transplantation

In the transplantation the organic material of another person is transplanted into a patient. This transplantation must take place under consideration of immunological effects and carries a high risk of rejection, which in current medicine can be reduced by immunosuppressive measures and the transplantation of stem cells or white blood cells.

Anyone waiting for a certain organ, organ system, limb or cells and tissue parts is placed on a waiting list, whereby the general condition, age and prospects of success of the project, along with many other parameters, determine the classification of a patient on the waiting list.

What is the transplant?

A transplant is the process of grafting organic material from another person into one patient. In addition to organs and organ systems, tissue components, limbs or cells can also be transplanted.

In medicine, the term transplantation describes the transplantation of organic material. This organic material can consist of different parts of the body. In addition to organs and organ systems, tissue components, limbs or cells can also be transplanted.

In contrast to transplantation, implantation does not work with organic, but artificial materials. Prostheses are, for example, an implant, while a transplanted heart corresponds to a transplant. In 1983, Theodor Kocher performed the first transplant on living humans when he transplanted thyroid tissue under the skin and into the abdominal cavity of his patient. It was not until the 20th century that the umbrella term transplant medicine, which was coined by the transplant doctor Rudolf Pichlmayr, was established with regard to such operations.

Transplants today are differentiated depending on the origin, the function and the location of the transplant. With isotopic transplantation, for example, the tissue and location of the organic material in the donor and recipient remain identical. Orthotopic transplants, on the other hand, only agree in terms of location in recipient and donor, while heterotropic transplants have no spatial correspondence whatsoever. There are four different subgroups related to the function of the transplant.

In the case of allovital transplantation, for example, the transplant is vital and fully functional. Transplants from allostatic transplantation, on the other hand, are limited in their function, while those from auxiliary transplantation are intended to support a diseased organ. Substitute transplants, in turn, replace organs that have become completely inoperable. There are two possibilities with regard to the origin of the transplant: either the material was removed post-mortem, i.e. after death, or from a living donor.

Function, effect & goals

The goals of a transplant depend on the individual. Most commonly, transplants are performed to replace an inoperable or impaired organ or organ system and thus save the patient's life. In such a case, the organ that has become useless is completely explanted.

This distinguishes this type of transplant, for example, from operations that, in addition to the patient's existing and possibly weak organ, use a second, healthy organ that is supposed to support the low performance of the own organ. In some cases, however, a healthy organ has to be removed from the patient due to the operation, which can then be transplanted to a recipient. Such a scenario is also known technically as a domino transplant. Although the heart transplant is certainly one of the most well-known types of transplantation for some forms of heart muscle disease, there is an indication for a transplant in many other scenarios.

For example, chronic kidney failure often requires a kidney transplant to save the patient's life. However, patients with Eisenmenger's reaction require a combined heart-lung transplant. Liver cirrhosis can in turn be an indication for a liver transplant.

Cystic fibrosis requires a lung transplant, while leukemia patients are often saved by a stem cell transplant. In diseases such as breast cancer, reconstructive surgery using tissue grafts may restore the female breast. Skin grafts are often required for burns, while severed limbs can be transplanted after accidents, for example.

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Risks, side effects & dangers

The greatest risk of a transplant is usually an immunological overreaction, which can lead to the rejection of the foreign material. The immune system is trained to detect foreign substances and expel them from the body, which outlines the basis of transplant rejection. With peracute rejection, the graft is rejected in the first few hours after the operation.

Responsible for this are allospecific and blood group-specific antibodies that cause fibrin deposits to form in the transplant vessels. As a result, the inserted tissue dies. While this form of rejection is hardly treatable, acute rejection can often be contained in the first few weeks after surgery with immunosuppressants and similar measures. Such acute rejections are cellular interstitial rejections and occur more frequently in kidney transplants, for example. Chronic rejection, on the other hand, usually only occurs after years and is related to chronic inflammatory processes caused by immunological reactions.

In most cases, this type of rejection requires a second transplant. In the meantime, transplant medicine has discovered the additional transplant of white blood cells and exogenous stem cells as a way to reduce the risk of rejection. Not every transplant is suitable for every patient. From an immunological and blood group perspective, the explanted materials must, for example, match the patient in order to be successfully transplanted.

As there are generally fewer transplants available than are needed, there are waiting lists in Germany.Whether and how high a patient is on a waiting list depends on their general condition, the chances of success, age and many other factors. In the meantime, transplants are carried out across national borders so that organs can be found more quickly in acute cases and, in particular, more suitable materials can be provided.