Organ Transplanta+on

Luis Baquero
Consultor Cirurgia Cardiotoracica
Diretor Heart Center .Hospital Cruz Vermelha Portuguesa

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Types ofTransplants

• Autograft

• Allograft

• Isograft

• Xenograft
 TYPES
• Autograft - A transplant of tissue from one to
oneself Skin grafts, vein extraction for CABG,
storing blood in advance of surgery

• Allograft - Transplanted organ or tissue from a

genetically non – identical member of the
same species
• Most human tissue and organ transplant
 TYPES
• Isograft -A subset of allografts in which organs or
tissues are transplanted from a donor to a
genetically identical recipient (e.g. identical twin)
• Anatomically identical to allografts, closer to
autografts in terms of the recipient’simmune
response
• Xenograft -Replacement of an individual’s defective
organ with an organ harvested from another species
- Source of organs for human use: primates (genetic
similarities to humans) and pigs (large availability)
 Organ and TissueTransplantation

• Cornea
• Kidneys
• Skin
• Bone marrow
• Heart and heart valves
• Intes8ne
• Bone
• Lung
• Liver
• Pancreas
 Organs that can be transplanted are:
Heart Kidneys Liver
Thymus

Lungs Pancreas Intesti

ne
 Tissues that can be
transplanted are:
Bones Tendons Skinof
Cornea face

H e a r t valves Skin V
of leg ein
 Who CanDonate?
Who can donate an organ?

Just about anyone, at any

age, can become an organ
donor.
Anyone younger than age18
needs to have the consent of a
parent or guardian.
For organ donation after death,
a medical assessment will be
done to determine what organs
can be donated.
Determining Brain Death and the Uniform Brain Death\. Act
• Irreversible coma

• Unresponsive to all stimuli

• Absence of spontaneous muscle
Activity

• Irreversible cessation of
circulatory and respiratory
function

• Isoelectric electroencephalogram
(EEG) for 30 minutes
Determining Brain Death and the Uniform Brain Death\. Act
 • Types of Living Donor Transplants
• Kidney (entire organ)
The Different • Liver (segment)

Types of Organ • Lung (lobe)

• Intestine (portion)
Donors: • Pancreas (portion)
• After brain death
• Kidney

ü Living • Heart
• Liver
ü Relative • Lungs
• Pancreas
ü Stranger • Intestine
• Heart valves
ü Cadaver • Connective tissue
• Cadaver
• After natural death
• Cornea
• Bone
• Skin
• Blood vessels
 Dadores e parade cardiaca : Expandendo as possibildades
• O número de doadores convencionais vem diminuindo em razão de dois fatores
principais:
• Menor número de pacientes vem a falecer de trauma e eventos cérebro-vasculares
• A parada cardiocirculatória na UCI re@ra uma parcela significa@va de pacientes que
não atendem aos critérios de morte encefálica. A u@lização destes órgãos é
dependente da extensão do tempo da chamada isquemia morna, isto é, o tempo
até que o órgão seja irrigado com solução de preservação. Apenas aqueles
classificados como categoria 3 ou 4, segundo a classificação de Maastricht estariam
aptos para doação de órgãos10,65,66.
How are organs allocated?
• ABO blood type

• Medical urgency

• Time on the waiting list

• Geographic location
Howareorgans allocated...?
•ABO blood type
TRANSPLANTES EM PORTUGAL

Portugal atingiu, em 2017, o segundo lugar na

lista mundial de países com mais órgãos de
dadores falecidos, num universo de 50 países,
onde estão representados todos os países
ocidentais. Em 2016, Portugal ocupava a
terceira posição e, em 2015, o quarto lugar.
Organ Donor Waiting list:
Organ Donor Waiting
list:
Prioritizing Patients for Transplantation
• Each organ type has its own individual distribution policy

• Patients who are close biological matches with a particular donor

offer are given priority

• Patients whose medical status is most urgent receive priority

• Organs are offered locally first

• Children are often offered priority

• Wait time is used to break ties between patients who are similar
Transplant rejection Signs & Symptoms
• Hyperacute • Pain at the site of the
• Occurs minutes to hours after transplant
transplantation
• No treatment (organ must be • Feeling ill
removed)
• Flu-like symptoms
• Acute
• Occurs days (one week) to
• Fever
months after transplantation • Weight change
• T- cytotoxic lymphocytes
attack the transplanted organ • Swelling
• Chronic • Decreased urine output
• Occurs over months to years
• Most common in lung
transplants