What is the threat of organ transplantation

Transplantation without myths and secrets

Nika Batchen, KM.RU

In the 30s of the XX century, in the novel "Professor Dowell's Head", the science fiction writer Belyaev described the transplantation of the head of a deceased person. For the author's contemporaries, it looked absolutely incredible. For us, the people of the XXI century, there is nothing impossible in a fantastic assumption.

Experiments with head transplants have been carried out on animals since the 60s of the last century. In 1970, the head was successfully transplanted from one monkey to another. In 1991, the embryonic cerebral cortex was transplanted. Finally, in 2005, a human face was transplanted for the first time in France. It is quite possible that only a few steps remain before the head of one person is attached to the body of another. And while this barrier is not taken, virtuoso surgeons perform transplantation of other organs – liver, kidneys, heart. And by solving medical problems, saving terminally ill people, they create new moral, ethical, religious and spiritual problems.

Three roads of the transplantologistFor many centuries in a row, it seemed to people that the success of transplantation depends only on the skill of the doctor.

And there is nothing difficult in sewing a dead man's hand, a dog's tongue or a monkey's heart to a living person. We will find stories about such "transplants", for example, in the fairy tales of the brothers Grimm or Bulgakov's book "The Heart of a Dog". But all attempts to carry out such operations in reality ended in failure – the transplanted organs resorbed or died, and the recipient (the person to whom the organ is transplanted) as a rule, he died. The fact is that the immune system of the human body repels foreign cells, attacks and kills them.

So, no matter how skillfully the vessels, nerves and muscles are sewn, the transplanted tissues remain strangers. There are three ways to deal with this obstacle. The first is to grow an organ for transplantation from the patient's own cells in his own body or on the basis of a donor protein framework. The second is to transplant an identical or similar genetic material organ from a twin, if there is one, or a close relative. The third is to transplant a relatively, that is, a more or less compatible organ of a deceased or living donor to the patient and keep the recipient on immune suppressing pills for the rest of his life in order to avoid rejection.

Growing your own organ is very difficult, incredibly expensive and technically difficult to implement. Now this is done only with the skin, trachea and jaw. A related transplant is often limited by the absence of healthy relatives whose tissues are compatible with the recipient's tissues. An unrelated transplant depends on the presence of a "suitable" organ of the deceased or a volunteer who is ready to "share" his body – without significant harm to health, you can donate one kidney, lung, bone marrow, liver lobe.

In order for the transplant to be successful, an organ or tissue must be transplanted no later than 48 hours after separation from the body. For the heart and lungs, the period is even less – up to 6 hours. During this time, you need to pick up a patient in the transplant queue whose cells are best compatible with the donor's cells, prepare him for surgery, deliver the cooled organ from the operating room to the operating room and perform the operation. Today, it is not uncommon for operations on the "domino" principle – an incompatible relative of the patient agrees to donate an organ, it is transplanted to another patient, and in return a suitable one is selected.

Transplantation is an extreme measure: taking into account the complications and expensive medications that the recipient is forced to take all his life, it is used in hopeless patients with the last stage of cardiac, pulmonary, renal or hepatic insufficiency, incorrigible defects. Without a transplant, such patients face death within a few months. After the transplant, they do not have the opportunity to fully live, work, travel. However, it sometimes turns out to start families and have children – mothers who have survived kidney, liver and even heart transplantation give birth in large perinatal centers. Annual survival after transplantation of vital organs is up to 90%, five–year survival is about 50%, maximum survival is more than 30 years.

Background of the issueExperiments on the transplantation of human organs and tissues have been carried out since the beginning of the XX century, but patients died within a few hours or days.

The first successful transplantation in 1931 in Odessa was carried out by ophthalmologist V.P. Filatov – he found that the cooled cornea of the deceased was not rejected and restored vision to a patient with eyesores.

The founder of transplantology was the Soviet scientist V.P. Demikhov. In 1937, he created the world's first artificial heart and implanted it in a dog, in 1946 he performed a heart-lung transplant, and in 1954 he "constructed" a two-headed dog by transplanting the head and neck of one animal onto the trunk of another.

The first kidney was transplanted in 1954 in the USA. The patient lived for more than 17 years, the operation was successful because the donor and recipient were identical twins. The first successful heart transplant operation in 1967 in South Africa was performed by surgeon Christian Barnard – before that he had twice come to the USSR to study with Demikhov.

The liver was relatively successfully transplanted for the first time in 1967 in the USA. Lung – in 1983 in Canada. Hand transplantation in 2009 was performed by German surgeons, leg transplantation in 2011 – by Spanish doctors under the guidance of world celebrity Pedro Cavadas. Also, successful bone marrow, pancreas, eyes, teeth, hair, trachea, bones, face and complex operations are carried out in the world – heart and lung transplants, heart and liver, and so on.

Uterus transplantation from mother to daughter with the prospect of giving birth to a child and testicular transplantation are at the experimental stage. In August 2011, the surgeons of the Acadeniz Hospital performed a successful uterus transplant in Turkey, but the patient's pregnancy was not reported. Scientists at Stanford University (USA) are developing a technique for simultaneous organ transplantation and donor stem cells, which would avoid rejection during transplantation.

As for transplanting the head of one person onto the torso of another, it is technically feasible, but at the moment there is no effective technique for splicing the spinal cord – even with a successful transplant, the patient will be completely paralyzed.

Dangers on the way to a new lifeSometimes there are curiosities – so on January 11, 2012 in Mexico City, a donor heart intended for 28-year-old Enrique Hernandez was transported...

it fell out of a container right at the airport! However, it did not hurt the patient: She successfully underwent surgery and was discharged from the clinic on January 24.

Sometimes the donor becomes an unwitting killer of the recipient – doctors do not have time to conduct a sufficient check and transplant the organs of people suffering from hepatitis, HIV, cancer. In the USA and Germany, there have even been cases of organ transplants from donors affected by the rabies virus and Creutzfeld-Jakob disease (a degenerative disease of the central nervous system). All the patients died.

In addition, the possibilities of transplantation create a lot of ethical and social problems. In a number of countries, including Russia, there is a "presumption of consent" – a deceased person is automatically considered consenting to organ harvesting. And, for example, in the USA and Ukraine, there is a "presumption of disagreement", that is, for transplantation, the lifetime consent of the donor and his relatives is needed.

Given that organs should be prepared for transplantation immediately after the death of the donor, this makes it difficult to perform operations. With pediatric transplantation, it is even harder – only a fraction of the liver and bone marrow can be transplanted from a living donor, a maternal kidney or lung will not fit the child in size. Due to the peculiarities of legislation in our country, the collection of organs of deceased children is impossible. In the European Union, to combat "black transplantologists", there is a law prohibiting unrelated organ transplants from citizens of some countries to citizens of others.

The Orthodox and Roman Catholic Churches support voluntary consent to organ transplantation as an act of self-sacrifice. "If you can and should lay down your life for your loved ones, for people, then all the more you can and should talk about the removal of organs of the deceased to save the life of a person still living," the head of the Spiritual Care Center named after him said in an interview with Nezavisimaya Gazeta. St. John of Kronstadt hieromonk Father Anatoly. At the same time, any possibility of paid donation is categorically condemned.

There is no unambiguous research data on how transplanted organs affect a person. But it is known that over time, donor cells appear in the blood of such people, sometimes even the blood type changes. This is the so-called phenomenon of chimerism. Mystical moments should not be discounted – cases of "transplantation" of habits and character traits of a deceased donor have been recorded.

So, a person after surgery suddenly begins to love chocolate bars or beer, mountaineering or car racing, or even suffers from nightmares reproducing the moment of death of the owner of the transplanted organ. Some people associate this phenomenon with cellular memory, but no large-scale study of the phenomenon has been conducted. We can only wait to see what science will say about this.

Portal "Eternal youth" http://vechnayamolodost.ru31.05.2012