Organ Transplantation Explained

You may need an organ transplant if one of your organs has failed. This can happen because of illness or injury. When you have an organ transplant, doctors remove an organ from another person and place it in your body. The organ may come from a living donor or a donor who has died.
The organs that can be transplanted include

• Heart
• Intestine
• Kidney
• Liver
• Lung
• Pancreas

You often have to wait a long time for an organ transplant. Doctors must match donors to recipients to reduce the risk of transplant rejection. Rejection happens when your immune system attacks the new organ. If you have a transplant, you must take drugs the rest of your life to help keep your body from rejecting the new organ.
In 50 years, transplantation has become a successful worldwide practice. However, there are large differences between countries in access to suitable transplantation and in the level of safety, quality, efficacy of donation and transplantation of human cells, tissues and organs. The ethical aspects of transplantation are at the forefront. In particular, the unmet patients’ needs and the shortage of transplants lead to the temptation of trafficking in human body components for transplantation. [1]

WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation
In 1987 the fortieth World Health Assembly, concerned at the trade for profit in human organs, initiated the preparation of the first WHO Guiding Principles on Transplantation, endorsed by the Assembly in 1991 in resolution WHA44.25. These Guiding Principles have greatly influenced professional codes and practices as well as legislation around the world during almost two decades. After a consultation process that took several years, the Sixty-third World Health Assembly adopted resolution WHA63.22 on 21 May 2010, endorsing the updated WHO Guiding Principles and identifying areas of progress to optimize donation and transplantation practices.
The first two components, GKT1 and 2 lead to a global database that is in the Global Observatory on Donation and Transplantation (GODT). It is made possible through the support of the Government of Spain and collaboration with the Organización Nacional de Trasplantes (ONT). [2]

​WHO Task Force on Donation and Transplantation of Human Organs and Tissues
Organ transplantation is an established form of treatment that is nowadays acknowledged as the best and frequently the only life-saving therapy for end-stage organ failure. Most recent data from the WHO Global Observatory on Donation and Transplantation (GODT) indicate that over 130,000 solid organ transplants are performed worldwide, and although impressive, it is estimated that this number represents less than 10% of the global need. Moreover, there is a huge discrepancy in the availability and access to services as rates of organ donation and transplantation vary widely between WHO regions. The situation of acute organ shortage causes high mortality rates of people that are on waiting lists or leads people (usually the wealthy) to obtain an organ through illegal and unethical pathways (usually from the poor and vulnerable). [2]
​Global Knowledge Base on Transplantation (GKT)
Through the GKT, the World Health Organization aims to bring together in one database information on organ, tissue and cell donation and transplantation from around the world. The GKT will be a source of information for all involved from the lay public, whose willingness to donate relies on an understanding of the value of transplantation and who might someday benefit as a recipient, to health professionals and health authorities responsible for the success, safety and quality of cell, tissue and organ transplantation, while maintaining the dignity of donors and recipients.
Four components to the GKT
The GKT has four components that are progressively developed:

• GKT1 activities and practices in allogeneic transplantation: number of transplantations carried out globally, access to transplantation, outcomes of transplantation.
• GKT2 legal framework and organizational structures of allogeneic transplantation.
• GKT3 threats and responses, reference information on risks and vigilance and surveillance of safety and ethics.
• GKT4 xenotransplantation.

​Global health ethics on organ transplantation
The Global Health Ethics Unit provides a focal point for the examination of ethical issues raised by activities throughout the Organization. The unit also supports Member States in addressing ethical issues that arise in their own countries. This includes a range of global bioethics topics; from public health surveillance to developments in genomics, and from research with human beings to fair access to health services.
This unit’s work is particularly important in the context of contemporary health challenges and raises and addresses difficult questions in areas such as resource allocation, new technologies, decision-making in clinical care and public health. [2]
Ethical issues in global health
Read through the public health areas where WHO is involved in providing leadership and guidance on the ethical issues involved.
 

• Ageing
• Big data and artificial intelligence
• Bio banking
• Good governance in medicines
• Health Systems and Implementation Research
• HIV/AIDS
• Human Genome editing
• Human organ and tissue transplantation
• Immunization
• Outbreaks and emergencies
• Research ethics
• Surveillance
• Tuberculosis care and control
• Vector-borne diseases [2]

​Infections after Solid Organ Transplantation
Worldwide, an estimated 119,873 solid organ transplants were performed in 2014.  In the United States, 30,970 organ transplantations were performed in 2015. Renal transplants were the most common, followed by those of the liver, heart, lung, and others, including dual organ, pancreatic, and intestinal transplantation. Over the last several decades, the field of solid organ transplantation (SOT) science and practice has advanced significantly, only to be continually challenged by the risks for infection in SOT recipients.
The positive effects of the immunosuppressive agents, obligatory for the prevention of organ rejection, have been tempered by the negative effects of these same therapies, leading to various infections that range in both frequency and severity. Fortunately, experienced SOT researchers and practitioners have been involved in the development and implementation of proactive guidelines such as the 2006 American Society of Transplantation guidelines on screening, monitoring, and reporting of infectious complications in SOT recipients. [3]
Transplant Safety Overview

• In the United States, the most commonly transplanted organs are the kidney, liver, heart, lungs, pancreas and intestines. On any given day there are around 75,000 people on the active waiting list for organs, but only around 8,000 deceased organ donors each year, with each providing on average 3.5 organs. Living donors provide on average only around 6,000 organs per year.
• In the U.S, the most commonly transplanted tissues are bones, tendons, ligaments, skin, heart valves, blood vessels and corneas.  Of around 2 million tissue grafts distributed each year, it is thought that only about 1 million grafts are transplanted.
• While some organ transplantations are life-saving procedures, serious illness, graft loss and death can occur from undetected infections in donor organs and tissues.  Although infrequent, infectious pathogens (i.e., viruses, bacteria, fungi, or protozoa/parasites) have been unknowingly transmitted through transplants (i.e. human immunodeficiency virus (HIV), hepatitis C, rabies virus, (Mycobacterium tuberculosis (tuberculosis)) and (Balamuthia mandrillaris).
• Laboratory testing for certain infectious pathogens is required in deceased organ and tissue donors and living kidney donors (i.e., human immunodeficiency virus (HIV), hepatitis B and hepatitis C viruses,  syphilis,  CMV, EBV). [4]

​CDC’s role in organ transplantation safety
Improvements in donor screening, serologic testing, reporting and investigating suspected donor-derived disease transmission have improved organ and tissue safety. The risk of acquiring an infection from an organ or tissue transplant is thought to be very low.  However, the risk for transmission of infectious pathogens, such as viruses, bacteria, fungi and protozoa/parasites, remains and requires continued vigilance.
 
Multiple organizations play a role in organ and tissue safety. CDC provides expertise and assistance investigating potential transmission of infections from organs or tissues. CDC investigates suspected disease transmission, assisting state and local health departments, especially when the investigation is multistate. CDC laboratories help identify the transmitted pathogens.  CDC disease detectives assist the healthcare community in tracing back diseased organs to the original donor in order to identify who else may have received contaminated organs and/or tissue.  Findings from investigations help inform regulatory decisions and guidance on reducing the risk of infectious transmissions through organ and tissue. [4]
Organ donation and transplantation collaborative
Organ donation rates have been improving in Canada but it is clear that there is more work to be done. Every year, hundreds of Canadians die while waiting for an organ transplant. With over 4,300 people in Canada waiting for a transplant right now and only a fraction of Canadians registered as donors—the need is critical.
 
The Government of Canada is strongly committed to improving the organ donation and transplantation system in Canada. Health Canada has been leading an initiative called the Organ Donation and Transplantation Collaborative (the Collaborative) in close collaboration with provinces and territories, Canadian Blood Services (CBS), patients, families and stakeholders involved in organ donation and transplantation (ODT).
The Collaborative goal is to develop concrete and actionable options to improve organ donation and transplantation performance that meet Canadians’ needs and improves patient outcomes.
This initiative is informed by consultations with a wide range of experts, including clinicians, government officials, Canadian Blood Services, research organizations, organ donation organizations, transplant programs, patient and family groups, and other key stakeholders. The Collaborative has summarized these stakeholders’ views in a synthesis report entitled What We Heard: Stakeholder Perspectives on the Path Forward (available upon request). [5]
Skin Cancer in Transplant Recipients: Scientific Retreat of the International Immunosuppression and Transplant Skin Cancer Collaborative and Skin Care in Organ Transplant Patients.
The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 500 physicians and scientists focused on the treatment of cutaneous malignancies following solid organ transplantation and in other forms of immunosuppression. It is well known that solid organ transplant recipients (SOTRs) have an approximate 100-fold increase in the risk of developing skin cancer with consensus guidelines recommending these patients be managed as high risk for local recurrence and metastasis associated with poor outcomes. In September 2018, ITSCC and its European counterpart, the Skin Care in Organ Transplant Patients-Europe (SCOPE), held their biennial scientific retreat in Essex, MA to discuss novel findings in the pathogenesis of cutaneous malignancy including new treatment and prevention strategies in this at risk population for significant morbidity and mortality from their cutaneous disease. This meeting report is a summary of the novel findings discussed. [6]
Risk of Post-Transplant Lymphoproliferative Disorders (PTLD) in Solid Organ Transplantation Patients with EBV Viremia
Post-transplant lymphoproliferative disorders (PTLD) are mostly Epstein-Barr virus (EBV) positive lymphoid proliferations resulting from immunosuppression following allogeneic stem cell or solid organ transplantation (SOT). Despite this strong association, there is a lack of data evaluating the risk of PTLD in SOT patients (pts) with (w/) EBV viremia. The significance of EBV detection remains unclear and can lead to unwarranted preemptive treatments in SOT pts. The aim of this study is to assess the association between peripheral blood EBV viral load and risk of PTLD post SOT. [6]

References:

1. https://medlineplus.gov/organtransplantation.html
2. https://www.who.int/search?query=organ+transplantation&page=1&pagesize=10&sortdir=desc&sort=relevance&default=AND&f.Countries.size=100&f.Lang.filter=en&f.RegionalSites.size=100&f.Topics.size=100&f.contenttype.size=100&f.doctype.size=101&facet.field=RegionalSites&facet.field=Topics&facet.field=doctype&facet.field=Countries&facet.field=contenttype&facet.field=Lang&tune=true&tune.0=3&tune.1=2&tune.2=2&tune.3=3&tune.4=180&tune.5=75&cname=highlight-en&cname=emronew&cname=who&cname=euro&cname=afro&cname=amro&cname=pmnch&cname=searo&cname=workforcealliance&cname=wpro&f.RegionalSites.filter=Global&f.contenttype.filter=html
3. https://emedicine.medscape.com/article/430550-overview
4. https://search.cdc.gov/search/index.html?query=organ+transplantation&sitelimit=&utf8=%E2%9C%93&affiliate=cdc-main
5. https://www.canada.ca/en/sr/srb.html?cdn=canada&st=s&num=10&langs=en&st1rt=1&s5bm3ts21rch=x&q=organ+transplantation&_charset_=UTF-8&wb-srch-sub=
6. https://ashpublications.org/blood/article-abstract/132/Supplement%201/4202/275648/Risk-of-Post-Transplant-Lymphoproliferative?redirectedFrom=fulltext

Author Details
Shadat Nabil
Student of Pharmaceutical Science, North South University.
VSHR Healthcare Book Officer.