By Roy Calne
In the earlier few years the transplantation of organs in guy has bought exposure extraordinary in clinical heritage. the 1st middle grafts have been lined through press, radio, and tv on a scal~ equiva lent to the inside track of the outbreak of an incredible conflict. Unwarranted and indulgent optimism has been through sour feedback. This has undermined public self belief within the clinical occupation and heavily impeded development in a tremendous endeavour geared toward lowering human agony. This unlucky state of affairs has arisen from common lack of expertise among the general public and the clinical occupation of the heritage, current achievements, and destiny strength of organ grafting. brief statements by means of specialists, usually misquoted or lower brief by means of tv interviewers, and misinformed derogatory pronouncements by means of prejudiced medically certified males, without wisdom of the sector, have produced a sorry kingdom of misunderstanding. it's the objective of this publication to try to elucidate organ transplantation. the rules of organ transplantation are universal to all organs yet i'm going to confine lots of the dialogue to transplantation of 4 very important organs, particularly the kidney, liver, middle, and lung. ROY CALNE Cambridge January 1970 CONTENTS Preface IX checklist of Illustrations Xlll Acknowledgements XVll I. the assumption I II. THE surgical procedure 7 III. REJECTION 15 IV. PREVENTION OF REJECTION 23 v. TISSUEMATCHING 39 VI. ORGAN renovation forty seven VII. appropriate DONORS fifty three VIII. ORGAN TRANSPLANTS fifty seven IX. ETHICS AND THE legislation eighty one X.
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Extra info for A Gift of Life: Observations on Organ Transplantation
From the above consideration of immunosuppression it is obvious that our currently available agents are far from ideal. Toxic drugs PREVENTION OF REJECTION and foreign protein inj ections are certainly not treatments of choice except as a last resort in an emergency situation. This unfortunately is the exact plight of a patient in need of a vital organ transplant, so until safer specific biological methods of immunosuppression become available, we must fall back on Imuran, steroids, and ALG. 37 CHAPTER FIVE TISSUE MATCHING In Chapter Three the inheritance of histocompatibility antigens that determine rejection was mentioned.
They may be the result of previous pregnancies, blood transfusions, or graft rejection, so it is particularly important to test for such antibodies in patients with a history of these conditions. To transplant a graft in the presence of antibodies that kill donor lymphocytes can result in immediate and disastrous hyperacute rejection of the transplant. 45 CHAPTER SIX ORGAN PRESERVATION The rapid deterioration of an organ deprived of its blood supply was referred to in Chapter Two. Individual organs differ in their susceptibility to ischaemic damage.
The most successful apparatus, so far designed, pumps diluted cold blood through the liver. The perfusate is oxygenated under high pressure. The disadvantages of this type of apparatus have been mentioned, but it can allow 4 hours additional preservation time compared with simple cooling. 50 ORGAN PRESERVATION Current methods of preserving organs fall far short of the ideal of an 'organ bank'. Many difficulties must be overcome before we can keep organs in the same way that blood is banked. (j /1 Diagram of a simple method used to cool the liver immediately aftcr death.