episode of acute rejection is seldom enough to
cause organ failure, especially when treatment is
prompt.
IMMUNOSUPPRESSIVE AGENTS
TO MINIMIZE ORGAN REJECTIONInduction and Antirejection (up to 30 days)
Atgam basiliximab
daclizumab methylprednisolone
muromonab CD3 rapamycin
Thymoglobulin
Maintenance (long-term)
azathioprine cyclosporine
mycophenolate mofetil prednisone
rapamycin tacrolimus
Chronic organ rejection represents the steady
and slow consequences of the immune system’s
efforts to eliminate the organ, which the immune
system perceives as an “intruder.” At present the
standard of treatment to minimize organ rejection
is lifelong IMMUNOSUPPRESSIVE THERAPY, taking drugs
that suppress the immune response. Doctors mon-
itor immune status and transplanted organ func-
tion with regular BLOOD tests. The risks of
long-term immunosuppression include increased
vulnerability to infection (such as COLDS, flu, and
OPPORTUNISTIC INFECTIONS), which may require
ANTIBIOTIC PROPHYLAXISor ANTIFUNGAL MEDICATIONS.
Long-term immunosuppression also increases the
risk for lymphoma and MULTIPLE MYELOMA, two
cancers of the immune system; when detected
early these cancers are easily treatable. Immuno-
suppressive agents also have numerous drug inter-
actions and potential side effects.
Organ Donation
Nearly anyone can be an organ donor. Most US
states incorporate organ donation permission on
driver’s licenses. A driver’s license is the most
common form of identification Americans carry,
and MOTOR VEHICLE ACCIDENTSare the most com-
mon cause of unexpected death. As well, organ
donation authorization forms are available at hos-
pitals, medical centers, doctor’s offices, public
health departments, and other providers of
health-care services. Some states also have donor
registries. A person age 18 or older can authorize
organ donation for himself or herself; a parent or
legal guardian must authorize organ donation for
a person under the age of 18. It is also a good idea
for a person who desires to donate his or her
organs after death to let a close relative or friend
know of this intention. Such knowledge eases the
decision-making process family members may
face.
Doctors must follow accepted standards of prac-
tice for determining when BRAIN DEATH (irre-
versible loss of complete BRAIN function) has
occurred or the person is pronounced dead, after
which they may seek the family’s permission to
proceed. The removal of donated organs, called
organ retrieval or organ harvesting, takes place in
an operating room under sterile conditions. The
window of opportunity for transplanting a
donated organ ranges from 4 hours after harvest-
ing for a heart, 6 hours for lungs, 12 hours for
liver, and to up to 24 hours for a kidney. Special
preservative solutions and methods (such as pul-
satile perfusion, which moves chilled preservative
fluid through the organ) help keep organs viable
until transplantation.NO COST FOR DONOR ORGANS AND TISSUES
Federal law in the United States prohibits buying
and selling human organs and tissues. Organs
and tissues for transplantation must come from
donors. The expenses associated with organ
transplantation are those of medical care before
and after the transplantation and for the trans-
plant operation and its related costs (such as for
hospitalization). There is no cost for being on the
organ donor registry or for donor organs and tis-
sues.Surgeons carefully remove organs to preserve
them as intactly as possible. Harvesting of hearts
and lungs must be take place before the heart stops,
which requires certification of brain death and
often life support to maintain oxygenation and
BLOODcirculation until the organ retrieval team can
remove them. When doctors cannot use the entire
organ, they sometimes can make use of key parts.
For example, a heart that has significant myocar-
dial damage due to HEART ATTACKmay have healthy
valves, which doctors can harvest for heart valve
replacement. There is no cost to the person’s family272 Surgery