Transplant history, reasons, process and risks

Organ transplant: A strange heart in my chest

The idea of ​​sharing people body parts to ensure their survival is old. Legend has it that the doctor Pien Ch'iao in China in the year 300 already transplanted a heart. It is a myth: With the technical possibilities of the then Chinese medicine such an operation was impossible.

It was not until 1967 that the first successful heart transplantation succeeded, and by the year 2000 more than 50,000 hearts had been transplanted. The following article shows the history of the transplant and provides information on the course of action as well as the chances and risks of such a procedure.

contents

• Organ transplant: A strange heart in my chest
• The history of the transplant
• Animal experiments with kidneys
• The first successful kidney transplant
• Liver, lungs and heart
• The first heart-lung exchange
• The transplant law
• heart transplants
• Experience report of a person affected
• Why are hearts exchanged??
• When does a heart-lung transplant take place??
• lung transplants
• Forms of organ transplantation
• What will be transplanted?
• Exchange of limbs
• Three and four transplants
• face
• penis
• skullcap
• uterus
• head transplant
• Reasons for transplants
• execution
• risks
• living donation

The history of the transplant

In Christianity, the story of the Hiligen St. Cosmas and St. Damian spread. This should have sewn the leg of a deceased black man to a white man. Very old is a magical charge of the Frankenstein motif, in which the grafted organs should transfer properties of the original owner to the new body.

Hindu mythology describes the god Ganesha, who was transplanted the head of an elephant. (Image: EdNurg / fotolia.com)

An absolutely fantastic "transplantation" knows Hinduism. Ganesha was the son of the god Shiva and his wife Parvati. The son guarded the mother's chambers so that no suitor could press her. Shiva wanted to go inside, but Ganesha barred his access. Thereupon the god became so angry that he tore off his son's head.

Only then did Shiva learn that Ganesha was his son. He regretted his action, and to undo it, he tore off the head of the nearest creature and planted it on the torso of his son. Since then he wears the head of an elephant.

Gaspare Tagliacozzi (1545-1599) reconstructed nasal tissue. He recognized the danger of rejection of alien tissue and wrote that the "singular character of the individual completely prevents us from performing this procedure on another person."

In the 17th century, surgeons successfully performed bone grafting. The Dutch Job van Meekeren described in 1668 a nobleman who had been used a graft from a dog skull. Also, to replace human skin with animal skin, doctors planned.

John Hunter, a Scottish surgeon, performed transplants in the 18th century, such as teeth and tendons. At that time there were also documented attempts to exchange thyroid tissue.

In the 19th century, doctors successfully transplanted skin, first from animal individuals to animals of other species. From 1850, the free self-skin grafting became a recognized therapy.

However, it was not until the 20th century that modern organ transplantation developed into a regular method: in 1900 Karl Landsteiner discovered blood types A, B and 0. Blood transfusions were thus possible. Even when exchanging blood, as banal as it seems to us today, it is transplantation.

Animal experiments with kidneys

In 1902 Emerich Ullmann (1861-1937) transplanted the first kidney. He put a dog animal on the neck of the same animal. The same year saw the first xenotransplantation - the kidney of a dog was planted in a goat, and the goat's organism accepted the foreign body.

Alexis Carrel and Charles Guthrie developed the sewn vascular connection. With them began the era of transplantation as an applied method of medicine: Between 1904 and 1920, the two doctors transplanted numerous organs and tissues from person to person. In 1912, Carrel was awarded the Nobel Prize for Medicine: the reason was an experiment in which he connected a dog heart to the neck vessels of another animal to prove the viability of the vascular sutures. This was also the first heart transplant.

Carrel and Guthrie realized that the metabolism slows down when the organs are artificially cooled and organs in this form can be better conserved. The two also investigated the biochemical reactions of the recipient body to grafts.

In 1906 Mathieu Jabouly (1860-1913) tried to transplant kidneys from pigs and goats. He failed. In the same year, however, succeeded the first successful transplantation of cornea by the ophthalmologist Konrad Zirm.

As early as 1906, the first successful cornea transplantation was reported by ophthalmologist Konrad Zirm. (Image: Alexandr Mitiuc / fotolia.com)

The first kidney of a deceased transplanted the Ukrainian Voronoy 1933, but it did not work.

Peter Medawar described in 1944 how the organism repels foreign tissue. This started knowledge about immunological tolerance.

The first successful kidney transplant

The first successful transplantation of a kidney resulted in 1954 Joseph Murray through Boston. The recipient lived perfectly healthy. Donor was a monozygotic twin, a tissue-identical human, and therefore there was no defense reaction.

In 1959, the first kidney transplants were performed on dizygotic twins. Despite the genetic differences, the recipients survived 20 and 26 years, respectively.

It took until the 1970s, the rejection reaction to get a grip. Today, medications that suppress the immune system allow organ transfusions in which the donor and recipient are not related.

Dr. Roy Calne tested thiopurine / azathioprine as early as 1960 to prevent a kidney transplant from being rejected. Only two years later, Azathioprine became the first immunosuppressant in therapy.

Liver, lungs and heart

1963 transplanted T. Starzl in Colorado the first liver, and dr. J. Hardy in Mississippi the first lung; Dr. K. Reemtsma transplanted the kidney of a chimpanzee into a human. A year later, Starzl exchanged a human liver for a chimpanzee liver and Hardy a human heart for a chimpanzee heart.

In 1967, Christiaan Barnard's first successful heart transplant in Cape Town was based on research by Norman Shumway and Richard Lower.

The Dutchman J.J. van Rood has shown that leukocyte antigen compliance is critical in determining whether the patient's body adopts the foreign organ, thereby significantly affecting the recipient's survival.

On this basis, he developed Eurotransplant, an international organization to exchange appropriate organs.

A medical sensation: In 1967, the South African physician Christiaan Barnard transplanted a human heart for the first time. (Image: kieferpix / fotolia.com)

The first heart-lung exchange

1968 was the first heart-lung transplantation by Prof. D. Hooley in Texas. The first law on organ donation is passed in the US in the same year: the relatives decide on a donation and willing people carry an organ donor card with them.

In 1969, brain death is defined. These include absolute unconsciousness, immobility and respiratory arrest, the complete absence of reflexes and the zero line in the EEG for at least 24 hours.

In 1976, Jean Francois Borel published an immunosuppressive drug derived from ciclosporin in a soil fungus. In 1979, the first clinical trial took place in Munich. Stanford's first patient treated with it in 1981 survived seven years thanks to cyclosporin. One year later Cyclosporin A comes into circulation with the name Sandimmun. Now the number of transplants is increasing rapidly.

In 1989, the 100,000th kidney was successfully replaced.

The transplant law

In 1997, the Transplantation Act comes into force. The criterion for death is the definitive failure of all brain functions. As in the United States, removal of organs is permitted if the deceased expressly endorses it, or if his deceased relatives deem it his will.

In 2000, 470,000 kidneys, 74,000 livers, 54,000 hearts and 10,000 lungs had been transplanted.

heart transplants

In 2015, there were 286 heart transplantations in 22 clinics in Germany - so a heart exchange is still not a frequent but regular operation.

It was a long way from the first patients who survived only a short time to a survival of years: the first human with a strange heart, Louis Washkansky, who operated on Barnard, died after 18 days.

Experience report of a person affected

Even today, the procedure is not routine. Concerned Hubert Knicker reports:

"2003 my heart let me down again. VF! Once again, the doctors brought me back to life and when I left the heart center in Bad Oeynhausen after being temporarily relocated, I was richer by a faithful companion. From now on, an implanted defibrillator put my heart back into the right rhythm whenever it stopped beating.

But even my "Defi" would not be enough at some point. This day came in 2008. My heart pumping performance was now 15 percent and the last alternative I had in the near future was an artificial heart system.
Once again, I decided to go with the operation. The organ, which stands for no other than the will of man to fight, may have been only a shadow of himself, but giving up was out of the question for me. How could I have done that to my wife, who had gone through all the ups and downs with me?

I got on well with my heart support system when a mechanical defect forced me to my last battle in May 2010. Back in the Heart Center Bad Oeynhausen it started, that almost unbearable waiting for a donor heart. Will you find a suitable organ for me? Would I even be able to survive a transplant? Again and again I asked myself these questions and secretly feared the answer to the first of them.

My lust for battle threatened to give way to the feeling of total helplessness, not least because I had to watch three of my companions die. For two, one donor heart came too late, another did not survive the transplant.

Many heart patients here in vain waiting for a transplant, because there are far too few organ donors. (Image: Alexander Raths / fotolia.com)

On July 24, 2010, the first question that tormented me was to be answered. Eurotransplant had a donor heart for me! Three months later I got the full certainty: The second question mark did not matter anymore. After a successful transplant and minor incidents around my lungs, it went home for me. "

Why are hearts exchanged??

Patients are considered candidates for heart transplantation if they are prone to advanced heart failure and all other therapies are ineffective. Every second affected person suffers from cardiomyopathy, but also congenital heart defects or heart valve malfunctions sometimes require an exchange.

When does a heart-lung transplant take place??

If the heart and lungs are both terminally ill, a complicated transplantation of both organs is recommended. This applies, for example, if a congenital heart defect leads to high blood pressure in the lungs or pulmonary fibrosis triggers heart failure.

lung transplants

Lungs are transplanted in Germany about the same frequency as hearts. In 2015, 296 patients had their lungs replaced and 399 patients were enrolled for transplantation. Most sufferers suffer from chronic obstructive pulmonary disease.

There are various lung transplants depending on the underlying disease. In cases of cystic fibrosis or bronchiectasis, the lungs have to be transmitted bilaterally; in most other lung diseases a one-sided exchange is sufficient.

At least until a few years ago this was the case with pulmonary fibrosis or pulmonary emphysema, but today a bilateral transplantation is also carried out with these causes. This improves the lung functions immensely.

However, a donor's organ can then help only one patient and not two people as before.

Cardiac lung transplants are now only needed for non-correctable heart defects with Eisenmenger reaction. If the heart fails to recover from pulmonary hypertension, it recovers in a few weeks.

Replacing a lung today follows a set pattern. First, the doctor cuts between the 8th and 9th rib. Then he removes the sick organ. Then he connects the pulmonary arteries of the donor lung with the veins of the recipient. In a bilateral transplant, the other lung is transplanted using the same method.

Even today, this often works without a heart-lung machine if the patient's second diseased lung gets enough oxygen during the transplantation of the first healthy lung. If the second lung is transmitted, it already breathes with the first healthy part.

If everything goes smoothly, the patients can already leave the intensive care unit for two days. Overall, they stay in the hospital for about two weeks. Every tenth to fifth patient experiences difficulties, and the stay in the clinic is prolonged accordingly.

Forms of organ transplantation

In allogeneic transplantation, the tissues, organs, or cells are taken from another human, and a monozygotic twin is an isogenic transplant. Since the tissue of the donor and recipient is identical, there is no need for immunosuppressants.

The autologous transplantation makes an exchange within an organism. Most common are skin and hair transplants. For example, after an accident, skin can be transferred from the shoulder to a burnt lower leg.

Xenogenic transplants refer to the exchange of organs from one species to another. Which is more common than layman would suspect. For example, transferring heart valves from pig bodies to human hearts is an often-practiced method of heart surgery.

What will be transplanted?

Today doctors transfer various cells, tissues and organs. Tissues are cell aggregates with the same functions: muscle tissue, nerve tissue or fatty tissue. An organ is a distinct part of the organism, which usually contains various cells and tissues, such as the heart, kidney, lungs or liver.

Transplantation of the pancreas is mainly considered for patients with type 1 diabetes. (Image: 7activestudio / fotolia.com)

Organ transplants include kidneys, livers, hearts, lungs, pancreas and the small intestine, tissue transplants skin, bones, cartilage, tendons, blood vessels, and cornea.

Exchange of limbs

Instead of using prostheses for amputations, surgeons sometimes go about transplanting limbs. For example, the John Hopkins Hospital in Baltimore transplanted the soldier Brendan Marrocco with both arms, which he lost by a road bomb in Afghanistan.

The rejection of the body is great in foreign arms, it is lower in the exchange of hands.

In Germany, doctors in Munich performed the first successful double transplantation of arms in 2008. In 2011, the team of Spanish surgeon Pedro Cavadas achieved the first double leg transplantation.

Three and four transplants

In Turkey, three and fourfold transplants were seemingly successful, but the two patients died when the doctors had to amputate some of their limbs again.

Atilla Kavdır had both arms and one leg transplanted. But the leg had to be removed shortly after the operation, because Kavdirs body did not accept it. The case went around the world when the man could move his hands after a few weeks, and the 34-year-old's son took his hand; Kavdir had lost his arms and leg as a child by electric shock. But shortly after, the patient died because of a urinary tract infection as a result of the transplants.

For Dr. med. Ömer Özkan, professor of the department of plastic, reconstructive and aesthetic surgery in Akdeniz, it was a disaster.

Even a quadruple surgery in Turkey failed. Sevket Cavdar had to remove his transplanted limbs.

At both clinics, the Hacettepe University Clinic and the Akdeniz Hospital, an independent commission found massive deficiencies. The university hospital even lost its license to carry out transplants.

The new arms generally do not work completely. They can only be used to perform simple actions such as tying shoes or eating with a spoon. The psychic effect may be more important than the physical abilities: Especially young patients regard the transplanted arms much more as a part of the body than even good dentures and are less afraid to go public with the foreign limbs.

face

Since 2005, surgeons have been risking facial transplants. The first person with the face of another human being was a French woman who had distorted dog bites.

Patrick Hardinson worked at the Fire Department in Mississippi and suffered burns in 2001 that made him look like a monster. Besides, he could not close his eyes. More than 70 operations could not undo what happened.

The NYU Langone Medical Center helped with the most complete facial graft yet. The operation lasted 26 hours. Hardison not only got a new face, but also a new scalp, new ears, ear canals and parts of the bones of the chin, cheeks and nose, new eyelids and muscles. After that he could close his eyes again.

It had taken more than a year to find a donor that matched his age, size, skin and hair color. 26-year-old David Rodebaugh complied with the profile and his mother gave permission for organ donation. The hospital bore the costs for the operation and the REHA.

penis

American doctors transplanted a penis in 2016. A 64-year-old man suffered from penile cancer and now carries the limb of a dead man who had the same blood type. The operation lasted 15 hours and was the third worldwide.

skullcap

In 2015, physicians in the US first completed the transplantation of a scalp skull from the Anderson Cancer Center in Houston. The sufferer suffered from a cancer that had affected all of these organs. There was a leiomyosarcoma on the scalp, and one wound on the skull did not heal.

The blood vessels were sutured together under the microscope.

uterus

Wombs successfully transplanted doctors in several European countries. In Germany, the Erlangen University Hospital is planning such transplantation. So women who can not give birth to children, the desire to have children are met, because they have no uterus or their uterus is too small.

In Sweden in 2014, a woman with a transplanted uterus gave birth to a healthy baby.

A uterus transplantation could help many women with unmet need for children. (Image: unlimit3d / fotolia.com)

In Erlangen, the clinic director Prof. dr. Matthias Beckmann: "We are currently preparing for the first uterine transplantation. But first we have to get the necessary permits from the Bavarian Ministry of Health and train the intervention on the animal model. "

Uterine transplantation is not without risk, so the surgery with vascular surgeons and plastic surgeons is trained down to the smallest detail. Above all, it is crucial to connect the donated uterus with artificial blood vessels to the recipient's blood system.

Beckmann sees a need for action, because a uterine transplant is in his eyes, the only way to legally get a child, if this was impossible for anatomical reasons. Because egg donation and surrogacy are banned in Germany, and this legislation is driving women into illegality.

For example, a reproductive physician in Franconia was sentenced to five years' imprisonment for implanting women with the oocytes of foreign women, which is prohibited in Germany by the Embryo Protection Act.

A uterine operation would cost around 100,000 euros, and would be the only way for up to 10,000 women in Germany to have their own child. In addition, there are up to 1,000 women a year who lose their womb due to illness.

head transplant

The Italian physician SergioCanavero is considered Erich von Däniken his guild: The surgeon wants to transplant a complete head. Edgar Bierner, who performed an arm transplant himself, said, "That's impossible. That's speculative, and there's nothing on the horizon. "

Canaveros idea: He wants to cool the bodies of the brain-dead donor and the receiver so far that the cells can survive as long as possible without oxygen. The spinal cord must then be separated cleanly.

Veit Braun, a neurosurgeon from Stuttgart says: "If I separate a spinal cord from the head, then that's it, once and for all." In the best case, the result is a patient with a functioning brain with no control over his body.

Ethically cruel animal experiments preceded Canvero's fantasies. In the 1950s, Vladimir Demikhov planted a second head on a dog, and in 1970 Robert White transplanted a monkey head. The abused animals died after a few days.

Canavero was inspired by Ren Xiaoping, who transplanted a mouse head in 2013.

The head grafting should be like this: After the surgery, Canavero wants to put the patient into a coma for a month, next year the affected person should learn to speak and walk. The operation would take about 36 hours and cost ten million euros.

It sounds like a science-fiction movie, but it's a reality: The Italian surgeon Canavero wants to transplant a human head for the first time. (Image: agsandrew / fotolia.com)

The surgeon has already found a potential buyer: The Russian Valeri Spiridonov is sitting in a wheelchair and wants to get his head transplanted to a healthy body. He is aware that the risk of death from this operation is high.

He suffers from Morbus Werdnig-Hoffmann, a loss of muscle, tissue and organs that usually leads to death.

The paralyzed is also thrilled. He says, "You feel like the hero of a science fiction novel, almost as if you were flying into the cosmos."

Canavero's colleagues consider his idea not just science fiction, but dangerous nonsense.

However, he considers his head transplantation to be the biggest revolution in human history. He even dreams of more: "My goal is immortality. And I will get them, because I work fast! "

To transplant a head is the solution to all diseases: "Do you have cancer? New body! Do you have diabetes? New body! Are you paralyzed? New body! "

Reasons for transplants

Yes, according to organ, tissue and cell, the reasons for a transplantation are manifold.

1.) Heart: In general, heart failure that leads to heart failure in the long term is a cause for heart transplantation, including heart muscle disease, heart valve and congenital heart disease.

2.) Liver: Liver cirrhosis, Wilson's disease, acute liver failure, malformations of the biliary tract, multiple metabolic disorders.

3.) Lungs: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, sarcoidosis, pulmonary hypertension

4.) kidney: A kidney transplant is not always vital, because dialysis can replace the function of the organ. With a donor organ, however, a patient can lead a normal life without having to constantly connect to the dialysis machine. In addition, some sufferers are no longer able to dialysis.

5.) Pancreas: Doctors transplant here only if those affected can no longer produce insulin, for example in type 1 diabetes. However, diabetes can also be treated with insulin syringes so that the physicians weigh on a case-by-case basis.

6.) Bone marrow: Transplanting bone marrow is often the last resort to cure leukemia and thalassemia.

7) cornea: The transplant allows people to see clearly again when their cornea has been damaged.

8) skin: Skin grafts cover burns, burns and chronic wounds.

9) Hair: A hair transplant has no medical, but cosmetic reasons.

A hair transplant is usually not performed for medical, but for cosmetic reasons. (Image: Catalin Pop / fotolia.com)

execution

In Germany, only physicians in transplant centers are allowed to transplant organs. If the brain death of a person who committed himself in life as an organ donor, or give relatives their consent, comes a coordinator of the German Foundation for Organ Transplantation (DSO).

He initiates the investigations, this includes above all the typing of the tissue characteristics. This information will be sent to Eurotransplant. The organization uses the computer to find a suitable recipient. The DSO coordinator manages organ harvesting and transport.

The recipient arrives immediately in the transplant center, where the operation is prepared immediately. The doctors now remove the donor organ. It has to go very fast now. Every lost minute increases the risk of functional damage.

A kidney transplant usually takes two to three hours, but a heart-lung transplant can take ten hours or more.

risks

There is an acute rejection reaction immediately after surgery and a chronic one that continues for years.

Anyone carrying a foreign organ must take immunosuppressants throughout their lives. These weaken the body's defense. Unfortunately, this weakness can not be focused on the new organ, and those affected are prone to infections, bacteria, viruses and fungi of all kinds.

living donation

Some organs can also be taken from living people, especially the kidneys. A healthy person can easily live with a kidney. In the liver, living people can donate part of the organ.

According to the Transplantation Act, a living donation is only permissible if no organ of a dead person is available. As with all surgeries, the healthy donor carries a risk and the doctor must inform him about it. Psychological coercion or financial incentives should not play a role.

However, strictly speaking, the blood donation falls under transplants, as here also cells of other people benefit a sick person. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)