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  • No one likes being at the DMV, but it's time to fill out that license renewal form.

  • It's mostly routine - name, address, and other information - but there's one box

  • that sticks out.

  • It readsDo you wish to be an organ or tissue donor?”.

  • You've heard about organ donation of course, but you're not really sure what it entails

  • - and you've got to decide whether to sign up for it right now!

  • What actually happens when you donate your organs?

  • Around the world, countless people are sick because one of their organs isn't functioning

  • properly.

  • This could be due to an injury requiring the removal of an organ, an illness that causes

  • damage to the cells in the organ, or a genetic condition that slowly degrades the function.

  • In past times, there was little way to save someone with a malfunctioning necessary organ,

  • although some artificial methods like dialysis were developed.

  • But in the 19th century experiments began in transplanting a healthy organ from a donor

  • to a new recipient.

  • The earliest attempts at organ transplant were called autografts and involved skin - transplanting

  • skin from a healthy area of a person's body to a damaged area on the same person.

  • Some reports indicate this technique was created by the Indian surgeon Sushruta over 2000 years

  • ago, and later continued by Italian surgeon Gasparo Tagliacozzi

  • The science of organ donation, though, had a long way to go.

  • Experiments in transplanting parts from one person to another may have gone back much

  • further, but lacked the understanding we have today.

  • Roman Catholic doctrine say Saints Damian and Cosmas managed to replace the gangrenous

  • leg of the Roman Emperor Justinian with the leg of a dead Ethiopian man.

  • If it happened, it would have been a miracle - even today most amputees are still limited

  • to state-of-the-art prosthetics, with limb transplants still being a work in progress

  • and very rare.

  • Other reports say Pien Chi'ao, an early Chinese physician, performed a double heart

  • transplant between two men to balance their spirits.

  • But all these reports are apocryphal and heavily doubted by modern scientists.

  • It would be centuries later before doctors would find the trick.

  • Transplant of organ or tissue to a different donor is called the allograft, and it wasn't

  • until 1837 when the first successful attempt was made - on a Gazelle, who had been used

  • for experiments on corneal transplants.

  • Once it was successful, it would be Doctor Eduard Zirm in the Czech Republic who performed

  • the first successful transplant of a cornea on a human.

  • The next step would be transplanting of Thyroid tissue to replace an organ's function, performed

  • in 1883 by Doctor Theodor Kocher - twenty-two years before Zirm's breakthrough.

  • While this was successful, tissue was working and organs weren't - yet.

  • That changed in 1954.

  • Richard Herrick was a Navy man who was gravely sick with kidney failure.

  • His brother Ronald was willing to do whatever was needed to save him, and Dr. Joseph Murray

  • believed he could help.

  • He performed a kidney transplant, and unlike past unsuccessful cases where recipients lived

  • less than a month, Richard lived another eight years!

  • Dr. Joseph Murray received the Nobel Prize, but there was one key to this surgery that

  • wouldn't be easy to duplicate.

  • The Herrick brothers were identical twins and had identical genetics, meaning the kidney

  • transplant was essentially an autograft.

  • But not everyone has an identical twin to be their perfect donor.

  • So what's the trick to making organ donation work?

  • Preventing rejection.

  • Our bodies are complex, and two key elements have to match for an organ to be a suitable

  • match for a person.

  • The first is blood type, and there are four blood types - each with different compatibility

  • for donation.

  • While type O blood is considered the universal donor and is the most common, type A, B, and

  • AB are progressively more limited in who they can donate to.

  • Then it's on to HLA typing, to make sure the proteins, or antigens, in the body cells

  • won't conflict.

  • If the antigens are different, the body can make antibodies against their new organ and

  • reject it.

  • That's where the wonder of modern medicine comes in.

  • While perfect matches on HLA type are rare, medicine is available to keep the body from

  • creating these antibodies.

  • These anti-rejection medications are prescribed to people after almost all transplants, and

  • most people wind up taking these drugs as long as they have their transplanted organ

  • - so ideally, their whole life.

  • Medical science marched on, and with the development of anti-rejection drugs, it became possible

  • to transplant many organs that people couldn't live without.

  • So what organs are transplanted today?

  • Besides corneas and kidneys, which started it all, today heart, lung, and liver transplants

  • are common.

  • Pancreas and intestine transplants are less common but possible, and tissue transplants

  • of skin, bone marrow, and blood are almost routine.

  • Experiments in transplanting hands and arms have been performed, but preventing rejection

  • is far trickier and many have failed after a period of time.

  • There are even experiments in transplanting a uterus so that a woman who has had a hysterectomy

  • can carry children.

  • The most stunning recent advancement in transplant science, though, is also the most visible.

  • In the last twenty years, scientists have successfully managed to transplant whole faces!

  • When dealing with patients who have been seriously disfigured from gunshots, industrial accidents,

  • fires, or animal attacks, they take the facial tissue from a donor and place it on the surgically

  • prepped facial surface of the disfigured recipient.

  • After transplant, the face eventually shifts to the skeletal structure of the donor, so

  • they don't look exactly like they did before - but not like the donor either.

  • This surgery requires vigilance with anti-rejection medication, but was successfully performed

  • first as a partial face transplant on a woman who lost all the skin on her lower face in

  • a dog attack.

  • This led to full face transplants being performed around the world.

  • But in almost all these cases, the donors had one thing in common.

  • They were all dead.

  • The most common type of organ donation today is from a cadaver to a living donor, and this

  • is what you're being asked when you sign on that dotted line.

  • You're agreeing that should you meet an untimely end, your organs will be harvested

  • from your body before you're buried or cremated.

  • Those will then be given to people who need them, letting you live on beyond your body.

  • There's no real downside - you don't need them anymore, right?

  • So why wouldn't everyone sign up?

  • Well, some object because of religious rules, and others worry that the doctors wouldn't

  • work as hard to save them in the hospital if they saw that their organs would be harvested.

  • But there is no evidence of that, and doctors say that the more people who sign up as organ

  • donors, the better.

  • So what happens when an organ becomes available?

  • Organ donors whose organs can be used are usually in good health, with their organs

  • functioning well.

  • But anything can happen, and a piano can fall on the head of anyone at any time.

  • If a person is dead or brain dead and they're an organ donor, the hospital springs into

  • action to keep the organs in good condition until the time.

  • If someone is still clinically alive, they may be kept on life support longer than usual

  • to keep their organs healthy.

  • If they didn't have a directive either way on whether they're an organ donor, the doctors

  • will often ask the grieving family if they would be willing to sign the papers - but

  • it is always up to the person or their family.

  • From there, the organs will go to the next person on the organ donation list.

  • Wait, there's a list?

  • In the United States, the United Network for Organ Sharing oversees the transplant system

  • for most cases, keeping a registry of everyone who is in need for an organ.

  • When an organ comes in, they filter it by compatibility, size, and geography to give

  • the transplant the best chance for success.

  • Each person's place on the list is determined by their medical urgency, their waiting time,

  • and their age - with younger recipients being higher on the list.

  • The things that don't play a role?

  • Income, insurance status, or celebrity status.

  • If you wind up on the organ donation list, it doesn't matter who you are - the factors

  • are always the same, and you can't buy your way into a higher slot ahead of someone who

  • needs it.

  • And when the time comes, the organ donation team moves fast.

  • A patient comes in and can't be saved.

  • They are assessed for organ health and matched to a recipient.

  • The organs are harvested and chilled until use, but the clock is ticking.

  • Doctors will try to find a match as close as possible, but if a high-priority recipient

  • is far away, they will transport that organ via courier with the highest priority.

  • The goal is to get it to the hospital for transplant while it's still fresh and keep

  • it from getting damaged - although, despite what a TV show once showed, there are no reports

  • of transplant hearts getting eaten by dogs along the way.

  • The problem is, there are a lot more people in need of organs than there are organs available,

  • especially for those with rarer blood types.

  • That's why there's another way.

  • If you sign up to be an organ donor, the only time this will be relevant is if you're

  • dead or almost dead.

  • But since the first living donor transplant between the Herricks, living donor transplants

  • have become more common, especially for rare blood types who could be waiting a long time.

  • Approximately one in three donors of kidneys is now still living, and it's common for

  • them to be from family or close friends of the person who needs a kidney.

  • Doctors will assess the person's physical and mental health and the health of their

  • organs, and make sure they're not under any duress.

  • But what happens if someone doesn't have anyone they know willing to donate a kidney?

  • The advance of the internet and social media have given new hope.

  • People with a rare blood type have put out blasts on social media, asking for help to

  • find a donor.

  • In 2009, Chris Strouth managed to find a kidney donor on Twitter.

  • And when there's no direct match, a new possibility has emerged - kidney chains.

  • This is when someone gives a kidney to someone other than their loved one, in exchange for

  • one being given by another donor to theirs.

  • This can be as simple as a swap between two families, but for more complex cases, open-ended

  • chains have begun.

  • This can develop into a long, elaborate chain connecting dozens of families and giving one

  • person in each a new lease on life.

  • So what's donating a kidney like for the donor?

  • Donating a kidney is a serious operation, but not usually one with any complications.

  • While some surgeries are more invasive than others, with minimally invasive laparoscopic

  • surgery becoming more popular, it's common for a hospital stay for a donor to be between

  • four and six days.

  • Afterwards, it's mostly a matter of letting the incision heal, and heavy lifting and contact

  • sports should be avoided for about six weeks.

  • The most common risk during the surgery is serious bleeding, but it's a rare complication

  • and doctors are good at preventing damage.

  • After the surgery, donors can live a normal life - although they should be more careful

  • to protect themselves from injury, as they only have one kidney remaining.

  • And there is one perk of donating a kidney - if you should need a kidney donation later

  • in life, being a previous living donor bumps you up the list.

  • But have doctors perfected the art of living donations for any other organs?

  • Yes and no.

  • Most of our organs, we only have one or need both - like lungs.

  • But for liver transplants, it is possible to transplant a lobe from a living donor's

  • liver to someone who is dying of end-stage liver disease.

  • This was originally common for parents to give a part of their liver to save their sick

  • child, who wouldn't need a full-sized adult liver.

  • As this involves cutting into an organ, the risk of complications for the donor is higher

  • than with kidney donation, but the need for blood transfusions are still rare and most

  • donors recover in two to three months.

  • Sounds like living donors are usually pretty safe.

  • And you only need one kidney, right?

  • Many people have asked the question - if I can save a life with a kidney and I only need

  • one, can't I sell my kidney to someone in need?

  • Well, that's illegal.

  • Despite a worldwide shortage of organs available for transplantation, organ donation for profit

  • isn't allowed in any country but Iran.

  • While some have argued that the potential good outweighs the ethical issues, experts

  • say that allowing the sale of organs would encourage corruption, lead to the poor selling

  • organs to survive, and give a boost to the black market where kidneys could be harvested

  • from trafficking victims.

  • The oversight on this is serious - while the medical costs of donors are usually paid for

  • through insurance, any financial incentive such as a gift from the recipient family could

  • be seen as a bribe, and is grounds for the transplant to be called off by the hospital's

  • ethics team.

  • As of 2020, there are over a hundred thousand candidates on the waiting list for organ transplants

  • in the United States alone.

  • The wait for a heart or liver transplant can be close to half a year, while those with

  • the highest priority rating on the heart transplant list can still wait over two months on average.

  • So the people at UNOS are hoping everyone who qualifies checks yes on that organ donation

  • form - they need every organ they can get.

  • For more on the black market organ trade, check outHow Much Is an Entire Human Body

  • Worth?”, or check out this video instead.

No one likes being at the DMV, but it's time to fill out that license renewal form.

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This is What Happens When You Donate Your Organs

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    林宜悉 posted on 2021/02/07
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