Technische Universität München) is a public research university in Munich, Germany. It specializes in engineering, technology, medicine, and applied and natural sciences. Establis ...
, Germany) * 2008: First baby born from transplanted ovary. The transplant was carried out by Dr Sherman Silber at the Infertility Centre of St Louis in Missouri. The donor is her twin sister. * 2008: First transplant of a human windpipe using a patient's own stem cells, by
Paolo Macchiarini Paolo Macchiarini (born 22 August 1958) is a Swiss-born Italian thoracic surgeon and former regenerative medicine researcher who became known for research fraud and manipulative behavior. He has been convicted of research-related crimes in Ita ...
(
Barcelona Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within ci ...
, Spain) * 2008: First successful transplantation of near total area (80%) of
face The face is the front of an animal's head that features the eyes, nose and mouth, and through which animals express many of their emotions. The face is crucial for human identity, and damage such as scarring or developmental deformities may aff ...
, (including
palate The palate () is the roof of the mouth in humans and other mammals. It separates the oral cavity from the nasal cavity. A similar structure is found in crocodilians, but in most other tetrapods, the oral and nasal cavities are not truly separ ...
,
nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes ...
,
cheeks The cheeks ( la, buccae) constitute the area of the face below the eyes and between the nose and the left or right ear. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve. The area between the insi ...
, and
eyelid An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eye ...
) by Maria Siemionow (
Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...
, US) * 2009: Worlds' first robotic kidney transplant in an obese patient University of Illinois Medical Center * 2010: First full facial transplant by Dr. Joan Pere Barret and team (Hospital Universitari Vall d'Hebron on 26 July 2010, in
Barcelona Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within ci ...
, Spain) * 2011: First double leg transplant by Dr. Cavadas and team (Valencia's Hospital, La Fe, Spain) * 2012: First simultaneous robotic bariatric surgery (sleeve gastrectomy) and kidney transplantation (university of Illinois at Chicago).
1
.
2
* 2012: First Robotic Alloparathyroid transplant. University of Illinois Chicago * 2013: First successful entire face transplantation as an urgent life-saving surgery at Maria Skłodowska-Curie Institute of Oncology branch in
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, Poland. * 2014: First successful uterine transplant resulting in live birth (Sweden) * 2014: First successful penis transplant. (South Africa) * 2014: First neonatal organ transplant. (UK) * 2018: Skin gun invented, which takes a small amount of healthy skin to be grown in a lab, then is sprayed onto burnt skin. This way skin will heal in days instead of months and will not scar. * 2019: First drone delivery of a donated kidney, that was then successfully transplanted into a patient. (US) * 2021: First transplant of both arms and shoulders performed on an Icelandic patient at the Édouard Herriot Hospital. (FR) * 2022: First successful heart transplant from a pig to a human patient. (US) The recipient later died as the pig's heart was infected with porcine cytomegalovirus.


Society and culture


Success rates

Since 2000, there have been approximately 2,200 lung transplants performed each year worldwide. From 2000 to 2006, the median survival period for lung transplant patients has been 5.5 years.


Comparative costs

In China IN, In or in may refer to: Places * India (country code IN) * Indiana, United States (postal code IN) * Ingolstadt Ingolstadt (, Austro-Bavarian: ) is an independent city on the Danube in Upper Bavaria with 139,553 inhabitants (as of Ju ...
, a kidney transplant operation runs for around $70,000, liver for $160,000, and heart for $120,000.


Safety

In the United States, tissue transplants are regulated by the US Food and Drug Administration (FDA) which sets strict regulations on the safety of the transplants, primarily aimed at the prevention of the spread of communicable disease. Regulations include criteria for donor screening and testing as well as strict regulations on the processing and distribution of tissue grafts. Organ transplants are not regulated by the FDA. It is essential that the HLA complexes of both the donor and recipient be as closely matched as possible to prevent graft rejection. In November 2007, the
CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
reported the first-ever case of
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
and Hepatitis C being simultaneously transferred through an organ transplant. The donor was a 38-year-old male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients. Experts say that the reason the diseases did not show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies would not have existed in high enough numbers to detect. The crisis has caused many to call for more sensitive screening tests, which could pick up antibodies sooner. Currently, the screens cannot pick up on the small number of antibodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18–21 days before a donation is made.
Nucleic acid test A nucleic acid test (NAT) is a technique used to detect a particular nucleic acid sequence and thus usually to detect and identify a particular species or subspecies of organism, often a virus or bacterium that acts as a pathogen in blood, tissu ...
ing is now being done by many organ procurement organizations and is able to detect HIV and hepatitis C directly within seven to ten days of exposure to the virus.


Transplant laws

Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens. However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not. The
Indian government The Government of India (ISO: ; often abbreviated as GoI), known as the Union Government or Central Government but often simply as the Centre, is the national government of the Republic of India, a federal democracy located in South Asia, ...
has had difficulty tracking the flourishing organ black market in their country, but in recent times it has amended its organ transplant law to make punishment more stringent for commercial dealings in organs. It has also included new clauses in the law to support deceased organ donation, such as making it mandatory to request for organ donation in case of brain death. Other countries victimized by illegal organ trade have also implemented legislative reactions. Moldova has made international adoption illegal in fear of organ traffickers. China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent. However, doctors in other countries, such as the United Kingdom, have accused China of abusing its high capital punishment rate. Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China and Ukraine, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking. Some organs are also shipped to Uganda and the Netherlands. This was a main product in the
triangular trade Triangular trade or triangle trade is trade between three ports or regions. Triangular trade usually evolves when a region has export commodities that are not required in the region from which its major imports come. It has been used to offset ...
in 1934. Starting on 1 May 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime. On 27 June 2008, Indonesian, Sulaiman Damanik, 26, pleaded guilty in
Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
court for sale of his kidney to CK Tang's executive chair, Tang Wee Sung, 55, for 150 million
rupiah The rupiah (symbol: Rp; currency code: IDR) is the official currency of Indonesia. It is issued and controlled by Bank Indonesia. The name " rupiah" is derived from the Sanskrit word for silver, (). Sometimes, Indonesians also informally use ...
(S$22,200). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks." Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (US$20,200). Upon sentence, both would suffer each, 12 months in jail or 10,000
Singapore dollar The Singapore dollar (sign: S$; code: SGD) is the official currency of the Republic of Singapore. It is divided into 100 cents. It is normally abbreviated with the dollar sign $, or S$ to distinguish it from other dollar-denominated currencie ...
s (US$7,600) fine. In an article appearing in the April 2004 issue of
Econ Journal Watch ''Econ Journal Watch'' is a semiannual peer-reviewed electronic journal established in 2004. It is published by the Fraser Institute. According its website, the journal publishes comments on articles appearing in other economics journals, essays, r ...
, economist
Alex Tabarrok Alexander Taghi Tabarrok (born November 11, 1966) is a Canadian-American economist. With Tyler Cowen, he co-authors the economics blog ''Marginal Revolution''. Tabarrok and Cowen have also ventured into online education with ''Marginal Revoluti ...
examined the impact of direct consent laws on transplant organ availability. Tabarrok found that social pressures resisting the use of transplant organs decreased over time as the opportunity of individual decisions increased. Tabarrok concluded his study suggesting that gradual elimination of organ donation restrictions and move to a free market in organ sales will increase supply of organs and encourage broader social acceptance of organ donation as a practice. In the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
24 states have no law preventing discrimination against potential organ recipients based on cognitive ability, including children. A 2008 study found that of the transplant centers surveyed in those states 85 percent considered disability when deciding transplant list and forty four percent would deny an organ transplant to a child with a neurodevelopmental disability.


Ethical concerns

The existence and distribution of organ transplantation procedures in
developing countries A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
, while almost always beneficial to those receiving them, raise many
ethical Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns ma ...
concerns. Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of distributive justice. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
argues that transplantations promote health, but the notion of "transplantation tourism" has the potential to violate
human rights Human rights are moral principles or normsJames Nickel, with assistance from Thomas Pogge, M.B.E. Smith, and Leif Wenar, 13 December 2013, Stanford Encyclopedia of PhilosophyHuman Rights Retrieved 14 August 2014 for certain standards of hu ...
or exploit the poor, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. Regardless of the "gift of life", in the context of developing countries, this might be coercive. The practice of coercion could be considered exploitative of the poor population, violating basic human rights according to Articles 3 and 4 of the
Universal Declaration of Human Rights The Universal Declaration of Human Rights (UDHR) is an international document adopted by the United Nations General Assembly that enshrines the rights and freedoms of all human beings. Drafted by a UN committee chaired by Eleanor Roosevelt, ...
. There is also a powerful opposing view, that trade in organs, if properly and effectively regulated to ensure that the seller is fully informed of all the consequences of donation, is a mutually beneficial transaction between two consenting adults, and that prohibiting it would itself be a violation of Articles 3 and 29 of the
Universal Declaration of Human Rights The Universal Declaration of Human Rights (UDHR) is an international document adopted by the United Nations General Assembly that enshrines the rights and freedoms of all human beings. Drafted by a UN committee chaired by Eleanor Roosevelt, ...
. Even within developed countries there is concern that enthusiasm for increasing the supply of organs may trample on respect for the right to life. The question is made even more complicated by the fact that the "irreversibility" criterion for
legal death Legal death is the recognition under the law of a particular jurisdiction that a person is no longer alive. In most cases, a doctor's declaration of death (variously called) or the identification of a corpse is a legal requirement for such recognit ...
cannot be adequately defined and can easily change with changing technology.


Artificial organ transplantation

Surgeons, notably
Paolo Macchiarini Paolo Macchiarini (born 22 August 1958) is a Swiss-born Italian thoracic surgeon and former regenerative medicine researcher who became known for research fraud and manipulative behavior. He has been convicted of research-related crimes in Ita ...
, in Sweden performed the first implantation of a synthetic trachea in July 2011, for a 36-year-old patient who had cancer. Stem cells taken from the patient's hip were treated with growth factors and incubated on a plastic replica of his natural trachea. According to information uncovered by the Swedish documentary "Dokument Inifrån: Experimenten" (Swedish: "Documents from the Inside: The Experiments") the patient, Andemariam went on to develop an increasingly terrible and eventually bloody cough to dying, incubated, in the hospital. At that point, determined by autopsy, 90% of the synthetic windpipe had come loose. He allegedly made several trips to see Macchiarini for his complications, and at one point had surgery again to have his synthetic windpipe replaced, but Macchiarini was notoriously difficult to get an appointment with. According to the autopsy, the old synthetic windpipe did not appear to have been replaced. Macchiarini's academic credentials have been called into question and he has recently been accused of alleged research misconduct. Left ventricular assist devices are often used as a "bridge" to provide additional time while a patient waits for a transplant. For example, former US vice-president Dick Cheney had such a device implanted in 2010 and then 20 months later received a heart transplant in 2012. In year 2012, about 3,000 ventricular assist devices were inserted in the United States, as compared to approximately 2,500 heart transplants. The use of airbags in cars as well as greater use of helmets by bicyclists and skiers has reduced the number of persons with fatal head injuries, which is a common source of donors hearts.


Research

An early-stage medical laboratory and research company, called
Organovo Organovo is an early-stage medical laboratory and research company which designs and develops functional, three dimensional human tissue (also known as 3D bioprinting technology) for medical research and therapeutic applications. Organovo was est ...
, designs and develops functional, three dimensional human tissue for medical research and therapeutic applications. The company utilizes its NovoGen MMX Bioprinter for 3D bioprinting. Organovo anticipates that the bioprinting of human tissues will accelerate the preclinical drug testing and discovery process, enabling treatments to be created more quickly and at lower cost. Additionally, Organovo has long-term expectations that this technology could be suitable for surgical therapy and transplantation. A further area of active research is concerned with improving and assessing organs during their preservation. Various techniques have emerged which show great promise, most of which involve perfusing the organ under either hypothermic (4–10 °C) or normothermic (37 °C) conditions. All of these add additional cost and logistical complexity to the organ retrieval, preservation and transplant process, but early results suggest it may well be worth it. Hypothermic perfusion is in clinical use for transplantation of kidneys and liver whilst normothermic perfusion has been used effectively in the heart, lung, liver and, less so, in the kidney. Another area of research being explored is the use of genetically engineered animals for transplants. Similar to human organ donors, scientists have developed a genetically engineered pig with the aim of reducing rejection to pig organs by human patients. This is currently at the basic research stage, but shows great promise in alleviating the long waiting lists for organ transplants and the number of people in need of transplants outweighs the amount of organs donated. Trials are being done to prevent the pig organ transplant to enter a clinical trial phase until the potential disease transfer from pigs to humans can be safely and satisfactorily managed (Isola & Gordon, 1991).


See also

*
Artificial organ An artificial organ is a human made organ device or tissue that is implanted or integrated into a human — interfacing with living tissue — to replace a natural organ, to duplicate or augment a specific function or functions so the patient m ...
* Beating heart cadaver *
Blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...
* Laboratory-grown organ *
Organ donation Organ donation is the process when a person allows an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive or dead with the assent of the next of kin. Donation may be for re ...
*
Regenerative medicine Regenerative medicine deals with the "process of replacing, engineering or regenerating human or animal cells, tissues or organs to restore or establish normal function". This field holds the promise of engineering damaged tissues and organs by st ...
*
Transplant rejection Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient ...
*
Xenotransplantation Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograft ...


References

* Isola, L. M., & Gordon, J. W. (1991). Transgenic animals: a new era in developmental biology and medicine. Biotechnology (Reading, Mass.), 16, 3–20.


Further reading

*


External links


Organ Transplant survival rates
from the Scientific Registry of Transplant Recipients
The Gift of a Lifetime – Online Educational Documentary
*
"Overcoming the Rejection Factor: MUSC's First Organ Transplant"
online exhibit at Waring Historical Library {{DEFAULTSORT:Organ Transplant