Organ Transplantation brief Dr Rushikesh Deshpande

1. ORENBURG STATE
MEDICAL UNIVERSITY
THEME : TRANSPLANTATION.
TECHNICAL CAPABILITIES
DEPARTMENT OF CLINICAL ANATOMY AND
SURGERY

2. INTRODUCTION
 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

3. TYPE OF TRANSPLANT
 Autograft
 Allograft
 Isograft
 Xenograft
 Split transplant
 Domino transplant

4. Types of Transplant :
 Autograft
 Autograft is a transplant of tissue from one to
oneself. Sometimes this is done with surplus
tissue,
or tissue that can regenerate, or tissues more
desperately needed elsewhere (examples
include skin grafts, for CABG, etc.)
sometimes this is done to the tissue and then
treat it or the person
before returning it.

5.  Allograft and allotransplantatio
 An allograft is transplant of an organ
or tissue between two genetically non
identical members of the same
species. Most human tissue and organ
transplants are allografts.

6. Isograft
 A subset of allografts 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
allografts, they are closer to autografts
in terms of the recipient's immune
response

7. Xenograft and
Xenotransplantion
 A transplant of organs or tissue from one
species to another. Xenotransplantion is
often an extremely dangerous type of
transplant. Examples include porcine
heart valves, which are quite common and
successful, a baboon-to-human heart
(failed), and piscine-primate (fish to non-
human primate) islet (i.e. pancreatic or
insular tissue), the latter's research study
directed for potential human use if
successful. See: xenotransplantation.

8. Split transplants
Sometimes, a deceased-donor organ
(specifically the liver) may be divided
between two recipients, especially an
adult and a child.

9. Domino transplants
 This operation is usually performed for cystic
fibrosis as both lungs need to be replaced
and it is a technically easier operation to
replace the heart and lungs en bloc. As the
recipient's native heart is usually healthy, this
can then itself be transplanted into someone
needing a heart transplant. That term is also
used for a special form of liver transplant, in
which the recipient suffers from familial
amyloidotic polyneuropathy in which the liver
(slowly) produces a protein that damages
other organs; their liver can be transplanted
into an older patient who is likely to die from
other causes before a problem arises.

10. Sources of organs for
transpalntation:
The current Main Sources of organs
for transpalntation are:
1-Deceased (cadaver) donor (however
the recipient has to wait till this
cadaver becomes available)
2-Living donor transplantation (has
medical, ethical, financial, and
psychosocial

11. Major organs and tissues transplanted
 Thoracic organs
 Heart (Deceased-donor only)
 Lung(Deceased-donor and Living-Donor)
 En bloc Heart/Lung (Deceased-donor and Domino transplant)
 Other organs
 Kidney (Deceased-donor and Living-Donor)
 Liver (Deceased-donor and Living-Donor)
 Pancreas (Deceased-donor only)
 (Deceased-donor only)
 Tissues, cells, fluids
 Hand (Deceased-donor only
 Cornea (Deceased-donor onlySkin graft including Face transplant (almost
always autograft)
 Penis (Deceased-donor only)
 Islets of Langerhans (Pancreas Islet Cells) (Deceased-donor and Living-Donor)
 Bone marrow/Adult stem cell (Living-Donor and Autograft)
 Blood transfusion/Blood Parts Transfusion (Living-Donor and Autograft)
 Blood vessels (Autograft and Deceased-Donor)
 Heart valve (Deceased-Donor, Living-Donor and Xenograft[Porcine/bovine])
 Bone (Deceased-Donor, Living-Donor, and Autograft)
 Skin(Deceased-Donor, Living-Donor, and Autograft)

12. Organ donation and procurement
Most organs for transplant are obtained from brainstem dead, heart
beating cadaveric donors , multiple organs are procured
• In kidney transplant live donors and arrested heart cadaveric donors are
Common
• Acceptable donor age- Kidney -2 yrs to no upper age limit
Liver – No age limit - Heart -0 to 65 yrs
Lung – 0 to 60 yrs -Pancreas-10-50yrs
• Donor organ should be free from primary disease and infection
• Organs are procured through midsternotomy (heart & lungs ) and
midline laparotomy (liver,pancreas & kidneys). Organs are perfused in
situ and after removal with –heart with cold cardioplegia solution, lungs
with University of Wisconsin UW sol. Liver with UW sol, kidneys and
pancreas with Euro- Collins sol.
• Various organs can be stored for different period after cold perfusion
-kidney 24-48hrs Liver 12-24hrs Pancreas -10-24hrs Small intestine 4-8hrs Heart 3-
6hrs Lung 3-8hrs

13. Heart Transplant
 1967-1st human heart transplant by Dr
Christiaan Barnard in Cape Town South Africa
(based on labortory work of Shumway & Lower)
 Surgical technique
• Median sternotomy- Systemic heparinisation and pt is placed on CP
Bypass, cooled to 26 C
-Aorta cross clamped and recipient heart excised
at mid atrial level
- Donor heart is removed from ice, left atrium
opened by incisions in post. wall between
orifices of pulm. Veins to make atrial cuff
- Left and then right atrial anastomoses done
and Pulm artery and Aorta anastomosed to
donor vessels. Pt rewarmed and weaned off
from CPB.

14. Dr christiaan barnard

15. Transplant Techniques
 This new technology, called an Organ
Care System, is designed to maintain
organs in a warm, functioning state
outside of the body to optimize their
health and allow continuous clinical
evaluation. Hearts beat, lungs breathe,
kidneys produce urine, livers produce
bile.
 Through the use of proprietary
technology, the Organ Care System is
designed to:
 Increase the amount of time that an
organ can be maintained outside the
body in a condition suitable for
transplantation by reducing time
dependent ischemic injury
 Provide surgeons the opportunity to
assess the function of the organ outside
the body
 Enable resuscitation of the organ and
potentially improve function after removal
from donor
 https://www.fda.gov/downloads/AdvisoryCommittees/C
ommitteesMeetingMaterials/MedicalDevices/MedicalDe
vicesAdvisoryCommittee/Gastroenterology-
UrologyDevicesPanel/UCM558324.pdf

16. organox metra
 Conventional cold preservation
involves storage of the liver at 4˚C,
using a non-physiological perfusion
solution that aims to minimise liver
degradation.
 By contrast, warm preservation
seeks to re-create an environment
that mimics the human body by
continuously perfusing at
physiological pressures and flows
with oxygen-carrying red cells at
37˚C and providing nutrition.
 The liver is therefore functional
during the preservation period,
producing bile, metabolizing glucose
and maintaining a physiological pH.
 This enables objective assessment
of organ performance prior to
transplant, extended preservation
time.

17. Outcome after transplantation
Transplant improves the quality and duration of life in
most of recipients
• Transplant outcome has improved progressivel due to
better immunotherapy,organ preservat ion,
chemoprophylaxis and technical advances
• Graft survival after kidney,heart and liver trans plant is
around 90% at 1 yr and 70-80% at 5yrs
• Results of lung and small intestine transplant are less
Impressive
• Chronic rejection is most common cause of graft
failure after all types of solid organ transplant
• Death from CV disease with functioning transplanted
organ is common

18. Rushikesh Deshpande
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