If you tell an organ transplant patient there will be no need for immunosuppressant drugs anymore without a risk for rejection, what would be the reaction?  I think there would be a suspicious reaction at first and then a big sigh of relief.  Nobody else is better informed than these patients regarding the risks and side effects of anti-rejection therapy.  This is the only way known to transplant specialists to keep the graft working and the patient alive.  Hope is on the way.  Not one, not two but three studies came out this week in the Science Translational Medicine suggesting that one day it could be possible.

One of the study is led by Britains Oxford University Andrew Bushell and calls for retraining or reprogramming  the patient owns Treg-cells (regulatory T-cells: those white blood cells” role is to suppress our own immune system response as needed).  The goal would be for those T-cells to recognize the transplanted organ as friendly instead of an intruder like it is now.  If that can successfully be done in human (it has been accomplish with mice in the research), the regulatory T-cells would do the current job of the anti-rejection drugs.  The patients” own regulatory (AKA suppressor) T-cells would prevent the body’s immune system from attacking the transplanted organ and as a result will decrease the risk of rejection.

Basically, those T-cells are like the police of the immune system; they keep the other kind of white blood cells under control so they don’t attack continuously the body.  They regularize the immune system just like the name defines it.  That would potentially eliminate the need for powerful drugs like neoral, prograf, rapamune and cellcept to name a few in the long run.  In the immediate transplant phase, those drugs are still expected to be given as the T-cells are reprogrammed in a lab.

That study was conducted on mice in a lab we are years away from testing that on humans but it is a promising start.  This would be a major breakthrough in improving graft and patient survival.   By having less rejection and longer graft survival, more people could be transplanted with the same number of organs available.  The reason being less people needing a second transplant.  Also, there should be less complications caused by the current drugs like kidney failure and skin cancer by example.  Those two complications are very common and debilitating.  Their respective treatments, dialysis and chemotherapy,  can be very expensive too.

Another important point in the study was the fact that the regulatory T-cells would still be able to recognize infections and cancer as a threat to the body.  Therefore, they will get out of the way of the attacking white blood cells.  The other good news is it could also benefits the patients with autoimmune disease who are taking medications similar to the transplant patients to weaken their immune system.

In short, this could be a major breakthrough for the transplant community and their patients if it ever becomes available at the bedside to treat real people.

Source:http://www.reuters.com/article/2011/05/18/transplants-cells-idUSLDE74H09B20110518

If you live in China and you happen to believe in the wrong religion and have the bad luck of getting caught and put in jail, you have a really good chance of becoming an organ donor without your consent. This is what happened to thousands of people just about every year.  Most of them are executed and then become organ donors. Those prisoners are from the Falun Gong spiritual group who has been persecuted by the government for years and kept in labor camps. They seem to keep a match list from the prisoners and execute them as needed.

Obviously this has brought bad press to the transplant community in China where the government is now trying to start a registry program just like here in the US and other industrialized countries. Without a big surprise, up to 90% refused to sign it for several reasons ranging to lack of trust in the system to personal beliefs.

Here in the US, once someone signs the organ donor registry, they automatically become potential donors.  It is unclear how the whole registry thing works over there but I bet some people don’t trust the government if they sign it.

In China, last year, only 28 persons in the entire country gave their organs according to a Legal Evening News report.  There are about 13,000 transplants every year, so, if you do the math you start wondering how many prisoners got executed for their organs.  There are a lot of conflicting reports on the source of the organs. Amnesty International said in its 2009 report that China executed at least 1718 prisoners.  Where are the other 10,000 organs coming from?  Your answer is as good as mine.

Source: http://www.theepochtimes.com/n2/china/chinas-new-organ-donation-registry-unlikely-to-take-off-55639.html

I have read a lot of misinformation lately about Steve Jobs regarding his 2009 liver transplant.  Even at the time it was make public a couple of years ago, that misinformation was coming out.  A lot of people are saying that Steve Jobs received a liver transplant by bypassing the waiting list.  I will tell you that it is impossible because the rules are so strict.  A transplant center can be put on probation or even be shut down by UNOS (United Network for Organ Sharing) for doing such things.  UNOS is the government contractor who manages organ allocation and enforces regulations.  There is no way a transplant center will risk its future just to transplant a known person.  I am sure they kept good documentation of what they did just in case complaints like these would come back.

Reasons for his Fast Liver Transplant

Steve Jobs just did what a lot of Americans would do if they had the money; they would pick the hospital that gives them the best chance to be transplanted quickly.  This is why he went to Methodist University Hospital in Memphis, Tn.  This hospital performs about 120 liver transplants a year which is way more than the average hospital.  They also have a really good outcome: 90% of their patients are alive after a year with the national average being of 84%.  The main reasons he choose that transplant center is because of their short median wait time of 2 months.  This is really short.  The average wait time for a hospital in California for a liver transplant is 5 years!!  It really makes sense now why he went to Tennessee and it did not take time.  All the information I am giving you is available to the public.  The organ transplantation world is so regulated and monitored that there are tons of transplant statistics available.

Wait List

I forgot to mention that a transplant recipient can be on the wait list of more than one transplant center as long as the patient meets the criteria.  Usually, transplant hospitals want their patients to live within 2 to 3 hours of the hospital.  Let’s pretend Steve Jobs had a private jet, I guess he did, he could have lived in a central location, be on several hospitals wait list and be on stand bye to fly when he gets the call for his liver transplant.  That would have been theoretically possible but hard to manage.

Nothing Wrong

Basically anybody could have done what Steve Jobs did as long as you can afford it.  People are shopping for transplant centers every day in this country for diverse reasons.  Patients from overseas are even coming to the states to be transplanted.  Steve Jobs did nothing wrong, he could just afford what a lot of people couldn’t but would do.

Pig Cornea

According to a group a scientists from Pittsburgh University, pigs are to be used sooner than later for human organ transplantation. In fact they are planning to start using the cornea from genetically modified pigs into human with poor eye sights. As you may already know, pig valve is already being used in human with much success for years. In order to have the organ accepted by the human body, the pig protein galactosyltranferase (you don’t need to remember that 🙂 ) has to be removed so the corneas are not rejected.

How about Lung, Liver and Heart?

Solid organ transplantation from pigs (heart, lungs, liver) is several years away to be ready thought. Many issues have occurred, such as bleeding, clotting and organ failure during and after surgery. Scientists have transplanted pig organs in non-human primates for research but within months at the most, all organs had failed. There is also a major concern of transmitting animal viruses into an immune deficient human body which could cause a pandemic at the worst.

Controversy?

Another hurdle that scientists need to account for is groups for animal rights. These people will surely come out in force if pigs are used in mass for organ transplantation one day. In the mean time, scientists expect to be ready by the end of 2013 for corneal transplantation from pigs to human. We’ll see.