Organs are Allografts, Too!

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Did you know that organs are also a type of allograft? We usually think of skin, tendons, bone, and heart valves as allografts, but solid organs are also allografts, which are defined as “a tissue or organ obtained from one member of a species and grafted to a genetically dissimilar member of the same species.”1

Deceased organ donors can donate two kidneys, one liver, two lungs, one heart, one pancreas, and their intestines. Living organ donors can donate one kidney, one lung, or a portion of their liver, pancreas, or intestine.2 Approximately 115,000 people, including children, await organ transplants in the United States right now. 82% of individuals waiting are waiting for a kidney. There are 8,000 deaths each year in the U.S. because donated organs are not procured in time. 683,000 transplants have taken place in the U.S. since 1988.3

To qualify as an organ donor, blood flow and oxygen must have not been interrupted to organs before tissue recovery, to ensure organ viability. As a result, organ donation requires an individual die under circumstances resulting in a fatal brain injury; usually a massive trauma to the head results in bleeding, swelling, or lack of oxygen to the brain which leads to a lack of brain or brainstem activity and brain death. After all efforts to save the patient’s life have been exhausted, a search is conducted to determine if the patient has personally authorized donation or, if not found on the registry, the next of kin or authorized representative is contacted to be offered the opportunity to authorize donation. Once authorization is obtained, medical and social history is collected from the family. Donation and transplantation professionals determine, based on this information, which organs can be donated and match those organs to patients on the national transplant waiting list.4

In 2014, hands and faces were added to the organ transplant list to be collected from deceased donors.2 The first modern hand transplant was performed in France in 1998. The first hand transplant in the United States occurred one year later, in 1999 in Louisville.5 Less than 100 people have received hand transplants in the world, and less than 30 have received hand transplants in the U.S., largely because of concerns about the risk of rejection, the risks of long-term immunosuppression, and the high level of function that can be obtained with modern prosthetics.6  Hand transplants are still considered experimental by most insurance companies because of a lack of evidence as to their effectiveness; the first hand transplant recipient in France stopped taking his immunosuppressants within two years and requested his transplanted hand be removed, while the first American with a double hand transplant complains that he “can do absolutely nothing” with his transplanted hands, and explored the possibility of getting them removed.5,6

A face transplant is a procedure that replaces all or part of a patient’s face with that of a donor. This is usually performed on individuals who have suffered extreme disfigurement to the face such as through burns, trauma, birth defects, or diseases. Those with severe disfigurement are often ostracized by society for not looking “normal,” and, as the tissue is delicate, they may also have issues with eating and talking. The first face transplant was performed in France in 2005. In 2007, the first full-face transplant was conducted, also in France. The first near-total face transplant was performed in the United States in 2008 at the Cleveland Clinic, which was also the first face transplant to be conducted in the U.S.7 Faces are at higher risk for rejection than solid-organ transplants, since they involve so many different kinds of tissue including muscles, nerves, blood vessels, bones, and skin. Preventing rejection requires a lifetime of taking high doses of immunosuppressive drugs, which makes the patient vulnerable to infections and diseases, especially lymphomas and other cancers.8 The first face transplant recipient, Isabelle Dinoire, developed two types of cancer as a result of prolonged use of immunosuppressants and anti-rejection drugs, eventually leading to her death in 2016.9 Because of concerns about the risks to the procedure, and its relative newness, it is still considered an experimental procedure. Face transplants have also been conducted in several other countries, including Spain, Turkey, China, and Poland.9

A newer, amazing application of allografts are penis transplants, which show incredible promise for restoring urinary function as well as, hopefully, sexual functioning. South Africa has successfully conducted two penis transplants from deceased donors.10 In 2016, Massachusetts General Hospital conducted the first penis transplant in the United States utilizing a genitourinary vascularized composite allograft (GUVCA)—which means it included arteries, veins, nerves, urethra, and skin graft pedicle to properly restore appearance and eventual function.11 Johns Hopkins School of Medicine in Baltimore conducted the first total penis and scrotum transplant in the world in 2018. Utilizing tissue from a deceased donor, they transplanted skin, muscles and tendons, nerves, bone, and blood vessels to repair an injury the patient received serving as a soldier in Afghanistan from an IED.12

As transplant medicine progresses, we may see more successful outcomes with these more complex and challenging types of transplants, which promise to improve the quality of life of many more people.

References

  1. Random House. (2018). Allograft. Dictionary.com. Retrieved from https://www.dictionary.com/browse/allograft
  2. U.S. Department of Health & Human Services. (2018). What can be donated. Organdonor.gov. Retrieved from https://www.organdonor.gov/about/what.html
  3. Donate Life America. (2018). Organ, eye and tissue donation statistics. Retrieved from https://www.donatelife.net/statistics/
  4. Donate Life America. (2018). Deceased donation. Retrieved from https://www.donatelife.net/types-of-donation/deceased-donation/
  5. Skelly, L. M. (2011, March 28). Rare hand transplant surgery successfully performed at Emory University Hospital. Emory University. Retrieved from http://shared.web.emory.edu/whsc/news/releases/2011/03/rare-hand-transplant-surgery.html
  6. Duke Health. (n.d.). Hand transplant: Vascular composite allotransplantation. Retrieved from https://www.dukehealth.org/treatments/transplant-program/hand-transplant
  7. NYU Langone Health. (n.d.). Facial transplant: Eye of the beholder? High School Bioethics. Retrieved from https://med.nyu.edu/highschoolbioethics/briefs/facial-transplantation-eye-beholder
  8. Connors, J. (2018, September). How a transplanted face transformed Katie Stubblefield’s life. National Geographic. Retrieved from https://www.nationalgeographic.com/magazine/2018/09/face-transplant-katie-stubblefield-story-identity-surgery-science/
  9. BBC. (2016, September 6). First face transplant patient Isabelle Dinoire dies in France. BBC News. Retrieved from https://www.bbc.com/news/world-europe-37290986
  10. Akwei, I. (2017, May 23). World’s third penis transplant successfully done in South Africa. Africa News. Retrieved from http://www.africanews.com/2017/05/23/world-s-third-penis-transplant-successfully-done-in-south-africa/
  11. Brown, N. (2016, May 16). First Genitourinary Vascularized Composite Allograft (penile) transplant in the nation performed at Massachusetts General Hospital. Massachusetts General Hospital. Retrieved from https://www.massgeneral.org/News/pressrelease.aspx?id=1937
  12. Kooser, A. (2018, April 23). Wounded US soldier gets first penis and scrotum transplant. CNET. Retrieved from https://www.cnet.com/news/soldier-gets-first-penis-and-scrotum-transplant-johns-hopkins/