Transplantation: Uses, Chronology, Complications and Advances

A transplant is the exchange of an organ that does not function properly for one that does. To do this, organs must be obtained either from a deceased person or, in some cases, from a living donor who donates altruistically.

The organs that can be transplanted are the heart and lungs for the thorax, and the liver, pancreas, small intestine and kidney for the abdomen. All of them currently offer excellent results and a great improvement in the quality of life of the patients.

Even so, one of the transplants with the greatest impact is the liver, since there is no alternative therapy when there is terminal liver failure or liver cancer.

There are complications that can affect the success of a transplant. The most feared of these is that the transplanted organ may not function properly due to damage caused during the preservation period. Other complications can be related to surgical technique or graft rejection. To avoid the latter, recipients must take immunosuppressive medication on a permanent basis, which can also have adverse effects.

Chronology of a transplant

1. Evaluation of the potential donor: Does he/she meet the established criteria for donation, is he/she suitable, are there any contraindications?
2. The most suitable recipient is sought for each organ. The transplant coordinators contact the different transplant teams.
3. The organs are harvested and the recipients are prepared at the corresponding hospital.
4. The harvesting teams travel to perform the harvesting. This process has to be very coordinated, as it involves different teams. In the event that the organ is not accepted, the recipient’s team is notified to stop the transplant. If the organ is accepted, the recipient is finished being prepared and the transplant surgical team is activated.
5. After surgery, the recipient goes to the ICU for a few hours or days (depending on his or her condition) and then to a conventional room. During the first few days, the function of the transplanted organs is monitored and immunosuppression protocols are initiated to prevent rejection. Infection is also fought against and attempts are made to avoid possible vascular thrombosis.
6. The patient’s pre-transplant condition largely determines the speed of recovery. After discharge, the recipient must be systematically monitored and his or her medication must be modified.

Advances in transplantation

Transplantation is a technique that has been in development for 50 years and, although there are fewer notable milestones today because it is already a very safe and effective solution, it is constantly evolving. For example, in the case of liver transplantation, the new antivirals against hepatitis C virus allow a very important improvement in infected patients after transplantation.

The problem of transplantation remains the lack of donors compared to the great need. With the aging of the population, donors are getting older with each passing year and, in addition, it is necessary to use donors who may have died of cardiocirculatory problems, which means that their organs may be of poorer quality.

Even so, work is being done on techniques to improve organ quality through better preservation. Another promising line of work in transplantation is the induction of tolerance and the study of biomarkers to reduce or avoid immunopressor treatment and its associated toxicity.

In the field of implants, Spain is an example and a world leader. This is due, in large part, to the establishment of a national transplant organization, with a team of professionals who structure the donation process, and to the great response of the population. On the other hand, the medical and surgical teams dedicated to the process also do a very high quality job.