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Accessed September 24, MLA Citation. Download citation file: RIS Zotero. Reference Manager. Autosuggest Results. Expand All Sections. View Table Favorite Table Download. Usually, a kidney can be safely donated because the body has two kidneys and can function well with only one. Living donors can also donate a part of the liver or a lung or a pancreas.
Succinct guide to liver transplantation for medical students
Organs from living donors are usually transplanted within minutes of being removed. In the United States, being paid to donate an organ is illegal, but reimbursement for cells and tissues is allowed. Organs from deceased donors usually come from people who previously agreed to donate organs. Deceased donors can be otherwise healthy people who have been in a major accident, as well as those who died of a medical disorder that does not affect the organ being donated.
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Doctors do not take the potential for organ donation into account when deciding whether to recommend withdrawal of life support from people who are terminally ill or who are brain dead. One deceased donor can provide several people with transplants. For example, one donor could provide two corneas, a pancreas, two kidneys, two liver segments, two lungs, small intestine, and a heart. When people die, organs deteriorate quickly. Some organs last only a few hours outside the body. Other organs, if kept cold, can last a few days. One deceased donor can provide two corneas, a pancreas, two kidneys, two liver segments, small intestine, two lungs, and a heart.
In the United States, a national organization United Network for Organ Sharing matches donors and recipients for transplantation through the use of a computer database.
The database includes all people who are on a waiting list for a transplant, along with their tissue type and other information. When organs become available, that information is entered and a match is made. Organs are allocated first among 12 geographic regions, then among local organ procurement organizations. An effort is underway to adjust the number of regions and the way organs are allocated to help distribute the available organs more fairly. If no recipient in the first region is suitable, organs are reallocated to recipients in other regions.
Breakthrough Antirejection Therapies
For some organs liver or heart , the recipient is chosen based on how severe the recipient's disorder is. For other organs kidney, lung, or intestine , the recipient is chosen based on how severe the disorder is, how long the person has been on the waiting list, or both. Because transplantation is somewhat risky and donor organs are scarce, potential recipients are screened for factors that may affect the likelihood of success.
The immune system normally attacks foreign tissue, including transplants. This reaction is called rejection. Rejection is triggered when the immune system recognizes certain molecules on the surface of a cell as foreign. These cell-surface molecules are called antigens.
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For blood transfusions, rejection is relatively easily avoided because red blood cells have only three main antigens on their surface. These antigens determine the blood type and are called A, B, and Rh. Doctors test to make sure that antigens in the donor blood and the recipient blood are a complete match. For organ transplantation, however, many antigens are involved. They occur on the surface of every cell in the body. Each person has unique HLA, which determine the tissue type.
However, a perfect HLA match is extremely rare, and some people are too ill to wait for a highly compatible donor. In these cases, doctors sometimes use donor tissue that is not an exact match but that is a close match. A close HLA match between the donor and recipient reduces the likelihood and severity of rejection and improves the long-term outcome. However, because immunosuppressant therapy has become more effective, the success of transplantation is less affected by the degree of matching.
The body may have produced such antibodies in response to a blood transfusion, a previous transplant, or a pregnancy. If these antibodies are present, transplantation may not be possible because immediate, severe rejection will occur. Plasma exchange and intravenous immune globulin IVIG have been used to remove or suppress the antibodies and thus make transplantation possible when a close match is not available. IVIG is antibodies obtained from blood that is collected from people with a normal immune system. These treatments are expensive but seem promising. Donors are screened for cancer and infections, which can be transmitted during transplantation.
Doctors screen donors for cancer by thoroughly reviewing their medical history and carefully inspecting the organ in the operating room at the time of organ recovery. Organs containing cancers are obviously not used for transplantation. Whether or not to use organs from donors who previously had cancer in another organ is based on the likelihood that cancer cells are still present or have spread to the organ being transplanted. If treatment has been adequate, organ transplantation is safe, although the recipient may be given additional antibiotic treatment. Some viral infections in the donor, such as HIV infection, mean that transplantation cannot be done unless the infection can be controlled.
Other viral infections, such as CMV and EBV infections, do not prevent transplantation, but the recipient must take antiviral drugs afterward. Recipients are also screened for cancer and infections, and their general health is evaluated. Because organ transplant recipients are given immunosuppressants in high doses at the time of transplantation, recipients who have active infections or cancers cannot undergo transplantation until these conditions are controlled or cured. Taking immunosuppressants could make an infection or cancer worse. People with poor overall health, certain viral infections, or other medical problems in addition to malfunction of the organ requiring transplantation are less likely to do well with a transplant.
Psychosocial screening is done because the lifelong regimen of drugs, treatments, and follow-up visits required to keep a transplanted organ functioning is quite demanding, and not all people are willing or able to comply. In addition to nurses and doctors, psychiatrists and social workers are involved to help people and their families understand the long-term commitment and difficulties involved in accepting a transplant.
Even if tissue types are closely matched, transplanted organs, unlike transfused blood, are usually rejected unless measures are taken to prevent rejection. Rejection results from an attack by the recipient's immune system on the transplanted organ.
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Rejection can be mild and easily controlled or severe, resulting in destruction of the transplanted organ. With the use of immunosuppressants, the transplanted organ is more likely to survive. Immunosuppressants must be taken indefinitely. High doses are usually necessary only during the first few weeks after transplantation or during an episode of rejection. After that, smaller doses can usually prevent rejection called maintenance immunosuppression.
Doses of immunosuppressants may need to be reduced further if recipients develop serious infections or if the drug has troublesome side effects, but reducing the dose of the immunosuppressant increases the risk of rejection. At the first sign of rejection, doctors increase the dose of the immunosuppressant, change the type of immunosuppressant, or add an another immunosuppressant. Different types of immunosuppressants target different parts of the immune system.
Today, UPMC is one of the most experienced transplant centers in the world. But none of these landmarks would have been achieved if we had not first undertaken exacting laboratory work to show that these operations would be feasible and effective. For more information or to refer a patient, contact our hour physician referral line at We're home to some of the world's foremost transplant experts: The medical specialists and surgeons who guide people to new lives as organ recipients The nurses, clinical coordinators, and physicians who provide care and support before and after surgery The researchers who move the field forward Breakthrough Antirejection Therapies We've been performing successful organ transplants for longer than most medical centers.
Pioneering Organ Transplant Procedures UPMC experts have a distinguished history of pioneering and refining new transplant procedures, making it possible to treat even more diseases and conditions that would otherwise cut short a human life.