Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the person's own body, to replace the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the person's own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called auto grafts. Transplants that are recently performed between two subjects of the same species are called allograft. Allograft can either be from a living or cadaveric source.
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Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through stereotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant.
Successful human allotransplant have a relatively long history of operative skills that were present long before the necessities for post-operative survival were discovered. Rejection and the side effects of preventing rejection (especially infection and nephropathy) were, are, and may always be the key problem.
Several apocryphal accounts of transplants exist well prior to the scientific understanding and advancements that would be necessary for them to have actually occurred. The Chinese physician Pien Chi'ao reportedly exchanged hearts between a man of strong spirit but weak will with one of a man of weak spirit but strong will in an attempt to achieve balance in each man. Roman Catholic accounts report the 3rd-century saints Damian and Cosmas as replacing the gangrenous or cancerous leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian. Most accounts have the saints performing the transplant in the 4th century, many decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure.
Transplanting organs, replacing old worn-out organs with healthier ones, has long been a dream in medicine. Several attempts were made in 1901 in Vienna, where investigators tried to transplant kidneys in dogs, pigs, goats, and calves. The exercise turned out to be purely technical due to the lack of understanding of vascular surgical techniques, organ preservation, and immunosuppressant. In 1902, Dr. Alexis Carrel developed the technique of vascular suturing that in principle is still in practice today. Dr. Carrel developed the technique when, in his attempts at transplanting kidneys to the neck of dogs, he found that the organs thrombosed. Believing that the transplants failed due to a simple technical problem, he developed the vascular surgical technique. Thanks to Dr. Carrel, vascular surgery began to develop, but transplantation still had a long way to go.
In 1933, the first real attempt at transplanting a human kidney to a human patient was done by Dr. YuYu Voronoy in Russia. A kidney was taken from a recently deceased individual and connected to a young woman who was suffering from lead poisoning. No immunosuppressant was given. The kidney never functioned. In 1948, Sir Peter Medawar performed experiments that for the first time defined the immunology of transplantation and began to define rejection. For his pioneering work in transplant immunology,...