Introduction:
Organ
transplantation is the moving of an organ from one body to another or from a
donor site to another location on the person’s own body, to replace the
recipient’s damaged or absent organ.
There have been a
great achievement in R&D in the mid 1990s and now we are fully aware of new
methods of surgeries like robotic surgery, micro vascular surgery, laser
surgery etc. Now the technology has been
more advanced and very fast in this field of organ transplant. Those days has gone
when the patient had to wait for years together with an ailing sickness or
illness of any major organ say the hair, eye, liver, kidney, lung, pancreas, heart
etc.The major organ failure today in India is the kidney failure and today lots
of lives have been saved in this field by doing renal transplant. So let’s go
back to peep in the past and talk about the first kidney transplant and then we
will come back as to the advancement in technology of this life saving
achievement.
Kidney Transplant:
The first kidney
transplant was done in December 1954 when R&D in organ transplant was miles
away. This first kidney transplant was
done between identical twins Ronald and Richard Herrick. This was done at the
Brigham Hospital (BWH) Boston, Massachusetts.
The three doctors involved in this kidney transplant were i) the donor
transplant surgeon Dr. John Hartwell Harrison, who had served in the US Army
Medical Corps and now had made Boston, Massachusetts his home, ii) Dr. Joseph
E. Murray the recipient transplant surgeon, and iii) Dr. John P. Merrill. This was the basic foundation stone laid down
some 61 years back on which basis the present techniques of transplantation
surgery have been renovated and revised for the betterment of human lives.
Chronic Kidney Disease (CKD):
What is CKD? What are its causes? Chronic Kidney Disease also known as chronic
renal disease is a progressive loss in renal function over a period of months
or years. Our kidneys function is to filter
wastes and excess fluids from our body. When the kidney stops working, and then
the waste accumulates in the form of blood urea nitrogen and creatinine which
results in complications like high blood pressure, anemia, weak bones, poor
nutritional health and nerve damage etc. Now let us look at the causes of
CKD. CKD can be hereditary or
non-hereditary. Looking at the
hereditary aspect the polycystic kidneys is a major hereditary disease and is
gene carrier. For non-hereditary or the chronic kidney
disease, there are two main causes of
diabetes and high blood pressure which are responsible for up to two
third of the cases. Diabetes happens when your blood sugar is too high, causing
damages to many organs in the body, including Kidneys and heart, as well blood
vessels and nerves and eyes. High blood pressure, or hypertension, occurs when
the pressure of your blood against the walls of your blood vessels increases.
If uncontrolled, or poorly controlled, high blood pressure can be a leading
cause of heart attacks, strokes and chronic kidney disease or other disorders.
Early detection and treatment can often keep chronic kidney disease from
genetic worse. When kidney disease progresses, it may eventually lead to kidney
failure, which in turn requires either dialysis or a kidney transplant to
maintain a normal healthy life.
Let me take break
here the discussions on the organ transplant & make you aware of my interest in writing this
topic now; one of my friends, a medical technologist, who had worked for two
decades in the field of medicine as a paramedics, worked in routine clinical
labs, hospital biochemical labs, and blood banks. When he heard the news that his wife is a
chronic renal failure patient when she had some ultrasound tests, he immediately
resigned and came back home. At that time, she was at the initial stage of
deterioration and that will be well monitored. After ten years, she was put on renal dialysis
and in November 2009 she received her kidney and is doing well for the last six
years. Here I think it will be
worthwhile to mention here that renal transplant survival rate will be high
based on the lifestyle the patient undergoes.
Let us go back to
the main discussion, CKD. Now I will
brief you point wise facts about CKD.
1)
About 26 million American adults have CKD &
millions of others are at increased risk.
2)
Heart disease is the major cause of death for all
people with CKD.
3)
Early detection can help prevent the progression of
kidney disease to kidney failure.
4)
Glomerular filtration rate (GFR) is the best
estimate of kidney function.
5)
Hypertension causes CKD & CKD causes
hypertension.
6)
Persistent proteinuria (protein in the urine) means
CKD is present.
7)
High risk groups include those with diabetes,
hypertension & family history of kidney failure.
8)
Two simple tests can detect CKD: Blood pressure,
urine albumin & serum creatinine.
There are series
of tests to be performed on the list of transplant donor. The first being GFR (glomerular filtration
rate), it determines how well the kidneys are working. The second test is removal of fat tissue from
belly (tummy) just close to the umbilicus. Renal transplantation using donor
adipose tissue derived esenchymal Stem Cells and Hematopoietic Stem Cells are implanted
in the recipient (i.e. the patient) so as to establish a firm transplant.
Table 1. Action Plan according to CKD
Stage
|
|
Stage
|
Action Plan
|
1
|
Diagnosis and
treatment of comorbid conditions, slow progression, CVD risk reduction
|
2
|
Estimate
progression
|
3
|
Evaluate and
treat complications
|
4
|
Prepare for
renal replacement therapy (Av fistula creation)
|
5
|
Renal
replacement
|
Blood Groups:
Now let us discuss
the blood group aspect to become the donor fit for transplant. To become the donor there is need for you to
be of the same group as that of the patient.
If you are blood related say a brother, sister, father, or mother of the
patient, and having the same blood group, you can close your eyes and donate. Now let us discuss the different types of
blood groups.
There are four
types of blood groups A, B, O, and AB and along with that Rh factor (the
antigen of the Rh blood group system). So in all, total eight different
categories of blood group separately put aside for the classification as we put
the Rh factor in to two classes, the Rh factor positive one and the Rh factor
negative. Now let us see there are A+
and A-, B+ and B-, AB+ and AB-, and finally O+, and O-. For the donor transplant list always there is
heading the blood group along with Rh factor and that it is vitally important
in that the donor should match the recipient blood group and the Rh factor.
The second is the
age factor for the doctor. Generally,
doctors do not take donors above 60s, and in rare cases where the donor is
still healthy at 60 and has insisted to be considered and that this aged person
still has a good GFR.
Further if the
patient does not get a donor in his/her circle then the patient goes in to the
cadaver (corpse) list. There are a lot
of accident cases coming in the hospital and the patient is breathing his last
and if he/she agrees or says the parents agrees to donate the organ of this
patient breathing his/her last breathe, then the doctors will operate him and
remove the vital organs for the transplant.
There are say about thousands of patient waiting for their turn to come
on the cadaver list and I have personally met a few who have received kidney
from a cadaver and are doing well.
Summary
Kidney transplantation is generally known as Life
Extending procedure. Because a patient will live 10 to 15 years longer with
kidney transplant than if kept on dialysis. From the statistical data it has
also been concluded that this increase in longevity is greater for younger
patients, but even 75 years old patients with kidney transplant gain an average
of four to six more years of life. People generally have more energy, a less
restricted diet and fewer complications with a kidney transplant than if they
stay on conventional dialysis. Some studies also reveals that longer a patient
is on dialysis before the transplant, the less time the kidney will last. The
exact reason for this is still not known, but it underscores for rapid referral
to a transplant program. From the statistics by country, year & donor type,
it has been found that Mr. Robert Perry remains the longest- surviving American
kidney recipient from an unrelated donor, having received his kidney in 1974 at
the age of 23; he survived over 41 years, dying May 31, 2015.
In
addition to nationality, transplantation rates differ based on race, sex and
income, but statistical data shows that the expenses undergoing transplant are
the least in India than any other country in the word.
Further more I
wish to add that a lot of awareness is necessary as there are still many
patients waiting for a transplant.
References:
Alexander, G. C.; Sehgal, A. R. (1998). "Barriers to
Cadaveric Renal Transplantation among Blacks, Women, and the Poor". Journal
of the American Medical Association 280 (13): 1148–1152. doi:10.1001/jama.280.13.1148. PMID 977781
Informative & nicely compiled blog. Please publish one on Liver Transplants. Thanking you in advance for that.
ReplyDeleteGood summarized information on CKD. It seems much more needs to be done about Organ Donation...
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ReplyDeleteVery informative
ReplyDeleteVery knowledgeable.....
ReplyDeleteI had not realised children on the waiting list would indeed need child donors with child-sized organs. https://biolife4d.com
ReplyDelete