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Presentation
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History of transplantation  |
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History
- Great discoveries and major names in transplantation
- Some key figures
- Laws giving a legal frame for transplantation
By definition, a graft is the transfer of a whohe organ from a donor, involving the afferent and efferent restoration of the organ vascular continuity with the circulatory system of the recipient.
Transplantation and graft have to be distinguished. A graft consists in a transfer of a tissue or part of an organ. To a larger extend, "graft" is more often used than transplantation. We can distinguish :
Autograft is a
tissue transplanted from one part of the body to another in the same individual.
Isograft
is a graft of tissue between two individuals who are genetically identical
Allograft is the transplant of an organ or tissue from one individual to another of the same species with a different genotype.
Xenograft is a graft of tissue from one species to an unlike species.
HISTORIC DISCOVERIES AND MAJOR NAMES IN TRANSPLANTATION
In 1818, James Blundel, a British obstetrician, was the first to transfuse blood from man to man.
1900 – 1902 : German scientist Karl Landsteiner classifies blood type into three groups A, B and O, and his colleagues adds a fourth AB. (Later on, Landsteiner was awarded a Nobel Prize in 1930 for his entire work).
In 1902, Alexis Carrel was the first french to attempt an organ transplantation on one animal.
1902-1908 : Carrel develops technique for connecting blood vessels and puts it into practice for kidney, heart, intestine and limbs grafts on animals. He received the 1912 Nobel Prize in Medicine for his work on connecting blood vessels and for blood vessels and organs transplantation. He also demonstrated techniques for preserving blood vessels and organs in cold storage.
In 1906, French doctor from Lyon, Mathieu Jaboulay, who specialized in vascular surgery, is the first to remove a kidney pig and to insert it into a woman ; his attempt failed. At the same time, Emerich Ullmann tries the same experience. It was not until 1933 that the immunological rejection notion was put into evidence by the Russian Serguey Voronoy who will perform the first kidney allografts in human.
En 1940, British zoologist, Peter Medawar, uses experimental skin transplants on animals to explain rejection mechanism. In 1960, he would earn the Nobel Prize for his work and for the discovery of acquired immunotolerance.
World War II puts into parenthesis researches progress.
En 1947, American David Hume performs successfuly (in a non legal way for he was refused the authorization to do so) the first kidney transplantation from a deceased donor. In 1951, a second try is performed in Chicago by Richard Lawler.
1952 is a year full of new discoveries : Jean Dausset brought to light the HLA system (He would receive the Nobel Prize in 1980 for his work in deciphering the human immune system). For the first time, Jean Hamburger and Jean Vaysse together with the Necker's team, try to transplant a kidney from a living donor. the patient will live 21 days. Several attemps will be made in Boston (Peter Bent Brigham Hospital). David Hume and his teams keep on working on immune system.
In 1954, in Boston, transplant surgeons Joseph Murray (He was awarded a Nobel Prize in 1980 for kidney transplant), John Merrill and J. Hartwell Harrison performed successfuly the first kidney transplant from a living donor (between identical twins).
In 1958, Jean Dausset and Jean Bernard give rise to the role and groups of HLA system. In 1959, the first kidney transplant between non identical twins is a success.
In 1960, the first transplant between non related patient is performed by René Kuss and Marcel Legrain.
1962 is the year of the first successful cadaveric kidney transplant. The patient receives the new immunosuppressive drug azathioprine, and lives for 21 months.
In 1963, the first liver transplant is performed by Thomas Starzl in Denver but finaly fails. The same year, the first successful lung transplant is performed by James Hardy at the University of Mississippi Medical Center.
In 1964, first kidney xenotransplants are performed from chimpanzee kidney, in New Orleans by Reemtsma.
In 1966, the first successful pancreas transplant is performed by Richard Lillche and William Kelly in Minneapolis. In 1967, Thomas Starzl of the University of Colorado Hospital performs the first successful liver transplant, the liver functions for thirteen months. Christian Barnard performs the firs human heart transplant at Groote Schuur Hospital in Cape Town, South Africa. Christian Cabrol will perform the first human heart transplant in Europe in 1968.
In 1972, Jean-François Borel, Swiss biologist demonstrates the immunossuppressive actions of a new drug : ciclosporine which enable grafts to last longer.
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n 1976, islet of Langerhans transplant technique is performed in Lyon and gives a new rise to pancreas transplant which was left aside for 6 years..
In 1980, ciclosporine can be artificialy synthesized and can be commercialized in 1983.
In 1981, the first successful heart-lung transplant takes place at the Stanford University Medical Center; the surgeons are Norman Shumway and Bruce Reitz.
1984, Henri Bismuth demonstrates the split liver technique, consisting in spliting the donor's liver into two parts, and transplanting the two parts to two recipients.
In 1985, the fist intestine transplant is performed by Dr. Cohen in Toronto.
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n 1989, the first living-donor transplant of a liver is a success in Chicago. The wide spread use of living donor is imposed by the lack of grafts and by the lists of patients dying because of organ shortage. This is especially true for liver transplant, the only solid organ able to regenerate itself. In 1990, the first transplant of a lung lobe is a success in Stanford.
In 1992-93 Thomas Starzl performs two xenotransplants of a liver from animal (chimpanzee) to human in Pittsburgh.
In 1998, Jean-Michel Dubernard and Earl Owen for the very first time, perform in Lyon the first composite tissue transplant (hand transplant), followed in 2000 by the first successful double hand and forearms transplant.
In 2005, the first partial face transplant -nose/lips/chin/cheeks- is performed by French surgeon Bernard Devauchelle (Amiens) and Jean-Michel Dubernard (Lyon) and their team.
In 2009 : French surgeon Laurent Lantieri and his team perform simultaneously double hand and face transplants. The patient will live only few days.
SOME KEY FIGURES
IN FRANCE IN 2008,
- 43 395 is an estimation of the number of person living with a transplant.
- 4620 french patients have benefited from an organ tranpslant. (including 360 heart transplants, 196 lung transplants, 19 heart-lung transplants, 1011 liver transplants, 2937 kidney transplants, 13 intestine transplants, 84 pancreas transplants (including living donors).
- Kidney transplant represents near 63.6 % of total amount of transplants.
- About 40 000** patients are under kidney dialysis in France.
Waiting list to get transplanted is estimated at 3 years.
Now, more than 13 600 patients are waiting to be transplanted ( 13 112 in 2007).
- After a very dynamic period of rise, (+ 44 % since 2000), transplantation is quite still in 2008 (same as in 2007 (4867 transplants). However we can notice a slight increase of kidney grafts in 2008 +0.8 % compared to 2007 and that the number of intestine transplants has doubled compared to 2007.
- Transplantation is now steady after a great increase of 54 % since 2000.
(*Source Biomédecine Agency 2009 - Cristal data of march 21, 2009)
(** Source HEGP = Hôpital Européen Georges Pompidou 2009)
LAWS GIVING A FRAME TO TRANSPLANTATION IN FRANCE
For the first time, the notion of brain death is described by French neurologists Mollaret and Goulon in 1959.
The France-Transplant Association is created in 1969.
1976, the Cavaillet law gives a frame to the presumed consent. In 1978, refusal registers are created and are available in hospitals. It allows a patient to egistered into this list which states its refusal to donate an organ.
On July 2nd, 1993 a by-law was passed in the French Coucil of State acknowledging the brain death concept.
In 1994, the bioethic law is voted. It defines three fundamental principles for organ donation: donation is gratuitous, presumed consent and anonymous principle between donor and recipient.
The French Transplant Institution (EfG) is created in 1994 and is legally governed by the regulatory authority of the Department of Health.
In 1998, National Refusal Register (RNR) is created.
In 2000, the Graft program is settled by the Department of Health and funds dedicated to transplantation are increased.
In August 2004, Bioethic law is reviewed and more family members, friends, can donate organs while alive.
In 2005, The Biomédecine Agency replaces the French Transplant Institution.
Transplantation is labellized great national cause in 2009.