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Medicine has a powerful force, which is transplantation, that is, the transplantation of organs in whole or in part. They give you a chance for a long, dream-like life. A transplant operation is a complicated endeavor that usually requires the involvement of at least two highly qualified teams of surgeons.

When Christian Barnard firstheart transplanthalf a century ago, the whole world held its breath. Although it was said that it was just an experiment, he gave people with heart disease hope. Todayheart transplantation is a recognized life-saving method. Kidneys, lungs and liver are also successfully transplanted.

Transplant: necessary requirements

Each transplant is used to save the lives of people with extreme (end-stage) organ failure. The waiting time for a transplant depends, among other things, on blood type, age, weight (a large man cannot have a small woman's heart transplanted because it will quickly fail), a place on the waiting list. In the case of bone marrow, complete immunological compatibility is also necessary, i.e. the donor and recipient must be genetically identical. In the case of organs, it is important that the donor and recipient are as similar as possible in terms of tissue. The more they differ, the greater the risk that the body will reject the transplant. Unfortunately, perfect matching of the donor and recipient is usually very difficult. This is why some people may get an organ after a few months, others never.

Important

In 2004, 182 livers were collected from the corpse. 181 were transplanted in Poland, one - due to the lack of a suitable recipient - was transferred to the Eurotransplan ,which found a recipient. Living people were donors in 18 cases. 106 hearts were collected for transplantation. 105 were received by recipients in the country, and one was sent to Eurotransplan. In 16 cases, kidneys and pancreas were removed for transplantation. At the hospital of the Ministry of the Interior and Administration in Warsaw, for the first time in Poland, a pancreas was transplanted in a type 1 diabetic patient who had had a kidney transplant a few months earlier. The lungs were removed 5 times. In Zabrze, simultaneous lung and heart transplantation and lung implantation were performed. Three unused organs in Poland were transferred to Eurotransplant from Vienna. The kidneys were transplanted 1067 times, of which 1045 were from the deceased and 22 fromliving people.

Transplant: long waiting list

There are around 2,000 waiting for a kidney transplant in the country people, for the heart - 500, and for the liver - 600. Bone marrow is currently being searched for about 300 patients (the data is incomplete, because the needs are not fully identified). There are 8-10 thousand waiting for the cornea. patients. In 2004, Poltransplant - the Polish Organizational and Coordination Center for Transplantation - received 696 reports on the possibility of donating organs from deceased persons. 20 percent not used, of which 10 percent. due to family protest. In total, 1,364 cadaver transplants and 40 transplants from living donors were performed.

Transplantation is a complicated endeavor

Requires the involvement of at least two highly qualified teams of surgeons. Pursuant to the law in force in Poland, one team donates an organ (regardless of whether the donor is a deceased or a living person), and the other transplant it. If doctors know that they will obtain, for example, a kidney for transplantation, they must quickly find a recipient. This is a huge logistic job. At one time, it happens that in clinics that are far from each other, surgeons start working. Some take the organ and prepare it for transport, while others prepare the patient for implantation surgery. Once the organ is removed from the body of the deceased person, final laboratory tests are performed to confirm compliance with the recipient. Then the organ, properly packed and secured in a portable refrigerator, will be transported to its destination. For transport, airplanes and sanitary helicopters are used, and the passage of cars through crowded cities is often facilitated by police convoys. Everything has to be timed because most organs can't stay out of the body for too long. The second operation begins almost at the same time. Surgeons remove the failing organ. In his place they put in working condition. They connect all arteries, veins, muscles, nerves, etc. Each vessel or nerve (and some are thinner than a hair) needs to be connected so that it retains its function, is open and properly responds to electrical stimuli. So they have to be sewn as if we were joining - eyelet into eyelet - two pieces of previously cut stocking. The operation often requires the participation of surgeons of many speci alties - neurosurgeons, cardiac surgeons, etc. It takes many hours. After its completion, it is checked in the operating room whether the transplanted organ has started work. Then the patient goes to the intensive care unit, where doctors and equipment monitor his condition. If there are no complications, he may stand up after a few days and begin postoperative rehabilitation. Then it startshis new life.

Who can get an organ for transplantation

Not everyone can get an organ for transplant. There are strictly defined criteria that a potential donor must meet. Organs are not collected from people who have been infected with bacteria, fungi or viruses (especially HIV), have had malignant tumors, generalized atherosclerosis or immune diseases, and those that have damaged individual organs. Contraindication to the collection is also the age over 70, hypertension, diabetes, alcohol abuse, and pharmacological agents that destroy organs. The organs of an accident victim may be harvested after confirmation of death. Final cardiac arrest is usually taken as the criterion of death. The criterion of cerebral death is also used. It is established on the basis of guidelines developed by many specialists. They have been in force since 1996. Approved by Polish law, it is believed that cerebral death occurs when the patient stops breathing independently, is in a coma, and when, through specialized tests, damage to the structure of the brain has been found. If there is a suspicion of cerebral death, the head of the ward must check twice, with an interval of three hours, that there are no brainstem reflexes:

  • constriction of the pupils under the influence of strong light,
  • closing the eyelids after touching the exposed eyeball with a foreign body,
  • eye movements, nystagmus after pouring a small amount of ice water into the ear,
  • muscle reactions to severe pain stimuli,
  • vomiting or coughing after insertion of a foreign body into the esophagus and larynx,
  • returning the eyeballs to the previous position after the head is suddenly turned to the sides,
  • even temporary attempts to breathe after disconnecting the ventilator.

When neither of these reflexes occur, a board of three physicians and one specialist in anesthesiology and intensive care will declare brain death. In accordance with the law in force in Poland, the obligation to continue using any therapy ceases at this point, even despite the ongoing independent work of the heart. In such a situation, the organs can be harvested.

In accordance with the law in force in Poland, the National List of Recipients (KLB) collects information about people waiting for a liver, heart, lung, kidney or kidney and pancreas transplant. The list includes people reported by dialysis centers for kidney patients and transplant centers. The list works according to the rules that define the method of reporting patients and the optimal time in which the operation should be performed (the so-calledsurgery). In accordance with international transplant law, organs removed from a cadaver may only be transplanted to persons placed on an official waiting list. Patients who receive an organ from a living donor must also be included in this list due to a possible need to perform a cadaver transplant. The list is constantly updated in order not to wait too long for the operation. The fate of the donated organs is tracked by transplant centers. This is to prevent organ trafficking. Persons who traffick cells or organs are subject to imprisonment.

Organs that can be transplanted

Organ

Age

Other requirements for the donor

Kidneys

7 days to 70 years

no chronic kidney disease

Pancreas

5-50 years

no pancreatitis, no alcohol addiction

Liver

5-50 years

hospitalization in the ICU (intensive care unit) for no more than 7 days

heart

under 50

no extensive damage to the chest, no heart disease, short stay in the ICU

Lungs

under 55

no aspiration symptoms, no smoking addiction, unidentified lung trauma, and no traces of lung surgery to be collected

Marrow

18-50 years old

good he alth, submission of a declaration to the Registry of Bone Marrow Donors, consent to undergo specialist tests determining HLA antigens

Semen

18-35 years old

a man must be generally he althy, married and have at least two he althy children, check his he alth every 3 months, and refrain from intercourse 5 days before donating sperm

Waiting for transplant

  • A RECIPIENT is a sick person who cannot be cured by administering drugs or undergoing surgery. He must consent to the transplant.
  • After giving the patient's consent, he or she is referred for a series of specialist tests - from standard morphology, through testing for the presence of viruses (HIV, hepatitis), chest X-rays, gynecological and urological tests, to nutritional status assessmentbody and talking to a psychologist. One of the most important studies is the determination of HLA antigens from a blood sample, which give knowledge about the so-called tissue compatibility, i.e. the possibility of matching organs.
  • After collecting information about the characteristics of the organ in question, the patient enters the National List of Recipients (KLB).
  • The patient waits at home for the news that there is an organ for him.
  • When he receives information that the correct organ for him has been selected, he must quickly report to the hospital.
  • Here the sick person undergoes the final examination. The slightest deviation from the norm, and even a minor infection, make transplantation impossible.
Important

What can be transplanted

  • cornea
  • heart
  • lungs
  • liver
  • pancreas
  • kidneys
  • intestines
  • bone marrow
  • dice
  • skin

Preparation of the organ for transplantation

  • DONOR is the person from whom the organ is taken .
  • After the confirmation by the independent brain death committee, the possibility of donating organs for transplant is considered.
  • The doctor checks whether the deceased still alive did not object to the removal of organs from him for transplantation. If so, the body is buried. If not, organs can be obtained.
  • Now tests are performed that mark the features of the organ and qualify it for the appropriate recipient.
  • From the clinic where the organ was harvested, information about obtaining the organ for transplant is sent to Poltransplantu. An employee of the Coordination Center checks on the National List of Recipients for which of the waiting persons it will be appropriate in terms of tissue compatibility. This is called match the donor with the recipient.
  • The organ is transported as soon as possible to the clinic, where the doctors prepare the recipient for the transplant.
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