Abdominal surgery and organ and tissue transplantation. Where do organs come from?
Organ transplantation (transplantation) is the transplantation of body parts or organs taken from one person (donor) to another (recipient). Sometimes a so-called autotransplantation is performed, in which a person’s own tissues or organs are transplanted from one place to another. Very often, a person’s own tendons, ligaments and skin are transplanted.
When performing autotransplantation operations, when the donor and recipient are the same person, the danger of a rejection reaction rarely arises. In other cases there may be big problems, since the human immune system reacts very strongly to any foreign tissue. Therefore, the organ often dies after transplantation. Finding a suitable donor or recipient for an existing organ is extremely difficult; it is not easy to find a donor of the same type for a recipient, and vice versa. The fact is that it is important to ensure maximum matching of the factors of the immune systems of the donor and recipient. This condition is met 100% when homozygous (developed from one egg) organs or tissues are transplanted from one twin to another. Natural rejection reactions that occur in the human body after transplantation are suppressed by medications. A patient who has had an organ transplanted is under medical supervision throughout his life.
The need for such operations arises when an organ or part of the body loses the ability to perform its functions. The reason for this may be congenital anomaly, illness or serious injury, poisoning (liver transplant). Fire victims often have their own intact skin grafted onto burned areas of their bodies.
How is an organ transplant performed?
The main condition for organ or tissue transplantation is the stable condition of the recipient before the operation. In addition, the transplanted organs must be intact, healthy and functioning normally. The operation of the donor and recipient follows the same procedure. At first the right organ separated by cutting all the blood vessels feeding it. To completely remove an organ, it is necessary to cut all the nerves that support its activity. Everything is done very quickly, since from the moment the organ is separated from the blood vessels, destructive processes begin in it.
True, cooling the organ can significantly slow down these processes. Before the replacement operation itself, the organ taken from the donor is brought to the required temperature. It is then attached to the recipient's blood vessels and nerves. The transplanted kidney is connected to the ureter, the liver to the bile ducts, and the lungs to the trachea. Before completing the operation, doctors check whether the transplanted organ is functioning.
Before each operation, the immune system data of the donor and recipient are very carefully compared. However, despite the full compliance of these data and being performed flawlessly, according to the surgeon, the operation is not always a guarantee that the transplanted organ will take root. Even in this case, a rejection reaction is possible.
Possible complications
Most dangerous complications occur when the transplanted organ never begins to function. When neither medications, nor electric irritation, nor any other methods help, the transplanted organ is removed.
A patient who has received a foreign organ transplant must take anti-rejection medications for the rest of his life. Due to the fact that these drugs also suppress part of the functions of the immune system, such patients show less resistance to various infectious diseases.
What organs can be transplanted?
Theoretically, any organ can be transplanted. But in reality, the capabilities of doctors are limited. Today, transplantation operations of only some organs are feasible.
Kidneys
Patients whose kidneys are severely damaged or do not function at all often wait several years for a treatment that is suitable for them. donor kidney. The more similar HLA systems(protective cell structures) of the donor and recipient, the higher the likelihood that the kidney replacement surgery will be successful and it will take root.
Since the 60s of the 20th century, the technique of transplantation operations and postoperative drug treatment are constantly being improved. After the first critical years, more than half of all transplanted kidneys continue to function. By the way, most often a patient receives only one donor kidney. The fact is that one kidney is enough for the body.
Heart
Heart transplant operations are among the most difficult. But often their outcome is more successful than with kidney transplantation. 7 out of 10 patients who have had a heart transplant remain functional! Heart transplantation is indicated only for those patients whose heart is unable to perform its functions even at rest, for example, with cardiomyopathies (this congenital diseases, in which changes in the heart muscle progress, caused, for example, by the accumulation of defective metabolic products in the muscle fibers). The heart is a very sensitive organ. Seized from chest The donor heart can be stored for a maximum of 4-6 hours. Therefore, often, if a suitable recipient is available, complex and expensive operations are performed to urgently transport the heart (usually it is delivered by plane or helicopter).
IN recent years Increasingly, complex simultaneous heart and lung transplant operations are being performed, since anatomically these organs are strongly interconnected.
Pancreas
Few operations have been performed to replace this gland. Sometimes they are quite successful. More often, not the entire gland is transplanted, but some part of it.
Bone marrow transplant
The transplant operation itself bone marrow is not complicated: a syringe is filled with bone marrow cells from the donor and they are injected intravenously into the recipient. Usually, the donor does not experience any complications as a result of taking his bone marrow, since the lack of bone marrow is quickly replenished. However, sometimes it happens that the donor’s bone marrow cells “attack” the recipient’s body.
Liver
Due to the fact that the functions of the liver cannot be replaced by any devices or medications, it is extremely important to transplant it to the patient in a timely manner. Livers are transplanted in cases of severe, life-threatening poisoning. Although the liver is very complex organ, often after successful operation After its transplantation, patients retain their working capacity and the ability to live without any special restrictions.
Skin graft
Often a person has their own skin transplanted (autotransplantation), but when the skin of another person is transplanted, the probability of a successful outcome is high.
Operations are performed for both complete skin replacement and individual sections of it (the latter is based on the replacement of only upper layers skin, which contributes, if there are no complications, fast healing skin, maintaining its sensitivity).
Lungs
Lung transplant surgery has a low success rate, and most lung transplant patients only live a few days or weeks.
In addition, the operation is performed simultaneously in two adjacent operating rooms, since the lungs removed from the donor’s body require immediate transplantation.
HLA system
Which substances the immune system perceives as foreign and which ones it “attacks” depends on the surface of the lymphocytes (one of the types of white blood cells - leukocytes). The HLA system can be accurately examined in the laboratory and described. The established properties of the HLA system of donors and possible recipients before surgery can be compared. The more similarities there are between them, the higher the likelihood of a successful outcome of the operation.
Many diseases threaten not only the full functioning of an individual, but also his life in general. Illnesses quite often make it impossible to continue normal functioning organs and systems. In some cases, the normal well-being of such patients can be maintained with the help of diet, medication, etc. But sometimes the only way to save an organ or the life of a patient - to perform a transplant. The topic of our conversation today will be human organ transplantation; in addition, we will discuss the removal of organs for transplantation in a little more detail.
Why and who needs a transplant?
By replacing a diseased organ, you can increase life expectancy and improve general health many patients with renal, cardiac or liver failure. Although patients with kidney problems can be treated with dialysis, a transplant is the best option. Failure of the liver, heart or lungs can only be treated by transplantation. Modern doctors also transplant some other organs, for example, the pancreas, small intestine or even several organs at once.
From the point of view of the law, organ transplantation is a means of saving lives, as well as restoring the health of patients. The conditions and procedure for this method of treatment are determined by law - the Law on Transplantation, as well as the Law on the Protection of Citizens' Health.
To date, the list of organs suitable for transplantation has been approved by the Ministry of Health and Social Development of Russia together with the Russian Academy of Medical Sciences. It includes organs such as the heart, lung, kidney, liver, bone marrow, etc.
Removal of organs for transplantation
According to the law, organs and tissues for transplantation can be removed from both living patients and corpses. Therefore, today doctors distinguish two types of transplantation.
Removal of organs and tissues from a living donor
Such removal is usually practiced only if doctors cannot find another method of therapy comparable in effectiveness to transplantation, and if they do not have organs and tissues from a corpse suitable for transplantation.
Only legally capable persons over eighteen years of age can be donors for transplantation. They need mandatory medical examination. If a donor is diagnosed with an illness that is dangerous to life and health, the donor cannot be removed. In addition, transplantation is not possible from persons who are dependent on the recipient (official, etc.).
The law provides that the removal of organs from a living donor can only be carried out if medical commission will show that such an intervention will not greatly harm his health. The donor is provided free treatment, if it is necessary due to the operation performed. The most popular type of such transplantation is, of course, .
Consent to organ removal is expressed by the donor himself: in writing with the certification of a doctor or notary, or orally in front of witnesses. The same methods are suitable for expressing consent or disagreement to the removal of one’s organs after death for transplantation to other people. This information is entered into medical documentation.
Removal of organs from a deceased person
This manipulation can be carried out only after it has been determined complete death– death of the entire brain. The permission for such a seizure is signed by the head physician of the hospital. Doctors do not have the right to remove organs if the deceased himself, his relatives or legal representatives do not agree to this.
If an adult did not express his consent or disagreement during his lifetime to the removal of tissues or organs for transplantation, then after death his spouse can express his will, and in their absence, other close relatives. If the death of a minor or incompetent person occurs, tissues or organs can be removed after the consent of one of the parents.
Removal of organs for transplantation without the consent of relatives
Not so long ago - in March 2016, the Constitutional Court of Russia recognized the legality of the removal of tissue from corpses for subsequent transplantation and the removal of organs without the consent of relatives, or rather, without notification. If the relatives of the deceased are against such extraction, they themselves must inform the medical institution about this. Otherwise, organs and tissues may be removed without obtaining their consent. However, the Constitutional Court reminded that if there is information about the negative attitude of the deceased or his relatives to organ transplantation, this procedure cannot be carried out.
It is worth emphasizing that at the legislative level the illegality of buying and selling donor organs is indicated. Such attempts are subject to criminal liability and punishment of up to ten years in prison. Any violence or threat of violence to consent to organ removal is grounds for criminal prosecution.
Organ transplantation can save the lives of a huge number of patients. Therefore, information about organ donation is now very relevant.
Traditional treatment
Means traditional medicine are widely used to treat and prevent diseases that may require organ transplantation. Among them is leukemia, which requires a bone marrow cell transplant.
A series can be used to improve the well-being of patients with this diagnosis. Brew twenty grams of crushed dry leaves with a glass of boiling water, strain after three hours of infusion. Drink a tablespoon of infusion three or four times a day.
Healers also advise patients with leukemia to take a decoction of birch buds or leaves. Brew a couple of tablespoons of crushed raw materials with half a liter of boiling water and cook over low heat for fifteen to twenty minutes. Leave until cool, then strain. Take half a glass three times a day. Taking birch sap will also be beneficial.
If you want to learn more about liver transplantation, read this article. In it you will find information on the history of this procedure, as well as how the patient prepares for the operation and how it goes. In the fifties of the twentieth century, the first liver transplantation on animals was performed in America. The first such operation from person to person was carried out there, in the United States in the early sixties. This operation was unsuccessful. Baby who received a liver transplant lived only five hours after surgical intervention. This was followed by many such operations, which one way or another ended unsuccessfully, because longer than a year none of the patients lived.
People with the most various diseases there are more and more buds every day. Therefore, the importance of this treatment method is increasing. If you are interested in learning more about kidney transplantation, read this article. In this process, you can use either an organ from a living donor (often these are relatives of the patient, which is much preferable) or from a dead donor. When using a kidney from a deceased donor, the chance of successful engraftment increases by ten percent. Before surgical intervention The patient undergoes a lot of examinations. It is necessary to donate blood general analysis, on the level of sugar, electrolytes, creatinine, urea, protein, bilirubin, AST and ALT blood levels.
Transplantation of skin, musculocutaneous flaps, muscle-bone fragments, and specific muscles on vascular (sometimes nerve) connections is widely practiced. Of particular importance is the transplantation of phalanges from the foot to the hand, the greater omentum to the lower leg, parts of the intestine for plastic surgery of the esophagus, and so on. A special case of organ autotransplantation is kidney transplantation, which is performed for prolonged stenosis of the ureter or for extracorporeal reconstruction of the vessels of the renal hilum. Kidney transplantation is carried out both orthotopically and heterotopically (in the iliac region). IN specific situations in case of cryptorchidism, a testicle is transplanted with its implantation via microvascular anastomoses into the scrotum. A prominent type of autotransplantation is the transfusion of the patient’s own blood in case of blood loss or special exfusion of blood from the patient 2-3 days before the operation for its infusion to him at the time of the operation.
Tissue allotransplantation is usually used for transplantation of the cornea, bones (usually lyophilized), bone marrow, and quite rarely for transplantation of pancreatic b-cells for the treatment of diabetes, hepatocytes (for severe liver failure); Brain tissue transplantation is rarely used. Most frequent sight Transplantation is the transfusion of allogeneic blood and its components.
Experiments were carried out on animals. As a result of the first experiments, it was found that organs separated from the body can be brought back to life after some time. V.P. Demikhov was the first scientist who dared to suggest that transplantation is vital important organs– possible.
Is it possible to transplant a person's head, just like a heart or kidney, to save a life? Would a head on another person's body be the same person?
There is an experimental and clinical transplantation. Experimental is in demand as a preliminary stage in the practice of all biological, surgical and organizational issues of transplantation of any organs or tissues. In the experiment, absolutely all tissues and organs are transplanted, even the brain. Experimental transplantation is needed to observe immune processes in the recipient’s body after transplantation of allogeneic or xenogeneic organs and tissues into his body. It is also in great demand for the discovery of new methods of immunosuppressive treatment that create immunological tolerance for the implantation of transplanted genetically non-identical organs and tissues. Such transplantation is also of considerable importance in oncology, in particular for the analysis of specific digestible tumor strains.
In clinical transplantology widest distribution acquired autotransplantation of organs and tissues, since this practice excludes immune reaction to the donor organ. Transplants of skin, adipose tissue, fascia, cartilage, pericardium, bone tissue, nerve fibers. IN reconstructive surgery vessels, vein transplantation is often practiced, in particular large saphenous vein hips. Often, resected arteries are used for this operation - the internal iliac artery, the deep femoral artery. With the introduction of microsurgery into surgical practice, the importance of autotransplantation has grown even more.
Organ and tissue transplantation is the replacement of lost or severely damaged tissues or organs by diseases with tissues or organs extracted from another organism.
Separate autotransplantation - replacement of organs and tissues within the boundaries own body; isotransplantation - transplantation of organs and tissues extracted from organisms that are genetically identical (for example, identical twins); allotransplantation - replacement of organs and tissues between two living beings of the same species; xenotransplantation - transplantation of organs and tissues between two organisms various types. This procedure It can be orthotopic and heterotopic. Orthotopic is a replacement in which an organ or tissue is grafted onto the site of an identical removed organ or tissue. Heterotopic - in which an organ or tissue is implanted in an unnatural place. In special situations, heterotopic transplantation has an auxiliary function, for example, when the organ to be transplanted (heart, liver, pancreas) plays an auxiliary role in the life of a damaged, but still to some extent working, organ.
Transplant is a part of tissue, organ or whole organ that is used for transplantation. The organism from which organs or tissues are removed for transplantation is called a donor, and the organism into which tissues or organs are implanted is called a recipient. To identify the second transplantation of any organ (tissue), the concept of “retransplantation” is used.
Quite widely practiced in Western countries transplantation of allogeneic vital organs. For example, in the United States, about 10 thousand kidney transplants, 1500 heart transplants and 1000 liver transplants are performed every year. According to information from leading clinics in the world, these organs function normally for about 5 years in 50-60% of patients. Due to rare successful outcomes, the pancreas, lungs, and intestinal segments are not often transplanted. This is especially true for lung and intestinal transplants.
Donors for allogeneic transplants in the clinic are usually people who have died from severe traumatic brain injury or brain cancer. In all developed countries, organs for transplantation are removed when brain death is recorded. Some leading clinics in Russia have permission to register brain death and remove organs for transplantation. Relatives (mother, father, brothers, sisters) can serve as donors, usually for kidney and bone marrow transplants.
Xenotransplantation of organs and tissues is usually practiced in experimental transplantology. IN clinical activities As a rule, specially processed pork skin, bovine arteries, pork valves heart and b-cells of the pancreas. Isolated practices of transplanting vital organs to patients from great apes have not been successful.
Transplantation of organs and tissues often faces the challenge of preserving them. Today's preservation methods make it possible to store specific tissues and organs for months and even years (bones, vessels, etc.). The duration of preservation of vital organs is usually several hours (heart, liver, pancreas), sometimes several days (2-3 days maximum for a kidney).
At least there is hope for this. This hope is connected with the fact that scientists from the United States of America conducted a large-scale study of data on eighty thousand cases of kidney transplantation from living donors. Previously, it was believed that the removal of one kidney from a donor’s body greatly reduces the length of his life and contributes to the occurrence of a host of diseases. According to the latest data, this is not the case. All studied cases of organ donation for transplantation dated back to the mid-nineties of the last century. At the same time, a control group of people was created, which included nine thousand ordinary residents of the United States, approximately similar in age to the donors. Fifteen years after the operation, the condition of the kidney donors was studied.
According to comparative analysis quantity deaths There is virtually no difference between donors and people with both kidneys. These data suggest that removing one kidney does not reduce the donor's life expectancy. This situation is also encouraging because the technology of kidney transplantation has changed significantly over the years, but this has not particularly affected the study data. Doctors now have hope that people will not be afraid to give their sick relatives and friends a kidney for transplantation. Many patients die without receiving their donor kidney.
The condition of mildly severe kidney patients can be significantly alleviated with the help of special herbal dietary supplements (dietary supplements).
Organ transplantation or transplantation is medical appointment, which consists of transferring tissue or organ from one person to another, or within one organism to another place for the purpose of healing. Transplantation of human organs and tissues became possible thanks to the development of blood vessel surgery, understanding of the immunological mechanisms of the body, the discovery of the histocompatibility antigen, the introduction immunosuppressive therapy- the process of inhibiting the production of antibodies and immune cells.
Modern transplantology distinguishes the following types transplantation:
· autologous transplantation is a transplantation within one organism (i.e. one person is both a donor and a recipient). An example is the transplantation of one's own skin in case of a burn.
Isogenic transplantation is a transplantation in which the donor and recipient organisms are genetically identical (identical twins).
· allogeneic transplantation - transplantation within one species, i.e. from person to person.
xenogeneic transplantation is a transplantation from an individual of one species to an individual of another species. For example, from animal to human.
·endoprosthetics is the transplantation of non-biological materials to a person. This means that a person is transplanted with a graft made of metal or other artificial material, which performs the functions of a prosthesis in the body.
All types of transplantation are intended exclusively to save, prolong and improve the quality of human life - the living comfort of people who have undergone such therapy.
History of transplantations and their current situation.
Man has always wanted to replace damaged parts of the body or organism with healthy ones. This is evidenced by the first mention of successful transplantation, dating back to XIII century. This mention is presented in the form of a legend about the life of the holy martyrs, the doctors Cosmas and Domian, who were supposed to miraculously replace a sick leg with a healthy one, taken from a dead person. This successful procedure is immortalized in paintings found in many countries. In subsequent centuries, similar information about transplants is also found, although they do not have historical confirmation. Only in new history The treatment of some diseases included the technique of surgical transplantation of living tissue from one organism to another. The first experimental skin grafting operation was performed by the Italian surgeon Boroni in 1840. He operated on the animal.
The era of transplantation was opened in Vienna in 1902 with an attempt to transplant a dog kidney by E. Ullmann. The first attempt at a human kidney transplant (the donor was a monkey) was carried out in 1936 in Berlin. The operation was unsuccessful. The same failure ended in the attempt of the Soviet scientist Voronin to transplant a kidney from a healthy person to a sick person in the same 1936. And only in 1954, an attempt to transplant a kidney into twenty-four-year-old identical twins was successful by three American scientists from Boston, Murray, Merilov and Kharis. Two years later, the same scientists performed kidney transplants on non-identical twins. From this time on different countries kidney transplant operations began, the donors of which were healthy people or corpses. Attempts have also been made to transplant non-biological materials and preserved dead tissues into humans. In 1958, the first bone marrow transplant was performed, and in 1959, a lung transplant (the donor was a dead person).
In 1963, in cardiology center Yaconville (USA), a group of cardiac surgeons led by J.D. Hardy made the first unsuccessful attempt at a heart transplant. In the same year it was possible to transplant a liver, and in 1967 a pancreas was transplanted. The first successful heart transplant was performed by A. Kantowitz in 1967. Artificial heart was transplanted into a terminally ill man. Also in 1967, two more successful heart transplant operations were performed in Cape Town. And, despite the fact that in the first case the recipient lived only 15 days, and in the second - several years, during both operations new, previously unknown, prospects were opened scientific research aimed at saving and prolonging human life.
Nowadays, transplantation of tissues, organs and cells saves the lives of thousands of people. Today, transplantation of the heart, bone marrow, lungs, kidneys, liver, pancreas and even intestines is possible. In transplantation practice they can be used artificial organs. But there are negative aspects to such therapy: the patient cannot be completely cured due to dependence on the equipment, artificial organs can only partially replace natural organs, which ultimately leads to inadequate functioning of the body, which leads to discomfort, which can also manifest itself psychological discomfort, as a result of constant dependence on the device. That is why the ideal solution is transplantation of natural human organs.
Patients after a successful transplant of such organs are better rehabilitated and enjoy better standards of life, but sometimes they have to undergo lifelong therapy and take immunosuppressants in order to prevent the body from rejecting the transplanted organ. Immunosuppressants weaken the immune system and promote the development of cancer. Organ transplantation in the terminal stage of the disease is a reserve method of treatment, but at the same time effective, competent and financially acceptable.
The problem in our country, as in others, is the lack of donors. Most likely, this phenomenon has two reasons. The first is insufficient understanding in the medical community and society of the possibility of increasing the actual collection of tissues and organs from corpses, as well as some organs and tissues from living donors. Second, there may be poorly thought out legislative acts having huge amount shortcomings and shortcomings.
Transplantation(late lat. transplantatio, from transplanto- transplantation), tissue and organ transplantation.
Transplantation in animals and humans is the engraftment of organs or sections of individual tissues to replace defects, stimulate regeneration, and cosmetic surgeries, as well as for experimental purposes and tissue therapy. The organism from which the material for transplantation is taken is called a donor, the organism into which the transplanted material is implanted is called a recipient, or host.
Types of transplantation
Autotransplantation - transplantation of parts within one individual.
Homotransplantation - transplantation from one individual to another individual of the same species.
Heterotransplantation - a transplant in which the donor and recipient are related different types one kind.
Xenotransplantation - a transplant in which the donor and recipient are related different kinds, families and even squads.
All types of transplantation, as opposed to autotransplantation, are called allotransplantation .
Transplanted tissues and organs
In clinical transplantology greatest distribution received autotransplantation of organs and tissues, because With this type of transplantation there is no tissue incompatibility. Transplantations of skin, adipose tissue, fascia ( connective tissue muscles), cartilage, pericardium, bone fragments, nerves.
Vein transplantation, especially the great saphenous vein of the thigh, is widely used in vascular reconstructive surgery. Sometimes resected arteries are used for this purpose - the internal iliac artery, the deep femoral artery.
With implementation in clinical practice microsurgical technology, the importance of autotransplantation has increased even more. Transplantations on vascular (sometimes nerve) connections of skin, musculocutaneous flaps, muscle-bone fragments, and individual muscles have become widespread. Important We acquired transplants of toes from the foot to the hand, transplantations of the greater omentum (fold of the peritoneum) to the lower leg, and segments of intestine for esophagoplasty.
An example of organ autotransplantation is a kidney transplant, which is performed for extensive stenosis (narrowing) of the ureter or for the purpose of extracorporeal reconstruction of the vessels of the renal hilum.
A special type of autotransplantation is the transfusion of the patient’s own blood during bleeding or deliberate exfusion (removal) of blood from blood vessel patient 2-3 days before surgery for the purpose of its infusion (administration) to him during surgery.
Tissue allotransplantation is used most often for transplantation of the cornea, bones, bone marrow, and much less often for transplantation of pancreatic b-cells for the treatment of diabetes mellitus, hepatocytes (for acute liver failure). Brain tissue transplants are rarely used (in processes accompanying diseases Parkinson's). Mass transfusion of allogeneic blood (blood of brothers, sisters or parents) and its components is a mass transfusion.
Transplantation in Russia and in the world
Every year, 100 thousand organ transplants and more than 200 thousand human tissue and cell transplants are performed worldwide.
Of these, up to 26 thousand are kidney transplants, 8-10 thousand - liver, 2.7-4.5 thousand - heart, 1.5 thousand - lungs, 1 thousand - pancreas.
The United States is the leader among countries in the world in terms of the number of transplants performed: every year American doctors perform 10 thousand kidney transplants, 4 thousand liver transplants, 2 thousand heart transplants.
In Russia, 4-5 heart transplants, 5-10 liver transplants, and 500-800 kidney transplants are performed annually. This figure is hundreds of times lower than the need for these operations.
According to a study by American experts, the estimated need for the number of organ transplants per 1 million population per year is: kidney - 74.5; heart - 67.4; liver - 59.1; pancreas - 13.7; lung - 13.7; heart-lung complex - 18.5.
Transplant problems
To category medical problems problems arising during transplantation include problems of immunological selection of a donor, preparing the patient for surgery (primarily blood purification) and postoperative therapy that eliminates the consequences of organ transplantation. Incorrect selection of a donor can lead to the process of rejection of the transplanted organ immune system recipient after surgery. To prevent the rejection process from occurring, immunosuppressive drugs are used, the need for which remains in all patients until the end of life. When using these drugs, there are contraindications that can lead to the death of the patient.
Ethical and legal issues of transplantation concern the justification and unjustification of transplanting vital organs in the clinic, as well as the problems of taking organs from living people and corpses. Organ transplantation is often associated with great risk for the lives of patients, many of the relevant operations are still in the category of treatment experiments and have not entered clinical practice.
Taking organs from living people is associated with the principles of voluntariness and gratuitous donation, but nowadays compliance with these norms is called into question. On the territory of the Russian Federation, the law “On Transplantation of Human Organs and (or) Tissues” dated December 22, 1992 (with amendments dated June 20, 2000) is in force, prohibiting any form of organ trafficking, including those involving hidden form payment in the form of any compensation and rewards. A living donor can only be blood relative recipient (genetic examination is required to obtain evidence of relationship). Medical workers are not allowed to participate in a transplant operation if they suspect that the organs were the subject of a trade deal.
Taking organs and tissues from corpses is also associated with ethical and legal issues: in the USA and European countries, where trade is also prohibited human organs, the principle of “sought consent” applies, meaning that without the legally formalized consent of each person to use his organs and tissues, the doctor does not have the right to remove them. In Russia, there is a presumption of consent to the removal of organs and tissues, i.e. the law allows the taking of tissues and organs from a corpse if the deceased person or his relatives have not expressed their disagreement.
Also when discussing ethical issues organ transplantation, the interests of resuscitation and transplantation teams of the same group should be shared medical institution: the actions of the former are aimed at saving the life of one patient, and the latter - at restoring the life of another dying person.
Risk groups for transplantation
The main contraindication in preparation for transplantation is the presence of serious genetic differences between the donor and recipient. If tissues belonging to genetically different individuals differ in antigens, then organ transplantation from one such individual to another is associated with extremely high risk hyperacute graft rejection and loss.
Risk groups include cancer patients who have malignant neoplasms with a short time after radical treatment. For most tumors, at least 2 years must pass from completion of such treatment to transplantation.
Kidney transplantation is contraindicated in patients with acute, active infectious and inflammatory diseases, as well as exacerbations chronic diseases of this kind.
Patients who have undergone transplantation are also required to strictly adhere to the postoperative regimen and medical recommendations by strictly taking immunosuppressive drugs. Personality changes in chronic psychosis, drug addiction and alcoholism, which do not allow compliance with the prescribed regimen, also classify the patient as a risk group.
Requirements for donors for transplantation
The graft can be obtained from living related donors or cadaveric donors. The main criteria for selecting a transplant is the matching of blood groups (nowadays, some centers have begun to perform transplant operations without taking into account group affiliation), genes responsible for the development of immunity, as well as the approximate correspondence of the weight, age and gender of the donor and recipient. Donors must not be infected vector-borne infections(syphilis, HIV, hepatitis B and C).
Currently, against the backdrop of a worldwide shortage of human organs, requirements for donors are being revised. Thus, when transplanting kidneys, dying elderly patients who suffered from diabetes mellitus and some other types of diseases. These donors are called marginal or extended criteria donors. Most good results are achieved through organ transplantation from living donors, but most patients, especially adults, do not have young and healthy relatives who are able to donate their organ without harming their health. Posthumous organ donation is the only way to provide transplantation care to the majority of patients in need.
Illegal organ trade. "Black market"
According to the United Nations Office on Drugs and Crime, thousands of illegal organ transplants are performed around the world every year. The highest demand is for kidneys and liver. In the field of tissue transplantation, the largest number of operations is corneal transplantation.
First mention of the import of human organs into Western Europe dates back to 1987, when Guatemalan law enforcement discovered 30 children being targeted for use in the business. Subsequently, similar cases were registered in Brazil, Argentina, Mexico, Ecuador, Honduras, and Paraguay.
The first person arrested for illegal organ trafficking was in 1996 an Egyptian citizen who was buying kidneys from low-income fellow citizens for $12,000 apiece.
According to researchers, organ trafficking is particularly widespread in India. In this country, the cost of a kidney purchased from a living donor is 2.6-3.3 thousand US dollars. In some villages in Tamil Nadu, 10% of the population have sold their kidneys. Before the law prohibiting organ trafficking was passed, patients from wealthy countries came to India to undergo organ transplants sold by local residents.
According to statements by Western human rights activists, organs from executed prisoners are actively used in transplantation in the PRC. The Chinese delegation to the UN admitted that such a practice exists, but this happens “in in rare cases" and "only with the consent of the sentenced person."
In Brazil, kidney transplants are performed in 100 medical centers. There is a practice here of "compensated donation" of organs, which many surgeons consider ethically neutral.
According to Serbian media reports, the forensic commission of the UN Interim Administration in Kosovo (UNMIK) revealed the fact of organ removal from captured Serbs by Albanian militants during the Yugoslav events of 1999.
In the CIS, the most acute problem of illegal trade in human organs is in Moldova, where an entire underground kidney trade industry has been uncovered. The group was recruiting volunteers who were willing to part with a kidney for $3,000 to sell in Turkey.
One of the few countries in the world where kidney trade is legally permitted is Iran. The cost of an organ here ranges from 5 to 6 thousand US dollars.
