by Haibo Wang, MBBS MSc MPH, Rotary Club of HK Northwest

Organ transplantation is the surgical procedure of removing the organ(s) from one person and replacing the organ(s) that have failed in another person, which in many cases is the best or the only way to save the patient life. Organ transplantation is one of the greatest advances, and also the most challenging and complex areas of modern medicine. It is often described as the jewel in the crown of the medicine.

The ancient dream of organ transplantation existed in many cultures. The Taoist Text Liezi-Tangwen, (列子·湯問) described the earliest known Chinese physician Pien Chi’ao (扁鵲, 700 B.C.) exchanged hearts between a man of strong spirit but weak will with one of a man of weak spirit but strong will to achieve the balance in each of them. The painting of “Legendary transplantation of a leg assisted by angels” (Figure 1) demonstrated the story of 3rd-century saints Cosmas and Damian replacing the gangrenous leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian.

Figure 1. Saints Cosmas and Damian miraculously transplant the (black) leg of a Moor on the (white) body of Justinian. Ditzingen, 16th century

However, the fantasy of transplantation didn’t come to reality until about 60 years ago. Dr. Joseph Murray from Brigham and Women’s Hospital of Harvard Medical School performed the world’s first successful kidney transplant between the identical twins in 1954, which led to his award of Nobel Prize in 1990. The selection of identical twins was one of the keys for the success, because it bypassed the limitation of their time – the lack of potent drug that can effectively suppress the rejection from patient’s immune system to another person’s organ.

The success with the kidney led to successful attempts with other organs, including liver, heart, pancreas and lung. However, the patient survival of these successful transplants were not satisfactory until the discovery of a drug, named as cyclosporine in 1970, which is sufficiently powerful to suppress the immune rejection to the transplanted organs. It was the advent of cyclosporine that transformed transplantation from research surgery to life-saving treatment, and led to the booms of transplant practice around the world. Nowadays there are dozens of new drugs that could grant the transplant patients’ long-term survival and the quality-of-life same as normal people.

Worldwide, there are more than 100,000 transplantations performed every year. Ranked by their annual numbers from high to low, the solid organs now can be commonly transplanted are the kidney, liver, heart, lungs, pancreas and intestine.

The success of transplantation powered the sharp increase of demand for transplantable organs. Organ shortage is now a universal problem across the world with many patients died on waiting for organs. Organ transplant has become the victim of it’s own success. World Health Organization thus call on accountability of government of each member state to develop an efficient and effective national organ donation system to achieve the goal of self-sufficiency for the need of transplantation of its own people.

The transplant professionals are now developing the cutting edge technology to repair the damaged organs before transplant. So far the organ repairing technology works well on lungs. But the researchers mostly focus on the liver and the kidney, which are the two organs in great scarcity.

Meanwhile, progress made in cell and stem cell biology, material sciences and tissue engineering enabled scientists to create the skin, bladder, vessels and upper airways. The emerging field of regenerative medicine may allow the creation of organs in laboratory, like the fantasies in Sci-Fi movies. Growing functional organs will be much more difficult but theoretically possible, which could be the future of transplantation medicine.

 

Director

Ministry of Health Hospital Quality Monitoring System Research Center
China Organ Transplant Response System Research Center

Assistant Director
China Liver Transplant Registry
The University of Hong Kong

Advisor
World Health Organization
Project SONG and Project NOTIFY

Member
National Organ Donation Committee
National Organ Transplant Committee
Ministry of Health, P. R. China