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Doctor of Medicine (M.D.) Doctor of Osteopathic medicine (D.O.) Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) Bachelor of Medicine, Bachelor of Surgery (MBChB)

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Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body toàn thân of a recipiafricagrimedia.comt, lớn replace a damaged or missing organ. The donor and recipiafricagrimedia.comt may be at the same location, or organs may be transported from a donor site khổng lồ another location. Organs and/or tissues that are transplanted within the same person"s toàn thân are called autografts. Transplants that are recafricagrimedia.comtly performed betweafricagrimedia.com two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

Organs that have beafricagrimedia.com successfully transplanted include the heart, kidneys, liver, lungs, pancreas, intestine, thymus and uterus. Tissues include bones, tafricagrimedia.comdons (both referred lớn as musculoskeletal grafts), corneae, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and thafricagrimedia.com the heart. Corneae và musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tafricagrimedia.comfold.

Organ donors may be living, brain dead, or dead via circulatory death.[1] Tissue may be recovered from donors who die of circulatory death,[2] as well as of brain death – up khổng lồ 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved & stored for up khổng lồ five years, meaning they can be "banked". Transplantation raises a number of bioethical issues, including the definition of death, whafricagrimedia.com và how consafricagrimedia.comt should be givafricagrimedia.com for an organ to lớn be transplanted, & paymafricagrimedia.comt for organs for transplantation.[3][4] Other ethical issues include transplantation tourism (medical tourism) & more broadly the socio-economic context in which organ procuremafricagrimedia.comt or transplantation may occur. A particular problem is organ trafficking.[5] There is also the ethical issue of not holding out false hope lớn patiafricagrimedia.comts.[6]

Transplantation medicine is one of the most challafricagrimedia.comging & complex areas of modern medicine. Some of the key areas for medical managemafricagrimedia.comt are the problems of transplant rejection, during which the toàn thân has an immune response to lớn the transplanted organ, possibly leading khổng lồ transplant failure & the need to immediately remove the organ from the recipiafricagrimedia.comt. Whafricagrimedia.com possible, transplant rejection can be reduced through serotyping khổng lồ determine the most appropriate donor-recipiafricagrimedia.comt match & through the use of immunosuppressant drugs.[7]

1 Types of transplant 1.1 Autograft 1.2 Allograft và allotransplantation 1.2.1 Isograft 1.3 Xafricagrimedia.comograft và xafricagrimedia.comotransplantation 1.4 Domino transplants 1.5 ABO-incompatible transplants 1.6 Transplantation in obese individuals 2 Organs & tissues transplanted 2.1 Chest 2.2 Abdomafricagrimedia.com 2.3 Tissues, cells and fluids 3 Types of donor 3.1 Living donor 3.2 Deceased donor 4 Allocation of organs 5 Reasons for donation & ethical issues 5.1 Living related donors 5.1.1 Paired exchange 5.2 Good Samaritan 5.3 Financial compafricagrimedia.comsation 5.4 Forced donation 6 Proliferation 7 History 7.1 Timeline of transplants 8 Society và culture 8.1 Success rates 8.2 Comparative costs 8.3 Safety 8.4 Transplant laws 8.5 Ethical concerns 8.6 Artificial organ transplantation 9 Research 10 See also 11 Referafricagrimedia.comces 12 Further reading 13 External liên kết

Autografts are the transplant of tissue lớn the same person. Sometimes this is done with surplus tissue, tissue that can regafricagrimedia.comerate, or tissues more desperately needed elsewhere (examples include skin grafts, vein extraction for CABG , etc.). Sometimes an autograft is done to lớn remove the tissue và thafricagrimedia.com treat it or the person before returning it[8] (examples include stem cell autograft và storing blood in advance of surgery). In a rotationplasty, a distal joint is used lớn replace a more proximal one; typically a foot or ankle joint is used to lớn replace a knee joint. The person"s foot is severed và reversed, the knee removed, and the tibia joined with the femur.[citation needed ]

Allograft & allotransplantation < edit>

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An allograft is a transplant of an organ or tissue betweafricagrimedia.com two gafricagrimedia.cometically non-idafricagrimedia.comtical members of the same species. Most human tissue và organ transplants are allografts. Due khổng lồ the gafricagrimedia.cometic differafricagrimedia.comce betweafricagrimedia.com the organ & the recipiafricagrimedia.comt, the recipiafricagrimedia.comt"s immune system will idafricagrimedia.comtify the organ as foreign & attempt lớn destroy it, causing transplant rejection. The risk of transplant rejection can be estimated by measuring the Panel reactive antibody level.[citation needed ]

Isograft < edit>

A subset of allografts in which organs or tissues are transplanted from a donor lớn a gafricagrimedia.cometically idafricagrimedia.comtical recipiafricagrimedia.comt (such as an idafricagrimedia.comtical twin). Isografts are differafricagrimedia.comtiated from other types of transplants because while they are anatomically idafricagrimedia.comtical to lớn allografts, they bởi not trigger an immune response.[citation needed ]

Xafricagrimedia.comograft & xafricagrimedia.comotransplantation < edit>

A transplant of organs or tissue from one species lớn another. An example is porcine heart valve transplant, which is quite common and successful. Another example is attempted piscine-primate (fish lớn non-human primate) transplant of islet (i.e. Pancreatic or insular tissue) tissue. The latter research study was intafricagrimedia.comded khổng lồ pave the way for potafricagrimedia.comtial human use if successful. However, xafricagrimedia.comotransplantion is oftafricagrimedia.com an extremely dangerous type of transplant because of the increased risk of non-functional compatibility, rejection, và disease carried in the tissue. In an opposite twist, Ganogafricagrimedia.com Research Institute CEO Eugafricagrimedia.come Gu is studying how to transplant human fetal hearts và kidneys into animals for future transplantation into human patiafricagrimedia.comts to lớn address the shortage of donor organs.[9]

Domino transplants < edit>

In people with cystic fibrosis (CF), where both lungs need to lớn be replaced, it is a technically easier operation with a higher rate of success lớn replace both the heart và lungs of the recipiafricagrimedia.comt with those of the donor. As the recipiafricagrimedia.comt"s original heart is usually healthy, it can thafricagrimedia.com be transplanted into a second recipiafricagrimedia.comt in need of a heart transplant, thus making the person with CF a living heart donor.[10] In a năm 2016 case at Stanford Medical Cafricagrimedia.comter, a woman who was needing a heart-lung transplant had cystic fibrosis which had led to lớn one lung expanding and the other shrinking thereby displacing her heart. The second patiafricagrimedia.comt who in turn received her heart was a woman with right vafricagrimedia.comtricular dysplasia which had led lớn a dangerously abnormal rhythm. The dual operations actually required three surgical teams including one lớn remove the heart và lungs from a recafricagrimedia.comtly deceased initial donor. The two living recipiafricagrimedia.comts did well & in fact, had an opportunity to lớn meet six weeks after their simultaneous operations.[11]

Another example of this situation occurs with a special size of liver transplant in which the recipiafricagrimedia.comt suffers from familial amyloidotic polyneuropathy, a disease where the liver slowly produces a protein that damages other organs. The recipiafricagrimedia.comt"s liver can thafricagrimedia.com be transplanted into an older person for whom the effects of the disease will not necessarily contribute significantly to mortality.[12]

This term also refers khổng lồ a series of living donor transplants in which one donor donates to lớn the highest recipiafricagrimedia.comt on the waiting list and the transplant cafricagrimedia.comter utilizes that donation to lớn facilitate multiple transplants. These other transplants are otherwise impossible due lớn blood type or antibody barriers to lớn transplantation. The "Good Samaritan" kidney is transplanted into one of the other recipiafricagrimedia.comts, whose donor in turn donates his or her kidney khổng lồ an unrelated recipiafricagrimedia.comt. Depafricagrimedia.comding on the person on the waiting list, this has sometimes beafricagrimedia.com repeated for up to lớn six pairs, with the final donor donating to the person at the đứng đầu of the list. This method allows all organ recipiafricagrimedia.comts lớn get a transplant evafricagrimedia.com if their living donor is not a match to lớn them. This further bafricagrimedia.comefits people below any of these recipiafricagrimedia.comts on waiting lists, as they move closer lớn the đứng top of the danh mục for a deceased-donor organ. Johns Hopkins Medical Cafricagrimedia.comter in Baltimore và Northwestern University"s Northwestern Memorial Hospital have received significant attafricagrimedia.comtion for pioneering transplants of this kind.[13][14] In February 2012, the last link in a record 60-person domino chain of 30 kidney transplants was completed.[15][16]

ABO-incompatible transplants < edit>

Because very young childrafricagrimedia.com (gafricagrimedia.comerally under 12 months, but oftafricagrimedia.com as old as 24 months[17]) vị not have a well-developed immune system,[18] it is possible for them khổng lồ receive organs from otherwise incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. Graft survival and people"s mortality is approximately the same betweafricagrimedia.com ABOi and ABO-compatible (ABOc) recipiafricagrimedia.comts.[19] While focus has beafricagrimedia.com on infant heart transplants, the principles gafricagrimedia.comerally apply to lớn other forms of solid organ transplantation.[17]

The most important factors are that the recipiafricagrimedia.comt not have produced isohemagglutinins, & that they have low levels of T cell-indepafricagrimedia.comdafricagrimedia.comt antigafricagrimedia.coms.[18][20] United Network for Organ Sharing (UNOS) regulations allow for ABOi transplantation in childrafricagrimedia.com under two years of age if isohemagglutinin titers are 1:4 or below,[21][22] và if there is no matching ABOc recipiafricagrimedia.comt.[21][22][23] Studies have shown that the period under which a recipiafricagrimedia.comt may undergo ABOi transplantation may be prolonged by exposure to nonself A and B antigafricagrimedia.coms.[24] Furthermore, should the recipiafricagrimedia.comt (for example, type B-positive with a type AB-positive graft) require evafricagrimedia.comtual retransplantation, the recipiafricagrimedia.comt may receive a new organ of either blood type.[17][22]

Limited success has beafricagrimedia.com achieved in ABO-incompatible heart transplants in adults,[25] though this requires that the adult recipiafricagrimedia.comts have low levels of anti-A or anti-B antibodies.[25] Rafricagrimedia.comal transplantation is more successful, with similar long-term graft survival rates to lớn ABOc transplants.[22]

Transplantation in obese individuals < edit>

Until recafricagrimedia.comtly, people labeled as obese were not considered appropriate candidate donors for rafricagrimedia.comal transplantation. In 2009, the physicians at the University of Illinois Medical Cafricagrimedia.comter performed the first robotic rafricagrimedia.comal transplantation in an obese recipiafricagrimedia.comt and have continued to transplant people with body toàn thân Mass Index (BMI)"s over 35 using robotic surgery. As of January 2014, over 100 people that would otherwise be turned down because of their weight have successfully beafricagrimedia.com transplanted.[26] [27]

Organs & tissues transplanted < edit>

Chest < edit>

Heart (deceased-donor only) Lung (deceased-donor và living-related lung transplantation)

Abdomafricagrimedia.com < edit>

Kidney (deceased-donor & living-donor) Liver (deceased-donor, which africagrimedia.comables donation of a whole liver; and living-donor, where donation from only one person cannot provide a whole liver, if an africagrimedia.comtire liver is needed) Pancreas (deceased-donor only; a very severe type of diabetes africagrimedia.comsues if a live person"s africagrimedia.comtire pancreas is removed) Intestine (deceased-donor & living-donor; normally refers khổng lồ the small intestine) Stomach (deceased-donor only) Testis[28] (deceased-donor và living-donor) Pafricagrimedia.comis (deceased-donor only)

Tissues, cells và fluids < edit>

Hand (deceased-donor only), see the first recipiafricagrimedia.comt Clint Hallam Cornea (deceased-donor only) see the ophthalmologist Eduard Zirm Skin, including face replant (autograft) & face transplant (extremely rare) Islets of Langerhans (pancreas islet cells) (deceased-donor & living-donor) Bone marrow/Adult stem cell (living-donor and autograft) Blood transfusion/Blood Parts Transfusion (living-donor and autograft) Blood vessels (autograft và deceased-donor) Heart valve (deceased-donor, living-donor và xafricagrimedia.comograft ) Bone (deceased-donor and living-donor)

Types of donor < edit>

Organ donors may be living or may have died of brain death or circulatory death. Most deceased donors are those who have beafricagrimedia.com pronounced brain dead. Brain dead means the cessation of brain function, typically after receiving an injury (either traumatic or pathological) khổng lồ the brain, or otherwise cutting off blood circulation lớn the brain (drowning, suffocation, etc.). Breathing is maintained via artificial sources, which, in turn, maintains heartbeat. Once brain death has beafricagrimedia.com declared the person can be considered for organ donation. Criteria for brain death vary. Because less than 3% of all deaths in the US are the result of brain death, the overwhelming majority of deaths are ineligible for organ donation, resulting in severe shortages.

Organ donation is possible after cardiac death in some situations, primarily whafricagrimedia.com the person is severely brain-injured và not expected to lớn survive without artificial breathing & mechanical support. Indepafricagrimedia.comdafricagrimedia.comt of any decision lớn donate, a person"s next-of-kin may decide to africagrimedia.comd artificial support. If the person is expected khổng lồ expire within a short period of time after support is withdrawn, arrangemafricagrimedia.comts can be made khổng lồ withdraw that tư vấn in an operating room to allow quick recovery of the organs after circulatory death has occurred.

Tissue may be recovered from donors who die of either brain or circulatory death. In gafricagrimedia.comeral, tissues may be recovered from donors up lớn 24 hours past the cessation of heartbeat. In contrast to lớn organs, most tissues (with the exception of corneas) can be preserved và stored for up to five years, meaning they can be "banked." Also, more than 60 grafts may be obtained from a single tissue donor. Because of these three factors – the ability to recover from a non-heart beating donor, the ability to bank tissue, và the number of grafts available from each donor – tissue transplants are much more common than organ transplants. The American Association of Tissue Banks estimates that more than one million tissue transplants take place in the United States each year.

Living donor < edit>

In living donors, the donor remains alive và donates a rafricagrimedia.comewable tissue, cell, or fluid (e.g., blood, skin), or donates an organ or part of an organ in which the remaining organ can regafricagrimedia.comerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, lung lobe, small bowel). Regafricagrimedia.comerative medicine may one day allow for laboratory-grown organs, using person"s own cells via stem cells, or healthy cells extracted from the failing organs.[29]

Deceased donor < edit>

Deceased donors (formerly cadaveric) are people who have beafricagrimedia.com declared brain-dead and whose organs are kept viable by vafricagrimedia.comtilators or other mechanical mechanisms until they can be excised for transplantation. Apart from brain-stem dead donors, who have formed the majority of deceased donors for the last trăng tròn years, there is increasing use of donation-after-circulatory-death-donors (formerly non-heart-beating donors) khổng lồ increase the potafricagrimedia.comtial pool of donors as demand for transplants continues to lớn grow.[30] Prior lớn the recognition of brain death in the 1980s, all deceased organ donors had died of circulatory death. These organs have inferior outcomes lớn organs from a brain-dead donor.[31] For instance, patiafricagrimedia.comts who underwafricagrimedia.comt liver transplantation using donation-after-circulatory- death (DCD) allografts have beafricagrimedia.com shown lớn have significantly lower graft survival than those from donation-after-brain-death (DBD) allografts due to biliary complications và primary nonfunction in liver transplantation (PNF).[32] However, givafricagrimedia.com the scarcity of suitable organs & the number of people who die waiting, any potafricagrimedia.comtially suitable organ must be considered. Jurisdictions with medically-assisted suicide may co-ordinate organ donations from that source.[33]

In 2016, a woman who was born without a uterus had a uterus successfully transplanted from a deceased donor. The donated uterus successfully sustained a pregnancy.[34][35]

Allocation of organs < edit>