Organ Donation and Transplantation 2024.pptx

Organ Donation and Transplantation Overview

Definition of Transplantation

  • Transplantation: Act of transferring living cells, tissues, or organs from one site to another.

    • Graft: Cells, tissues, or organs from a donor to a recipient to replace damaged or failing cells.

    • Donor Types: Can be living or deceased.

      • Deceased Donors:

        • Brain Dead Donors (DBD)

        • Non-Heart Beating Donors (NHBD)

What Can Be Transplanted?

Thoracic Organs

  • Heart: Deceased-donor only

  • Lung: Deceased-donor and living-donor

  • En bloc Heart/Lung: Deceased-donor and Domino transplant

Other Organs

  • Kidney: Deceased donor and living donor

  • Liver: Deceased donor and living donor

  • Pancreas: Deceased-donor

Tissues, Cells, Fluids

  • Hand, Cornea, Face, Penis: All deceased-donor

  • Islets of Langerhans: Deceased-donor and living-donor

  • Bone marrow/Adult stem cell: Living donor and Autograft

  • Blood transfusions: Living-donor and Autograft

  • Blood vessels, Heart valves, Bone, Skin: Various combinations of donor types

Indications for Transplant

  • Death expected within 24 months without a transplant

  • Unacceptable quality of life without a transplant

  • Potentially lethal complications from underlying illness

  • Prevention of genetic illness manifestation

  • Failed medical and surgical management attempts

History of Solid Organ Transplantation

Milestones

  • 1954: First successful kidney transplant (Joseph Murray)

  • 1963: First lung transplant (Joel Cooper)

  • 1967: First heart transplant (Christiaan Barnard)

  • 1981-1989: Advances in heart/lung, double lung, and pancreas transplants

  • 1984: National Organ Transplant Act (NOTA)

  • 1990: First successful living-related lung transplant

  • 1998: Approval of cyclosporine for transplant

Pre-Transplantation Evaluation

  1. Blood type (A, B, AB, O)

  2. Human Leukocyte Antigen (HLA) Tissue Typing

  3. Serology tests (HIV, CMV, Hepatitis)

  4. Cardiopulmonary and Cancer Screening

HLA Tissue Typing

  • HLA Type: Present on almost all cells, crucial in immune response.

  • Mismatched HLA can cause transplant rejection as the immune system attacks foreign cells.

  • Graft versus Host Disease: Risk when donor immune cells react against the recipient's body.

  • Compatibility reduces rejection and complications.

US Organizations and Systems for Organ Donation

  • OPTN: Organ Procurement and Transplant Network

  • UNOS: United Network for Organ Sharing

  • OPO: Organ Procurement Organization

  • UNet APIs: Data exchange tools between OPOs, hospitals, and histocompatibility centers.

Organ Need vs. Donors in the US (June 2023)

  • Waiting List: 31,928 patients added; total = 104,234 patients

  • Transplants Completed: 20,209, with 29% from living donors

Organs Needed in the US (2022)

  • Kidney: 88,901 needed (83.2% total)

  • Heart: 3,365 needed (3.1% total)

  • Liver: 10,625 needed (9.9% total)

  • Pancreas: 857 needed

  • Lung: 960 needed

Waiting List by Age (2023)

  • Under 5: 634

  • Age 6-10: 451

  • Age 11-17: 887

  • Age 18-34: 8,387

  • Age 35-49: 22,786

  • Age 50-64: 44,529

  • Age 65+: 26,694

Estimated U.S. Average 2020 Transplant Costs

  • Single Organ/Tissue:

    • Heart: $1,664,800

    • Kidney: $442,500

    • Liver: $878,400

  • Multiple Organ Transplants: Evaluated by median household income and associated costs

Donor Types

  • Living Donors:

    • Can donate a kidney or part of the liver; can also donate lung/part, pancreas, intestines.

    • Tissues: Skin, bone, blood.

    • Directed Donation: Specific recipient named.

    • Altruistic Donation: No specific recipient; arranged based on compatibility.

    • Paired Donation: Trade donors to achieve compatibility.

Racial Distribution in Organ Donation

  • Waiting List by Race (2022):

    • American Indian/Alaska: 0.8%

    • Asian: 8.5%

    • Hispanic/Latino: 18.7%

    • White: 50.7%

    • Black: 22.5%

Gender and Organ Donation (2022)

  • Living Organ Donors:

    • Male: 36.7%, Female: 63.3%

  • Donor Recipients:

    • Male: 62.2%, Female: 37.8%

Policy Changes (2020)

  • Liver Allocation Policy: Aimed to reduce disparities by focusing on donor proximity and patient need.

  • Proposed fairness for sicker patients, but criticisms from poorer states suggest loss of donations.

Impact of Policy Change

  • Income Level and Transplants: States with lower household incomes saw a decrease in transplants.

  • Significant decline in transplants noted from 2019 to 2021 in specific states.

Conclusion: Everything is Connected

  • Historical Context: Changes in laws (e.g., seat belt laws) affected organ donation rates.

  • Drug Overdose Impact: Increased numbers of donors from overdose deaths highlighted needs in organ transplant activity.