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Transplant Information

 


Transplantation is the surgical removal of an organ from someone (a donor) to another (the recipient) in order to replace a diseased or an absent organ. Tissues like bones, tendons, cornea, skin, heart valves, hairs and veins can also be transplanted.

Transplantation offers life changing and lifesaving surgery to many patients with organ failure and for these people this is the only choice.

Various organs can be transplanted are they include the heart, kidneys, liver, lungs, pancreas, intestine and thymus. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. In Nigeria, this is also the case.

Transplantation raises a number of ethical issues, including the definition of death, when and how consent should be given for an organ to be transplanted and payment for organs for transplantation. Other ethical issues include transplantation tourism and in particular, organ trafficking.

Transplantation medicine is one of the most challenging and complex areas of modern medicine. Clinically, a key area is the problem of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. It is therefore important that the best possible match is made via serotyping and rejection is drastically reduced through the use of immunosuppressant drugs.

Transplantation involves a multi-disciplinary team which includes clinicians, scientists, nurses and donor coordinators as well as the patient and their family.

There still remains a lot to be done to help increase the success of transplantation. From the scientific, ethical, legal issues to the socio-economic aspects.

Organ donation is donating a vital organ to a recipient whose own organ has failed or is failing. That organ can either come from a deceased donor or a living donor. Depending on the type of donated organ that is transplanted the outcome will be either life-saving or life enhancing. 

The first organ to be transplanted was the kidney in the 1950s; followed by heart, liver and pancreas transplantation in the 1960s; and lung and small bowel transplantation in the 1980s. 
                     
Organ donors may be living, or brain dead. Brain dead means the donor must have received an injury (either traumatic or pathological) to the part of the brain that controls heartbeat and breathing. Breathing is maintained via artificial sources, which, in turn, maintains heartbeat. Once brain death has been declared the person can be considered for organ donation.

Organ Transplants are the best possible treatment for most people with organ failure.

Who can donate?

Some organs such as a kidney, lung and segment of liver, can be donated during life. However, worldwide, most organ and tissue donations come from people who have expressed a wish during their lifetime to help others upon their death. Often they do this formally by registering their desire to donate on the Organ Donor Register or by discussing donation with their loved ones.

Types of donors

A. Organ donors

They may be living or deceased.

  1. Living donor
  2. In "living donors", the donor remains alive and donates a renewable tissue, cell, or fluid (e.g. blood, skin), or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, small bowel). This is the most common type of organ donation.

  3. Deceased donor
  4. Deceased donors are donors who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation. In view of the growing demand for organs, which exceeds supply, it is essential to initiate a deceased donor program to augment the donor pool. Living donation program alone is not sufficient to meet this need. And the promotion of this practice is consistent with “The Declaration of Istanbul on Organ Trafficking and Transplant Tourism“.

    The challenges of setting up a deceased donor program in Nigeria include but not limited to;

    1. Absence of national health bill and brain death criteria.
    2. Social,cultural ,traditional and religious beliefs.
    3. Public acceptance and trust of organs from brain dead donors.
    4. Non existence of procurement organisation,transplant coordinators,world class intensive care units.
    5. Allocation issues.
  5. Apart from brain-stem dead donors, who have formed the majority of deceased donors for the last twenty years, there is increasing use of Donation after Cardiac Death Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered.

B. Tissue donors

Tissue may be recovered from donors who are cardiac dead. That is, their breathing and heartbeat has ceased. They are referred to as cadaveric donors. In general, tissues may be recovered from donors up to 24 hours past the cessation of heartbeat. In contrast to organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked." Also, more than 60 grafts may be obtained from a single tissue donor.

The following factors make tissue transplantation more common than organ transplants:

  1. the ability to recover from a non-heart beating donor,

  2. the ability to bank tissue,

  3. and the number of grafts available from each donor

Kidneys

Kidney transplantation or Renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. In Nigeria, we presently only perform living-donor transplantation.

Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Therefore if the donor of a kidney is of the same family as the recipient, then it is living-related and living-unrelated if the reverse is true.

Donation should be altruistic and so it is preferable that the living-donor is part of the proposed recipient’s family, preferably a nuclear one.

Kidneys were the first organs to be successfully transplanted in 1954.

The Kidneys
The Kidneys


Heart

Heart transplant is an operation in which a failing, diseased heart (end-stage heart failure) is replaced with a healthier, donor heart. Heart transplant is a treatment that's usually reserved for people who have tried medications or other surgeries, but their conditions haven't improved sufficiently.

It involves taking a working heart from a recently deceased organ donor (cadaveric allograft) and implanting it into the patient. The patient's own heart is either removed or, less commonly, left in place to support the donor heart. Post-operation survival periods average 15 years.

The heart can be transplanted singularly or combined with the lungs in a heart and lung transplant. The world's first human heart transplant was performed in 1967 in Cape Town South Africa.

The Human Heart
The Human Heart


Lung

A lung transplant is surgery to remove a person's diseased lung and replace it with a healthy lung from a deceased donor.

Lung transplants are used for people who are likely to die from lung disease within 1 to 2 years. Their conditions are so severe that other treatments, such as medicines or breathing devices, no longer work.

Lungs can also be given by living donors. Two or more people are needed. Each person donates a segment (lobe) of their lung to form an entire lung for the person who is receiving it.

Lung transplants aren't very common because of the small number of donor organs available. Most people who have lung transplants are between the ages of 18 and 65. The surgery sometimes is used for children and older adults.

Some people who have severe heart disease and lung disease get a heart and lung(s). This is called a heart–lung transplant. A rare kind of lung transplant is a living donor lobar lung transplant. For this surgery, a healthy adult donates a segment, or lobe, of one lung to another person. This type of transplant usually is done in children.

The Human Lungs
The Human Lungs


Liver

Liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor.

Liver transplant is a treatment option for people who have end-stage liver failure that can't be controlled using other treatments and for some people with liver cancer. Liver failure can occur rapidly, in a matter of weeks (acute liver failure), or it can occur slowly over months and years (chronic liver failure).

It is the second most commonly transplanted major organ after the kidney. It could either be from a living or deceased donor.

The first human liver transplant was performed in 1963.

The Liver
The Liver


Pancreas

The pancreas is an organ that makes insulin and enzymes that help the body digest and use food. A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly. Almost all pancreas transplants are done to treat cases of type 1 diabetes.

Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas which would quickly cause life-threatening diabetes, the recipient could not survive without the native pancreas still in place.

The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. The pancreas can be transplanted singularly or with the right kidney dependent on the recipient's requirements.

The Pancreas
The Pancreas


Small bowel

Intestinal transplant is a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN).

In intestinal failure, the intestines can't digest food or absorb the fluids, electrolytes and nutrients essential for life. Patients must therefore receive TPN, which provides liquid nutrition through a catheter or needle inserted into a vein in the arm, groin, neck or chest. Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over time, TPN also can damage veins used to administer the nutrition via the catheter.

It is becoming a more frequent operation in the UK.

The Small Bowel
The Small Bowel


 

Which Tissues Can Be Transplanted?

  • Cornea
  • Skin
  • Veins
  • Bone

The most important reason to consider organ donation is that you can save someone's life. Organ donation can give someone in need a new heart, liver, or set of lungs, and many transplant patients go on to live long, successful lives after their transplant surgery.

You can also make a big different in someone's life by donating optical material such as corneas, passing the gift of sight on to someone in need. Organ donation is also used to harvest skin for burn victims, intestinal material for people who have experienced abdominal trauma, veins and arteries, heart valves, bone, tendons, and pancreas.

Around the world, many people are encouraged to consider organ donation to save the life of another human being. Worldwide, organ donation process most commonly occurs after the donor has died but this is the reverse in Nigeria as only living individuals donate presently.

Most major religions are supportive of organ donation, although if you are concerned, you can contact a religious authority in your area.

Who is a matching donor?

For a transplant to be successful, donor stem cells should match genetically the patient's cells as closely as possible. Matching involves typing the human leukocyte antigen (HLA) genes. The HLA antigens on the surface of white blood cells determine the genetic make-up of a person's immune system. There are at least 100 different HLA genes. We test the major HLA antigens to determine whether a donor and recipient match. The more antigens match, the better the chance that the engraftment of donated stem cells will occur. Stem cell engraftment occurs when the donated cells make their way to the marrow and begin reproducing new blood cells. 

How is a donor found?

The family and closest relatives are tested first. If there is no match, friends who want to donate will be tested.

Do individuals who have received a transplanted organ have to take medicines to treat or prevent rejection for the rest of their lives?

Yes, in general that is true. Almost all patients who have to take these medicines long term can also undergo dose reduction as the body and the amount of medicine needed to control or prevent rejection is reduced.

How frequent is the medical follow-up of a patient after transplantation?

This varies for different procedures. It may consist of routine follow-up after the few months from the time of transplantation involving monthly blood tests and checkups. This will lessen as time goes on and your transplanted organ is stable.

Are patients who have received a transplant more susceptible to other infections?

Individuals who have received a transplant need to avoid exposure to infections as their immune system is suppressed. Also, they need to report illnesses to their doctor immediately, especially fevers, and take over-the-counter medications or prescription medications only under their doctor’s direct supervision.

Can individuals have physical activity after receiving a transplant?

The timelines given to transplant patients of different organs and tissue varies. Most patients can return to a normal or near-normal existence and participate in fairly vigorous physical exercise six to 12 months after a successful transplant. As with other physical activities, sexual activity may be resumed when desired.

Can a patient's original disease that caused the need for transplantation reoccur in the new, transplanted organ?

If a patient’s disease was caused by autoimmune hepatitis, hepatitis B or C viruses, then recurrence is possible.


What side effects do patients who have had transplantation commonly experience from the medicines they take to treat or prevent rejection?

All the medications used for rejection or to prevent rejection increase a patient’s susceptibility to infections and possibly, even though this is more remote, the development of tumors. Various medicines are used, and each has its own set of effects and side effects.

Can an organ or tissues be taken after biological death has occurred? How long after death can organs and tissues be taken?

There are two basic types of donation: organ donation and tissue donation. Organs that can be donated are the heart, lungs, liver, kidneys, pancreas and small intestine. These can only be taken while the heart is still beating and after the donor is "brain dead".

What is brain death? Doesn't a person's heart have to stop for them to be dead?

Brain death is the irreversible loss of all function of the brain. It can be established by:
1. Absence of electrical activity in the brain as determined by an EEG;
2. Absence of blood flow to the brain as determined by blood flow studies; or
3. Absence of function of all parts of the brain as determined by clinical assessment (no movement, no response to stimulation, no breathing, no reflexes).

Brain death is death that results from the total, irreversible loss of all brain function. All of the brain cells die and cannot come back to life. Since the brain causes breathing, a brain dead person does not breathe spontaneously. However, if a mechanical machine called a ventilator (also called a respirator) is used to breathe for the person, the heart will still beat for a period of time after they become brain dead, and the other organs such as the kidneys and liver will continue to function normally. It is this relatively rare kind of death that makes organ donation possible.

Brain death can be caused by anoxia, drowning, respiratory diseases, drug overdose, blockage of an artery leading to the brain, heart attack, head injury (a blow to the head), intracranial aneurysm (the ballooning of a blood vessel supplying the brain can cut off blood supply or rupture), and brain tumors.

A person who is declared brain dead is legally dead.

If the person is brain dead how can the heart still be beating?

The heart is a muscle that is not absolutely dependent on signals from the brain. The heart will continue to beat for a while even though the brain is dead, as long as there is oxygen entering the body and carbon dioxide is being removed through the lungs.

What is a coma?

Coma describes unconsciousness that may occur because the brain has been injured in some way but is still alive. It can still function and may heal in such a way that the person will regain consciousness or even completely recover.

How is brain death different from a coma?

One may recover from a coma, but brain death is permanent (recovery is not possible). 

Who can donate?

Age limits for organ donation no longer exist. Organs have been used from donors in their 90's. However, the general age limit for tissue donation is 70. Organs may be donated from someone as young as a newborn.

Nearly everyone who wants to be a donor can donate at least tissues, if not organs as well. Do not assume that you are not healthy enough to donate; medical staff will do testing at the time of death to make that determination.

Who can't donate? Why can't some organs be used?

There are a few diseases and conditions that rule out donation. If you are HIV positive, you will not be able to donate organs. If you have active cancer in a particular organ, you cannot donate that organ. If cancer has spread through the body, you will not be able to donate any organs.

Will the recipient also get the thoughts and memories of the donor?

No. Thoughts and memories are stored in the brain. The other organs are not capable of transferring memory from one person to another.

Does my religion object to donation?

Organ donation is consistent with the beliefs of most religions. This includes Catholicism, Protestantism, Islam and most branches of Judaism. If you're unsure of or uncomfortable with your faith's position on donation, ask a member of your clergy.

What causes organ failure?

The most common conditions causing organ failure that requires transplantation are given below:

Kidneys Glomerular Diseases, Diabetes, and Hypertensive Nephrosclerosis
Liver Cirrhosis due to viral hepatitis, Cirrhosis due to fatty liver, Cirrhosis due to alcohol, and Cirrhosis due to autoimmune disease
Heart Coronary Artery Disease, Cardiomyopathy, and Congenital Heart Disease
Lung Idiopathic Pulmonary Fibrosis, Alpha-1 Antitrypsin Deficiency, and Emphysema/COPD
Pancreas Diabetes

How many extra years of healthy life do transplant recipients usually receive?

A successful transplant nearly always provides both an improvement in quality of life and an increase in quantity of life. For many recipients, getting a transplant means not just preventing immediate death, but having many additional years of feeling dramatically better than when they were sick.

Some transplant patients have been sick nearly all their lives, and having a transplant means that they can finally lead the active life they've never had before. For those with kidney failure, a transplant frees them from dialysis - a very time consuming treatment on which they often feel exhausted. On average, patients that have had a kidney transplant will live about twice as long as patients that are kept alive on dialysis.

Some patients do experience life-threatening sudden organ failure, especially liver failure, and face rapid death without a transplant. For these patients, the transplant is immediately life-saving.

This is not to say that transplant recipients are freed from all medical concerns. All people who receive a transplant must take immunosuppressive (rejection-preventing) and other medications daily. They must monitor themselves for signs of rejection or other health problems, and in general take good care of themselves and the transplanted organ. But this is a small price to pay for the extra years of healthy life that they gain.

I'm too old to donate. Nobody would want my organs.

There's no defined cutoff age for donating organs. Organs have been successfully transplanted from donors in their 70s and 80s. The decision to use your organs is based on strict medical criteria, not age. Don't disqualify yourself prematurely. Let the doctors decide at your time of death whether your organs and tissues are suitable for transplantation.

I'm not in the best of health. Nobody would want my organs or tissues.

Very few medical conditions automatically disqualify you from donating organs. The decision to use an organ is based on strict medical criteria. It may turn out that certain organs are not suitable for transplantation, but other organs and tissues may be fine. Don't disqualify yourself prematurely. Only medical professionals at the time of your death can determine whether your organs are suitable for transplantation.

What is the success rate of transplantation?

Excellent. For example, liver and kidney recipients enjoy survival rates over 85 percent.

Is it legal to sell my own kidney?

It is illegal to buy and/or sell organs in Nigeria.

Can an organ or tissues be taken after biological death has occurred? How long after death can organs and tissues be taken?

There are two basic types of donation: organ donation and tissue donation. Organs that can be donated are the heart, lungs, liver, kidneys, pancreas and small intestine. These can only be taken while the heart is still beating and after the donor is "brain dead".

Is organ transplantation expensive?

The vast majority of transplant surgeries in Nigeria are for kidneys, and kidney transplantation actually saves money. Kidney dialysis costs up to N4, 500,000 per year. On the other hand, a successful kidney transplant costs approximately N4, 000,000 for the surgery and N1, 800,000 per year for the follow-up cost of the immunosuppressants.

 

Our Vision


We will facilitate development of the science of Transplantation and build capacity so as to ensure that the service is accessible to the large pool of patients in need.

Our Mission

The Transplant Association Nigeria will provide leadership and guidelines on ethical practice of transplantation, facilitate development of clinical care and promote education and research.

Our Objectives

Our vision is supported by the following objectives:

* Provision of Education, Training and research in transplantation science.
* Facilitation of the enactment of the Transplant Act/Bill.
* Development of Cadaveric (deceased) donor’ organ donation.