Transplants

The patient is put into a deep sleep with general anesthesia, and a cut is made through the breast bone. The patient's blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich. The patient's diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart.

A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Kidney transplants are one of the most common transplant operations nowadays. A donated kidney is needed to perform a kidney transplant.

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotropic transplantation, in which the native liver is removed and the donor organ is placed in the same anatomic location as the original liver. Liver transplantation nowadays is a well accepted organ transplant treatment option for end-stage liver disease and acute liver failure.

A bone marrow transplant is a procedure that transplants healthy bone marrow into a patient whose bone marrow is not working properly. Bone marrow is a soft, fatty tissue inside the bones. This is where blood cells (red blood cells, platelets, and white blood cells) are produced, and develop.

In some diseases of the blood cells -- especially cancers such as leukemia -- high doses of chemotherapy may be needed to destroy the cancer. However, this also destroys normal bone marrow and prevents it from making enough blood cells. In other cases in which hereditary or acquired disorders cause abnormal blood cell production, a transplant of healthy bone marrow may correct these problems. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

Bone marrow transplant patients are usually treated in specialized centers. The patient stays in a bone marrow transplant unit, or BMT, to limit exposure to infections.The healthy bone marrow may be taken from the patient before chemotherapy or radiation treatment (autograft). Or, it may be taken from a donor (allograft). The donor can be a relative (usually a brother or a sister), or an unrelated person (found through the national marrow donor program).

Donated bone marrow must match the patient's tissue type. Donors are matched through special blood tests called HLA tissue typing (see HLA antigens). Bone marrow is taken from the donor in the operating room while the donor is unconscious and pain-free (under general anesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered and treated. It can be transplanted immediately or frozen and stored for later use.

The patient is prepared for transplant by getting high doses of chemotherapy or radiation (conditioning). This serves two purposes:

• It destroys the patient's abnormal blood cells or cancer.
• It slows the patient's immune response against the donor bone marrow (graft rejection).

Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 - 20 days for the bone marrow to establish itself. During this time, the patient will need support with blood cell transfusions.

A heart transplant service may be recommended for heart failure caused by:

• Coronary artery disease
• Cardio myopathy (disease of the heart muscle)
• Heart valve disease with congestive heart failure
• Severe heart disease present at birth
• Life-threatening abnormal heart beats that do not respond to other therapy