Transplant, transplantation, organ transplant, organ replacement

During a transplant, an organ, cells or tissue are removed and placed in another part of the body or in another person’s body, where they are expected to continue functioning as normal to improve the recipient's quality of life or keep them aliv

Medical professionals

1 May 2021 | 5 Min. Reading Time

Overview

Basic problems relating to organ transplants

Retaining the function of the transplanted organ
Preventing rejection
Combating infections
Ethics of organ donations and transplants
- Waiting list, prioritisation
- Lack of organs

General legal framework: Transplantation Act of 1 July 2007

Types of organ donation

Autotransplantation: donor and recipient are identical
- Skin (most often)
- Hair
- Bone, cartilage (for defects)
- Blood vessels
- Tendons (hand and foot surgery)
- Nerves
- Autologous blood donation (i.e. for own use)
Allotransplantation: donor and recipient are two different persons
- Kidneys
- Liver
- Heart, heart valves
- Bone marrow/stem cells
- Lungs
- Pancreas, islet cells
- Small intestine
- Cornea of the eye
Xenotransplantation: a transplant of organs or tissue from one species to another
- Biological heart valve replacement

Information about allotransplantation

Donor has died
- Most common form of allotransplantation
- Consent during lifetime or from direct relatives is required
- After brain death or cardiovascular arrest
- Confirmation of death according to specific guidelines by two independent specialists
Donor is alive
- E.g. a kidney or part of the liver
Tissue compatibility must be ensured
- Tissue typing before surgery
Risk: rejection of the organ after the transplant
- Immune reaction to the new organ
- Immune system identifies the organ as a foreign body
- Rejection and destruction of the organ
- Consequence: medication to suppress the immune system is needed
Consequences of immunosuppression
- Higher susceptibility to infectious diseases
- Higher rate of cancer
- Objective: balancing the risk of rejection and the risk of infection
Criteria that exclude a transplant
- Tissue doesn’t match
- Very advanced age
- Advanced cancer
- Organ failure in patients with a severe lung or heart disease
- Dementia
- Severe infections (e.g. active tuberculosis or hepatitis B)

Causes and treatment

Cause

Objective of an organ transplant
- Improvement of quality of life
- Lengthening of life
Indications for an organ transplant
- Hereditary or acquired disease in the final stage
- Other treatment options unsuccessful or unpromising
- Noticeably diminished quality of life
Clinical pictures (list is not exhaustive)
- Kidneys (severe renal insufficiency)
- Liver (liver cirrhosis, liver cancer, liver failure)
- Heart (cardiac insufficiency)
- Bone marrow/stem cells (leukaemia, lymphoma)
- Lungs (e.g. CF, COPD, fibrosis)
- Skin (burns, ulcer)
- Pancreas, islet cells (diabetes)

Examination

A variety of examinations are required depending on the organ and clinical picture
Specific investigations and preparatory measures
- Ensure biological compatibility (is the organ a 'good match'?)

Therapy

Organ transplant
Immunosuppression (suppression of the immune system)
Careful rehabilitation
Regular follow-up checks

What can I do myself?

Take your own decision
- Attitude to organ donation
- Attitude to organ reception
Record decision (YES, NO, depending on the organ)
- National Organ Donor Register
- Organ donor card (on your smartphone or in your wallet)
- Advance healthcare directive
- Inform relatives/trusted persons
Advantages
- Easing of relatives’ burden
- Easing of medical staff’s responsibility
- Decision can be changed at any time