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Transplants give hope for recovery. Specialists predict that in just 10 years every tenth operation performed in the world will be a transplant - transplantation will help some patients to cure them completely, and others will significantly extend their lives.
The first patients to be transplantedorgansfrom deceased donors lived for several months because doctors could not cope with postoperative complications. Currently, transplanting human organs is a safe treatment. And effective. Eighty percent of patients survive after atransplant5 or more years with properly functioning organs. Some live 20 years and record holders even 40 years, leading a normal professional and family life. There are more and more women who give birth to he althy babies after kidney or heart transplantation.
Family Transplant
In Poland, the law allows the donation of a kidney or a fragment of the liver ormarrowto a relative. In the case of the liver, an organ fragment is taken from a he althy person and transplanted to a relative. This is an excellent solution for young children who find it very difficult to get an organ from the deceased.
According to Polish law, a kidney from a living donor can be transplanted to a genetically related person (siblings, parents, grandparents, cousins) or emotionally (spouses, foster parents, people living in cohabitation, friends). Organ donation is preceded by a number of specialist tests that confirm tissue compatibility and assess the general he alth of the donor, as well as an interview with a psychologist to make sure that the donor's decision is informed, voluntary and carefully considered.
Each donor is also informed about the course of the operation and possible complications. Transplantologists emphasize that the functioning and duration of a kidney transplanted from a living donor are many times better than that of a cadaver transplant. There is less risk of postoperative complications and rejection.
- Since 1996, 23,249 objections to posthumous organ removal have been received in the Central Register of Objections. 84.7 percent objections come directly from interested parties, and 15.3 percent. from legal representatives. More than half (52.6%) were referred by women. The most numerous group were people between 50 and 59 years of age, the smallest group were people up to 19 years of age. Most objectionsreported by residents of the Mazowieckie, Śląskie, Wielkopolskie and Kujawsko-Pomorskie voivodeships. Most withdrawals were filed by people aged 20-49.
- Legal solutions for transplantation in Poland are the same as in Austria, Belgium, France, Luxembourg, Spain and Portugal, and in some cantons in Switzerland, where organ donation is allowed if the deceased did not object to it during his lifetime . Finland, Denmark, the United Kingdom and Germany have a law known as the extended explicit consent model. This means that if the deceased did not express consent or objection to organ donation after death, consent is required - in the following order: husband, wife, children, siblings. A similar law applies in the USA.
Bone marrow transplant
- A rescue for leukemia patients
Bone marrow transplantation is a common method of treating blood neoplastic diseases (leukemia, lymphomas, myelomas). Annually for every 10,000 one person develops leukemia (leukemia), a cancerous disease that causes leukocytes (white blood cells) to change abnormally and multiply uncontrollably. Most people with leukemia can be cured by transplanting their bone marrow from a he althy donor.
Transplant can be performed in several ways:
autologous - the patient is implanted with his own bone marrow cleared of cancer cells,
syngeneic - marrow is collected from a twin (monozygotic),
allogeneic - marrow is collected from another person, related or not.
The source of transplantation in the case of blood diseases can also be peripheral blood cells or umbilical cord blood (derived from the placenta).
- What happens in the bone marrow
Marrow is the spongy tissue that fills the inside of large bones. Open, so-called red, is the site of the formation and growth of blood components. Every day, millions of blood cells are born here. This is what happens if the marrow is he althy. The patient produces huge amounts of immature leukocytes, leaving no room for the development of normal blood cells. Introducing cells taken from the bone marrow of another person into the patient's bloodstream (it does not pose a he alth risk to him!) Gives a chance to stop the disease. There is a high probability that the transplanted cells will resume their normal work and the hematopoietic process will proceed properly.
- Where to get he althy marrow
For the whole process to have a chance, you need to find the perfect donor. And that's the biggest problem with that. It has to be a human with the same antigen system. Among siblings, antigen compatibility is 25 percent. For othersthe sick need to look for unrelated donors. For this purpose, complex laboratory tests are performed on blood samples taken from people who want to donate bone marrow. It is marked, inter alia, HLA (Human Leukocyte Antigens) antigens, i.e. histocompatibility antigens. If you give a compatible donor, it will start fighting leukemia. If not, he will treat the body into which he has been implanted as an enemy and start a life and death war. In medical language, this is known as a graft versus host. Only perfect compatibility of the donor and recipient en titles the transplant to be performed.
- How to become a bone marrow donor
You should contact the donor bank - Poltransplant has a full list, tel. (0-22) 622 58 06 - and fill in the form, which is a declaration of will. Then our personal details will be entered into the database and supplemented with genetic information obtained after blood testing. The probability of becoming a donor is low (1: 25,000). So you can make a declaration and never donate your marrow. However, if it turns out that somewhere there is a patient with antigens very similar to ours, we will be asked to donate blood for testing again. After double checking the antigen compatibility, the transplant machine may start. The donor does not know the person to whom he is donating the marrow. Those are the principles. And he does it honorably. Pursuant to the Tissue and Organ Transplant Act, no one has the right to charge for providing bone marrow or other tissues for transplant.
- The decision must be made aware
First, the donor is thoroughly informed about the technique of bone marrow harvesting, possible results of the donation. Until then, you can still withdraw. This will not be possible when doctors start preparing the recipient for a transplant. He is given very strong drugs that destroy his own bone marrow. Withdrawal of the donor at this time means a serious threat to the life of the recipient.
- How the bone marrow is collected
A dozen or so days earlier, the donor donates blood (about 400 ml), which will be re-transfused after the procedure. This is needed so that it recovers faster. The bone marrow is collected in the operating room under general anesthesia. Doctors repeatedly puncture the bones of the iliac plate. After inserting the needle into the bone marrow, the bone marrow is collected - usually 1000-1500 ml (an adult has about 5000 ml). The amount depends on the weight of the recipient and the number of hematopoietic cells in the donor's marrow. Tests showing the content of hematopoietic cells are performed during collection. The procedure takes 45-90 minutes. Then the marrow is put into special containers containing a liquid to prevent it from clotting, and then it is pouredtransported to where the recipient is waiting.
- Is it dangerous
In principle not, but like any procedure performed under general anesthesia, it carries certain risks. You may feel sick or have a headache after anesthesia. Puncture sites can be sore, but most donors liken the pain to falling on a hard surface. The donor can leave the hospital after one day. The marrow fully regenerates after 2-3 weeks. After the procedure, you do not need to lead a sparing lifestyle, eat special nutrition or undergo checkups.
The Church allows transplants
- The Catholic Church - its position was clearly presented by Pope John Paul II during the 18th International Transplant Congress in 2000: "Every organ transplant has its source in a decision of great ethical value: the decision to selflessly donate a part of your own body with a view to about the he alth and well-being of another human being. This is the nobility of this act, which is an authentic act of love. "
- Judaism - allows organ donation when it comes to saving or improving the quality of someone's life. The donation of organs is a great merit in God's eyes. However, all medical procedures must respect the body of the deceased, and any unused parts of the organs must be buried with the donor's body.
- Islam - it is permissible to collect organs for transplantation, if the recipient's life is at risk, there is a chance to perform the operation, and the donor or his family consented to it. The Islamic Fik Assembly recognizes death as a fact if brain functions have ceased and it has been confirmed by medical equipment, and specialists have deemed this condition irreversible.
- Protestants - if the life of a sick person can be saved by taking organs from the deceased, accept it. Whoever gives consent to organ donation acts responsibly because it helps other people. A family that gives consent to such an action shows no disrespect for the deceased. Acts ethically and responsibly, because on behalf of the deceased he saves the lives of others.
- Evangelical Methodist Church - donating organs for transplant is an act of self-donation. It is an expression of love and service for the good of those in need.
- Japanese Shintoism - opposes the removal and transplantation of organs even to save another person's life.
First transplanted:
- cornea - 1906
- kidney - 1954
- marrow - 1958
- lungs - 1959
- liver - 1963
- swine heart valve - 1964
- simultaneously kidney andpancreas - 1966
- heart - 1967
- hand - 1998
- both hands simultaneously - 2000
- nerves of the hand - 2005
- face part - 2005
In the majesty of law
A new law on the collection and transplantation of cells, tissues and organs has been in force in Poland since January 1, 2006. It describes the rules for downloading these, both ex mortuo and ex vivo.
- Transplant ex mortuo is the removal of organs from a cadaver for diagnostic, therapeutic, scientific and educational purposes. This is possible because the law provides for the so-called the consent of the alleged donor, which consists in the lack of an objection expressed during the lifetime of the donor himself or his legal guardian.
In order to collect organs from a deceased person, the consent of the deceased person is not required. It is customary, however, to ask for such consent in each case. They are often refused, even though the family has no right to dispose of the remains. He only has the right to bury the body. The law specifies this privilege much more severely - "the body of the deceased does not belong to the estate". This means that the family has no right to decide what happens to the body after death, because it is the property of the hospital. The latter, on the other hand, must ensure that the body does not lose its proper appearance.
Daily practice, however, is far from the provisions of the act. If the family, even involuntarily of the deceased, does not agree to the donation of organs - the doctors withdraw from this intention. Clinical psychologists believe that this is the only solution in this situation. Forcible organ harvesting could do enormous damage to the family's psyche as well as undermine their trust in doctors and hospitals. - Ex vivo transplant is the collection of cells, tissues and organs from living donors (kidneys, parts of the liver, parts of the lung and bone marrow). A kidney from a living donor is harvested when the recipient is to be a donor's relative or someone emotionally connected with him. In the case of bone marrow or other regenerating tissue (blood), they can also be collected for a foreign recipient.
For the collection of cells, tissues or organs from a living donor or from the corpse of a human being, it is not allowed to demand payment or other material benefits. In the case of bone marrow transplantation, you can only count on reimbursement of costs (e.g. hotel, transport).
Leave a will
While many of us express a desire to share our organs, practice contradicts such assurances. In the face of the final test, we forget about previous declarations. Some people directly admit they fear that they or their loved ones will not receive the grace of a resurrection. Others still recognize that organ removal is a profanation of the body. So if we want our organs to save the life or he alth of otherspeople, let's be clear about it to our relatives and family. Thanks to this, after our death, they will not have to make difficult decisions. They will only have to respect our will. Consent or objection to the donation of our organs after death may be oral or written. An oral statement should be made in the presence of two witnesses, e.g. after being admitted to a hospital.
The objection may be submitted in the Poltransplancie in the Central Register of Objections. If you agree, you can contact the Association "Life After Transplant" (see box). We will receive a free form of the declaration, which must be completed and returned. The law also honors other written expressions of will that are good to carry with you. Just write: “My will is that in the event of sudden death, my tissues and organs are donated for transplant, saving the lives of others. I would like to inform you that I informed my family and loved ones about this decision, who should respect it at a critical moment ”. Such a will should be signed by a witness who will provide his address and personal details. The declaration must also contain our personal details (name, surname, date of birth, PESEL number and home address).
Hope doesn't die
Successful implantation of foreign nerves, muscles, or recently performed partial face transplants raise new hopes in us. We want to believe that soon, by using the properties of stem cells, we will grow replacement organs or regenerate biologically damaged ones. Perhaps we will also acquire the ability to manufacture spare parts that will perform as well as currently popular prostheses of hip joints, blood vessels, heart valves or bones. Before this happens, however, transplantation is the most perfect method to save the lives of patients with a "sentence".
I agree, but …
90 percent of Poles declare their willingness to donate organs for transplant, yet still too few are performed. In terms of the number of transplants carried out, we are at the bottom end in Europe. Transplants not only save lives, but can also improve its quality, as evidenced by successful hand and hand transplants or a recent transplant of a part of the face in France. We are happy when science and medicine make such progress, because hope is born to save our own he alth.
So why our moral concerns, and even more so, our opposition to organ harvesting from deceased people? There is not one answer here. Often the decisive factor is the lack of knowledge about the surgeries themselves and the possibilities they give patients. Some people also have a misconception about life after a transplant. Consider the man whohe will get a woman's heart, he will no longer be one, his character and even gender will change.
Others fear being bullied by the donor family to get some kind of compensation… These are unfounded concerns. Hospitals strictly protect the anonymity of donors. All they can find out is, "You have the heart of a 30-year-old woman." Nobody gives the addresses or other data allowing the identification of the donor.
Many of us wonder what are the benefits of such costly operations. He althy life for people who can work and continue their education after surgery. After transplantation, the kidneys also free up places at dialysis stations for other patients. It is also important that transplantation of, for example, a kidney requires less money than continuous dialysis.
Poltransplant, 02-005 Warsaw, ul. Lindleya 4 tel. 0-22 622 88 78, www.poltransplant.org.pl
"Life after transplant" Association, www.przeszczep.pl
"Zdrowie" monthly