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Anatomy and Physiology: Final Project

organ donation

Emily Andrulat

on 8 January 2013

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Transcript of Anatomy and Physiology: Final Project

Organ Donation The current practice of Organ Donation: How does someone donate an organ or tissue?
Good news, there is no age requirement to donate an organ or tissue! There are however some diseases which would automatically exclude a person from donating. Those diseases include HIV infections, active cancer, or a systemic infection. The condition of the organs is what is most important. Oftentimes there is a better chance of a having a successful match if the organ is from someone of the same racial background. What are the protocols for living and dead tissue donations? The OPO representative searches the state's donor registry to see if the patient who has died registered to be an organ donor. If they are not registered, the OPO will ask the family of the patient if they would like to have the patient donate organs. If a patient dies (brain death) the hospital is required to call the CDT with the patient's name, age, sex, race, unit where the patient expired, and the date of death. They will then ask the medical history of the patient. Once consent has been given, the coordinator discusses the past medical history with the family to ensure that the patient is a good potential donor. What organs can be donated? There are 8 transplantable organs in the body. The heart, lungs, liver, kidneys, intestine, and pancreas. What tissues can be donated? Bones, heart valves, skin, cartilage, tendons, veins, and corneas can all be donated. What are the limiting factors of organ donation? After a family has given consent for their deceased family member to become an organ donor, the organ procurement coordinator logs onto the UNOS (United Network for Organ Sharing) computer website. The UNOS computer system is a log of people on the waiting list for organs. This system can be thought of as an online dating service, the donor's organs are matched with a person or people on the waiting list. A ranked list is generated. Factors which affect the ranking can include blood type,immune status, length of time on the list, medical urgency, tissue match and geographical distance between the donor and potential recipient. Certain factors are never considered, these include race, gender, income level, and celebrity status. Emily Andrulat Anatomy and Physiology Honors Final Project Transplantation The CDT organ procurement coordinator gets a printout of the matching list beginning with the first name. Next, the coordinator contacts the recipient(s) transplant teams. Often, the first person on the list does not get the organ because they must be in healthy enough to have surgery and be willing to be operated on immediately. Usually, there is a lab test that will help determine the compatibility of the donor's organ(s) with the recipient's body. Once all the tests have been completed successfully, the recipient's surgical team arrives at the hospital to remove the donor's organ(s). Next, the organ(s) is taken to the recipient and surgically transplanted. Medical teams are sure to respect funeral requests, the funeral arrangements are NEVER disrupted by organ donation. Tissue Donation Tissue matching is an extremely involved process which involves testing proteins called antigens. Usually the antigens are tested through a blood test. Genes can determine antigens and lab analysts look at certain genes depending on what organ is being transplanted. For a kidney transplant, six specific genes are looked at because of the antigens they express. A more successful transplant occurs when these antigens are matched. Before the transplant, a crossmatch test is performed. For this test, the liquid part of the recipient's blood with the cells of the donor. If the cells are killed, this indicates the presence of antibodies. From the result, the medical team can tell if the transplant surgery should occur or not. Donation Timeline 1818 First successful human to human blood transfusion 1878 First successful human to human bone transplant 1881 First reported use of a skin graft 1896 First attempts at bone marrow transplants 1900-1902 Blood groups A, B, AB, and O are discovered 1902-1908 Dr. Alexis Carrel develops surgical techniques for sewing arteries and veins which are used in organ transplantation and other surgical procedures today. He developed his skills by studying with some of the finest embroiderers in France, learning to use the tiny needles and thread they employed. 1905 First successful cornea transplant 1908 First successful knee transplant 1909 First recorded animal to human kidney transplant 1913 Researchers create the first artificial kidney. To keep blood from clotting, it uses anticoagulant substances taken from leeches. This machine achieves dialysis. 1936 -Russians perform the first human to human kidney transplant
- First US Blood Bank 1943 The first practical dialysis machine is developed by Dr. Willem Kolff and associates in the Netherlands. 1944 First Eye Bank in US 1949 First Bone bank 1953 Cecelia Bavolek was the first to successfully undergo open heart bypass surgery, with a machine totally supporting her heart and lung functions 1954 First successful kidney transplant 1955 The first successful transplants of a human heart valve and an artery for a femoral bypass procedure were performed. 1960 Clyde Shields becomes the first person to have dialysis 1963 First successful lung transplant mid- 1960s Tissue transplants become increasingly available 1966 first successful pancreas transplant 1967 First successful liver and heart transplants 1968 Organ donor programs established 1972 Federal law passed to pay for dialysis treatments 1974 California recognizes brain death as the legal definition of death 1980 The Nobel Prize in medicine goes Dr.Jean Dausset, Dr. George Snell, and Dr. Baruj Benacerraf for their work in deciphering the human immune system - and contributing to transplant immunology. 1981 first successful heart-lung transplant 1984 US National Transplant Network is established 1989 -First successful live liver donor transplant performed
- Tissue transplants exceed 200,000 1990 Pope John Paul II supports organ donation early- 2000s number of kidney failure patients increases 2001 number of living donors passes number of cadaveric donors. 2004 and beyond Some day, we may use organs and tissue grown from our own stem cells, while millions of dollars are invested by companies researching xenotransplantation - the use of genetically modified animals as a source for transplantable organs. For now, you can decide whether or not donating is an option for you. You can save one or more lives! "Get me the kidney, STAT!" The patient receiving the kidney is under anesthesia before the surgery. The surgeon then makes a cut in the lower belly. Next, the surgeon will place the kidney inside your belly. Usually, your kidneys are left in place. The artery and vein of the new kidney are connected to the artery and vein in your pelvis. Blood is now able to flow through the kidney and the kidney is able to filter blood just as your own kidneys did when they were healthy. The new kidney is able to produce urine. The surgeon connects the ureter (the tube that carries urine to the bladder) from the kidney to the bladder. The only reason why your own kidneys would be removed is if they were causing high blood pressure, infections, or if they are too large for your body. This surgery takes approximately 3 hours. People who have diabetes would have a pancreas transplant at the same time and that would add about 3 more hours to the surgery. Liver Transplants Triggers: Acute hepatic necrosis- the death of liver tissue
Biliary atresia- the bile ducts have developed abnormally or are absent
Metabolic disease- conditions which the chemical activity in cells that are affected by the liver
Liver cancers- tumors that have started in the liver and have not spread to other organs or tissues
Autoimmune hepatitis- chronic inflammation of the liver which can cause cell damage
Cirrhosis- scarring of the liver Procedure: An IV is inserted into your arm. More catheters are inserted in your wrist and neck to monitor blood pressure and your heart. A catheter is also inserted into your bladder to drain urine.After you are sedated, a doctor will put a tube in your lungs so your breathing can be controlled by a ventilator. The skin around the surgical site is cleaned to prevent infection. The surgeon makes two cuts, slanting incisions just under the ribs on both sides of the abdomen. The incision will extend straight up for a short distance over the breast bone. The diseased liver is separated from other organs. The attached arteries and veins will be clamped to stop blood flow into the diseased liver. After blood supply is stopped, the diseased liver is removed.
The donor liver will be attached to the blood vessels. Blood flow to the new liver will be established and checked for bleeding at the suture lines. Next, the new liver will then be connected to the bile ducts. The incisions are closed with sutures or staples and a sterile dressing is placed on top. Survival Stats:
•91% 1 year adult liver transplant survival rate
•82% 1 year pediatric liver transplant survival rate
•84% 3 year adult liver transplant survival rate
•76% 3 year pediatric liver transplant survival rate
•Average length of stay across all transplants of 6 days. 4 days less than the national average
*Transplant survival rates through June 30, 2010 More than 16,000 people need livers.
In 2011, 6,341 liver transplants occurred in the United States (living and deceased donors) Pancreas Transplants Triggers: type 1 diabetes which is when the pancreas does not produce enough (or any) insulin. Procedure: A donated pancreas is taken from a patient who is brain dead but still on life support. Along with the pancreas, a portion of the donor's duodenum is donated. The duodenum and pancreas are transported in a cool solution that preserves the organ for up to 20 hours. The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the patient's abdomen. Blood vessels from the new pancreas are attached to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder. In general, a kidney transplant happens at the same time as the pancreas transplant in diabetic transplants. This two surgeries combined take about 6 hours. Transplant Stats: In 2011, there were 795 kidney-pancreas transplants and 287 pancreas only transplants.
Need Stats: More than 1,200 people need pancreas transplants.
Survival Stats: 1-2 people in 10 die within a year of getting a pancreas transplant Heart Transplants Procedure: On the operating table, you lie on your back and the doctors clean your chest with an antiseptic solution. A catheter is inserted into your bladder to drain urine. An incision is made over your breastbone or sternum, and the bone divided to allow access to all parts of the heart. You are connected to a heart-lung machine which circulates and oxygenates your blood during the operation. The surgeon opens the pericardium of your heart once the new heart arrives. Your heart is removed from its connections to the great arteries, leaving in place the back parts of your right and left atria. The new heart is fitted and sown to the parts of your atria that remained in your body. After the new heart is sown into place and begins to function, you are taken off of the heart-lung machine. -More than 3,000 people are in need of hearts.
-2,322 heart transplants occurred in 2011
- 85-90% of heart transplant patients are alive 1 year after their surgery, 3-year survival is almost 75% A patient might be a candidate for a heart transplant if...
-they have a history of hospitalization for heart failure
-Need for ventricular assist device or artificial heart to support circulation
-Increasing types, dosages, and complexity of medications
Over the years, living tissue donation have become increasingly popular. The first live donation was in 1954 when a man gave a kidney to his identical twin brother. A living person can donate part of their liver, part or one of their lungs, part of their pancreas, or part of their intestine. The liver will regenerate to almost its original size. Skin can be donated after certain surgeries and bone can be donated following a hip or knee replacement surgery. Blood and bone marrow can be donated and they will regenerate. Donors are emotionally, psychologically, and physically evaluated before and after donation. What is "The List"? First, a patient must be diagnosed with a condition which indicates organ or tissue failure. After being diagnosed, the patient must be evaluated by their physician in order to begin the process of getting on the list. Once the patient is determined to be a candidate for a transplant transplant team members will add him/her to the OPTN (Organ Procurement and Transplantation Network) national list. The OPTN national list is the list of all the people in the country who are in need of transplants. Approximately 10 days after the patient is added, they will receive a letter notifying them of the time and date that they were added to the list. The Future of Organ Donation and Transplants "Implantable devices, cellular transplantation, stem cell biology, and organogenesis might ultimately become future options in both the prevention and treatment of cardiac, liver, and kidney diseases. This symposium was highly innovative and exciting, and clearly is the first of many that in the future may suggest that it will be possible to replace organ function with all of the above." - David M. Briscoe, MD,of Harvard Medical School in Boston The issue that the National Institute of Health is facing is funding. The amount of money needed to further research is substantial and the funds are dwindling. Stem cell research is becoming more and more common. Researchers are exploring how to grow organs and other body tissues from stem cells. Dr. Tracy Grikscheit, a surgeon in Los Angelos, has successfully grown a human intestine and is working toward new advances in stem cell technology. The most commonly transplanted organ is the kidney followed by the liver, heart, lungs, pancreas, and intestines. The demand for organs is growing as more people are added to the list.
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