It has been estimated that over 150,000 solid organ transplants are carried out in the world every year. ‘Solid organ’ refers to the main organs of the body located in the abdomen. In the UK about 130,000 solid organ transplant procedures have been carried out since the early 1960’s. According to the UK Transplant Activity Report (www.organdonation.nhs.uk ) between April 2007 and March 2008 3,235 solid organ procedures were carried – yet nearly 8,000 people were actively listed for a transplant.

809 deceased donors and 856 living donors enabled the 3,235 transplant procedures to take place. Living donors tend to be relatives of the transplant patient, although there have been 18 stranger, altruistic kidney donations in the UK since the Human Tissue Act was put into action in 2006.

Stranger donations or non-directed donations are only permitted for living kidney donations in the UK since the Human Tissue Act was introduced in 2006 (passed in 2004). Andy Loudon (pictured below) was a very fortunate man to receive a healthy kidney from a complete stranger in September 2007.

Would you be a lifesaver?

Barbara Ryder chose to give a kidney without any notion of a reward. It is totally illegal to participate in any commercial transaction in relation to the exchange of tissue or organs in the UK – either as a donor or a recipient. Barbara and Andy chose to meet up in December 2007, although anonymity can be maintained by either individual in this potentially lifesaving relationship. (See the ‘Donor Experiences’ link for more on this item.)

In contrast to kidney transplants, heart transplants can only happen if the donor dies on a ventilator and is diagnosed as brain stem dead. Most lung, liver and kidney transplants are only possible if donors die in this way, although these organs can be retrieved from non heart beating donors that are not ventilated. Most heart beating deceased donors die in hospital intensive care units in order for organ retrieval to take place. 609 donors died in these circumstances between April 2007 and March 2008. In the same period there were 200 non heart beating donors who had treatment withdrawn and were not on a ventilator. These cardiac deceased donors cannot donate their heart.

Solid organ transplants are classed as allografts. This means they are transplanted from one human to another regardless of gender or ethnicity. An isograft. is a special type of transplant which takes place between identical twins. The early kidney transplants in the USA during the 1950’s were carried out between twins to avoid the risk of organ rejection which could not be managed by anti-rejection drugs at that time. A xenograft happens when organs or tissue is exchanged between different species. For example, this occurs when heart patients may receive a heart valve from a pig or a calf. This is also called a heterograft. There have been experiments with other organs. This will be discussed elsewhere on the website.

In the UK solid organ transplants only take place when all other medical treatments are failing. End stage organ failure has to be carefully monitored and assessed to ensure that no alternative therapy or treatment would be more successful or less risky to the patient. As donated organs are in short supply health professionals and their patients have to consider very carefully whether the proposed transplant is in the best interests of the patients. In reality the doctors are having to make an assessment about whether a patient would survive the transplant operation. Regrettably the decision can be taken too late. Medicine is more often an art than a science.

When I was told by my cardiologist at Wythenshawe Hospital that I needed a heart transplant he made it very clear that I had less than 6 months to live if we kept with the treatment I was currently on for heart failure. The high risk nature of heart, lung and liver transplants means that these procedures are a last resort. Dr Simon Williams described the procedure to me as being part of a controlled major road traffic accident. An event you would prefer to avoid unless there were no alternative options!

For a heart procedure you get a very narrow window of opportunity. The patient has to be ill enough to justify the operation, but still strong enough to survive the physical trauma of the procedure. And then a healthy organ has to become available at just the right time! All this is extremely difficult to manage and plan. Tragically people die because the timing of a suitable donor becoming available does not coincide with the needs of the patient.('Suitable' meaning that they are a good match for the potential recipient in terms of blood group, size, tissue type and that the donor's family says 'yes' to the request for organ retrieval to take place.) That is why more donors are needed and greater resources attached to the retrieval process in hospitals.

In the UK the following solid organ transplants take place:

Susanne Butscher - ovary transplant

In November 2008 baby Maja was born. This was only possible because her mother, Susanne Butscher, had received an ovarian transplant. Susanne’s twin sister had been the donor of the ovary that enabled the creation of Maja’s life. This transplant development may help thousands of infertile couples in the future. As medical science develops the potential for transplant procedures increases in terms of their variety and frequency. The demand for life saving organs will inevitably increase too. That is why we have to address the current shortfall of donated tissue and organs for transplantation. We also have to examine more closely the alternative sources of transplantable organs which may become available through stem cell bioengineering or genetically modified animal husbandry. These scientific developments raise profound moral, ethical, spiritual and legal implications that need careful consideration in the public domain.

Other countries have also carried out hand and arm transplants. Partial face and whole face transplants have also taken place as well as a male sex organ transplant carried out in China, though this was later reversed. (I would use the conventional term of p*n*s - but this gets blocked by Internet browsers - so male reproductive organ will have to do!) This is according to a Guardian newspaper report on September 18th 2006. [Guardian article]

Claudio Castillo - trachea transplant

As I’m not a medically qualified person I'm not sure what the recent trachea transplant counts as? Is it a tissue transplant or a solid organ transplant? By the time the donor’s trachea was stripped of their stem cells and the ‘scaffolding’ of the trachea was then coated with the recipient’s stem cells are we witnessing a breakthrough in solid organ or tissue donation? Perhaps this distinction is a minor issue compared to how it has transformed Claudia Castillo’s life. This bioengineering could help to eliminate the rejection risk for other types of tarnsplants in the future.

Claudia suffered from damage to her trachea (windpipe) caused by tuberculosis. The TB caused her trachea and bronchus to collapse. She was admitted to a hospital in Barcelona where she was confronted with two options. She could either have her left lung removed or face a lung transplant. A joint effort between hospitals in Barcelona and Bristol resulted in a bioengineering technique that ‘created’ a new trachea for Claudia.

Please get involved with these donor opportunities. Registration details are explained in the ‘How to become a donor’ link of this website.

By choosing to be a donor you give other people the choice of life.