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Information

Author(s): Elisa C.Walsh, Hovig VChitilian

  1. The first successful human organ transplant (kidney) was performed in 1954. Since that time, the heart, lungs, liver, pancreas, intestine, stomach, testis, penis, hand, thymus, and uterus have all been successfully transplanted.
  2. From the mid-1950s to the early 1970s, individual hospitals and organ procurement organizations managed all aspects of organ donation and transplantation. In 1984, the United Network for Organ Sharing (UNOS) was created to coordinate the allocation of organs and collect data about donors, transplant candidates, and transplant recipients in the United States.
  3. Although demand continues to exceed supply, modifications of the organ allocation system, expansion of criteria for acceptable donor organs, and advances in organ preservation techniques have increased the availability of organs and improved allograft survival.
    1. The LifePort Kidney Transporter is a perfusion preservation machine for donor kidneys that works by pumping the vasculature continuously with a cold perfusate, reducing the odds of delay in kidney function and improving first-year posttransplant success compared with static storage.
    2. US Food and Drug Administration–approved transport systems have been developed for donor lungs (eg, TransMedics’ OCS Lung, a “lung-in-a-box” device). This machine maintains normothermia, breathing, and perfusion throughout transport, allowing expanded retrieval ranges and successful use of organs that had been rejected by transplant centers using cold storage.
    3. Similar devices are now under investigation for donor hearts and livers.
  4. The success of solid organ transplantation critically depends on the careful selection of transplant recipients. The suitability of candidates is typically determined by a multidisciplinary committee and based on national criteria.
    1. Patients require a thorough history and physical examination as well as psychosocial evaluation to identify any behavioral, social, or financial issues that may preclude adherence to immunosuppressive therapy and medical follow-up after transplantation.
    2. In addition to standard laboratory tests, serologic tests for varicella, measles, mumps, rubella, HIV, hepatitis, tuberculosis, syphilis, cytomegalovirus, Ebstein-Barr virus; drug screening; ABO-Rh blood typing; age-appropriate screening; and electrocardiography are required.
    3. As of 2020, all recipients must be tested for novel coronavirus (SARS-CoV-2) via nucleic acid test from either the upper or lower respiratory tract as close to the time of transplantation as possible.
    4. The need for additional cardiac and pulmonary testing is dependent on patient comorbidities as well as the type of transplant to be performed.
    5. Absolute contraindications include active infection, active malignancy, substance abuse, uncontrolled psychiatric disease, life expectancy less than 1 year, and ongoing nonadherence to treatment.
    6. Ethical issues in transplantation are numerous and include the definition of death and brain death, financial incentives and organ trafficking, and coerced donation. A full discussion is beyond the scope of this chapter.