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This review covers key issues in organ transplantation, focusing on ethical considerations and organ availability. It highlights current transplantation frequencies and survival rates for end-stage organ disease patients.
Area of Science:
- Transplantation Medicine
- Organ Availability
- Graft Survival Rates
Context:
- Current state of perfused organ transplantation.
- Ethical and legal considerations in living donor transplantation, brain death, donor consent, and organ allocation.
- Impact of donor and organ availability on transplantation frequencies for end-stage organ disease.
Purpose:
- Highlight key issues in transplantation medicine today.
- Summarize basic information on the current state of perfused organ transplantation.
- Emphasize ethical and legal considerations in organ donation and allocation.
Summary:
- Organ donor rates of 25-30 per million inhabitants may suffice for kidney replacement therapy, while 15-20 liver transplantations per million could meet needs for non-malignant end-stage liver disease.
- Techniques like split liver transplantation can increase organ utilization.
- One-year graft survival for kidney transplants is 85-90%; patient survival for heart and liver transplants exceeds 80%.
Impact:
- Whole organ transplantation for kidneys, hearts, and livers are routine; lung transplantation is nearing standard status.
- Long-term graft survival depends on chronic rejection, patient comorbidity, and original disease.
- While technically established, the indications for pancreas and combined pancreas-kidney transplantation remain controversial.
Abstract:
Purpose of this review is, to highlight key issues in transplantation medicine today and to summarise basic information on current state of perfused organ transplantation. There is special emphasis on ethical and legal considerations with regard to living donor transplantation, brain death concept, donor consent and organ allocation. Transplantation frequencies and the impact of whole organ transplantation on the treatment concept for patients with end stage organ disease is heavily dependent on donor and organ availability. Organ donor rate of 25 to 30 donors per million inhabitants per year seems to yield sufficient organ supply for patients on renal replacement therapy. 15 to 20 liver transplantations per million inhabitants per year, my be sufficient, to cover the need of organs for non malignant end stage liver diseases. This frequency may be achieved by increasing donor rates and employing "split techniques", where one liver is used for two recipients. One year graft survival in kidney transplantation can be expected to be between 85 and 90%, one year patient survival in heart and liver transplantation can be expected to be beyond 80%. The risk of organ failure is highest in the first year, long term results are dependent on incidence of chronic rejection, comorbidity of the patient and original disease. Patient- and/or graft loss after the first year is in the order of 1 to 5%. Whole organ transplantation for kidneys, hearts and livers are considered routine procedures, lung transplantation is reaching standard phase, pancreas and combined pancreas kidney transplantation is well established technically, but its indication is still controversial.