Transplantation – the operation of replacement of damaged body organs – is now a routine; there are several thousand such operations in the world today. Healthy organs in exchange for the sick/damaged are received by people who have agreed (or have agreed with their surviving relatives) that their organs can used after their death for medical purposes, or by live donors, usually family relatives of the person that needs transplantation. In Europe, surgeons who are about to perform the kidney transplantation, send detailed requirements for computer processing to a special computer called Eurotransplant in the Netherlands. This computer aligns the needs of individuals waiting for the operation (especially the type of tissue required) with available donor organs.
This works well in many cases. For example, the kidney must be removed 30 minutes after the death of the donor and can be stored up to 24 hours before transplantation. The doctor can use the Eurotransplant to pick out suitable recipients of this (donor’s) kidney, without losing time.
Along with modern medical methods, the operation itself is easy. However, up to now, most of this transplantations have been mainly kidney transplantations. To date, more than 30,000 such operations have been performed, while all heart, lung, and liver transplants increase this number by less than 1,000. What is the difference?
To answer that question, we have to understand that the defense mechanism of the body is dealing with a “foreign” body as if it were a microbe that infects it and tries to destroy it by the action of white blood cells and antibodies. An ideal transplant would be the one with the same tissue as the body that it replaces. However, since perfect compatibility is impossible, the body’s response to the new body must be counteracted by the use of immunosuppressive agents. Such treatment is very risky and must be applied with precision that is difficult to achieve. It is therefore impossible to predict the success of most transplants.
This rule has two exceptions. First, the transplantation of organs of identical twins does not involve the risk of organ rejection, because the identical twin tissues are perfectly compatible and do not cause a reaction to the defense system. (This, of course, refers to the kidneys and other organs that one of the twins has in pairs.) Second, the corneal calamus “receives” is easy because the cornea is not bled and therefore is not armed for rejection with white blood cells and antibodies. But generally speaking, there is a greater chance of a final failure than the success of transplantation. Of course, rejection of the transplanted heart, liver or lung can mean instant death.
Renal (kidney) transplantation is much less risky. Renal failure does not necessarily ends with death as the patient can be maintained in life by artificial kidney until another transplant is available. Similar safety measures can not be applied to other organs, so surgeons will propose transplantation only if the alternative is the early death.
Treatment with immunosuppressive agents starts immediately after the operation and continues to the end of the patient’s life. Unfortunately, such treatment reduces resistance to infections, can stimulate the growth of malignant tumors (cancers), and can also injure bones and other organs. Therefore, the amount of these agents should be calculated precisely; a small dose can lead to rejection of the transplant at all times, and a large dose can have fatal consequences.
However, despite difficulties, some recipients of transplanted kidneys live 15 years and more, and several recipients of the heart, lung, or liver live today with active life five to many years after the operation.