Surgeon Answers Transplant Questions

I'm Dr. Dinee Simpson, abdominal transplant surgeon,

and I'm here today to answer your questions

from the internet.

This is Transplant Support.

[upbeat music]

@MrAnni11 asks,

How much do you think I can get for my kidneys?

I suddenly need money.

In the United States,

getting money or any other type of gift,

or coercion to donate is illegal.

You cannot get a raise, you can't get a brand new car,

you can't get a house, you can't get a money gift

to donate an organ.

We don't want people to feel pressured

to donate their organs,

and actually, in the case of living donation,

when a living donor comes forward to any transplant center

thinking about donation,

they actually have to meet separately with a psychiatrist

and a living donor advocate

to determine if there is any coercion

going on behind the scenes.

Unfortunately, outside of the United States,

that's not always true.

Coercion, or even deception to donate organs

is fairly common.

A Reddit user asks,

How long does the process of liver transplant last

from when the doctors decide to go

the liver transplant route to the actual surgery?

Why does it always seem like we're rushing in the movies

when we decide to go for a transplant?

Organs don't last forever, even when they're on ice.

There is a certain amount of time

that we need to be working against

to get that organ into a body,

into a warm environment where oxygenated blood

is flowing through that organ,

otherwise the organ starts to die and it's no longer usable.

That amount of time varies by organ, believe it or not.

Kidneys can stay out of the body on ice

or on a pump machine, we'll get to that later,

for up to 36, sometimes even 48 hours.

On the opposite end, however, hearts and lungs,

only four to six hours.

Now I mentioned a pump,

and pump technology is changing the face of transplantation.

This is an exciting technology

that kind of mimics being in a body.

So you can hook a liver, you can hook a heart or lungs

up to this pump, and blood is pumped through the organ,

thereby extending the amount of time

until we have to transplant it.

Theonlykd asks, If a body rejects an organ transplant,

can that organ be used by someone else,

or is it no longer usable?

It's no longer usable, because what rejection means

is that our immune system attacks that organ

and causes damage that makes it no longer usable.

Now, depending on the organ, though,

what we do with it varies.

With kidneys, we can just leave it there,

and then transplant a new kidney into a new spot.

We're all born with two kidneys.

You get your third kidney

when you get your first transplant.

If you have rejection over time,

you can get a fourth kidney, you can get a fifth.

I've had a patient who had six kidneys in his body.

Only one of them was working.

The other five were not.

ToitsExersNexqr, Do donated organs age

according to the donor's age,

or do they adapt to the age of the new body?

The age of the organ does matter somewhat.

So if you get an organ from a younger donor,

you can expect the lifespan of that organ

to maybe be a little bit longer,

particularly in the case of organs

that don't have the ability to heal themselves

like the liver.

However, getting an organ from somebody

who's very, very young does not mean that you get

20, 30 extra years on your life, per se.

PWTI007 asks, Is there an organ shortage?

The short answer is yes.

When we think about all the number of people

who need organ transplants,

and the number of people who are either willing to give

organ transplants and living donation,

which you can do with liver and kidney,

or people who pass away and are donor designated

on their driver's license,

we don't have enough to go around.

In fact, there are over 100,000 men, women and children

currently awaiting an organ transplant.

Mikerfoxlong asks, How do organ transplants actually work?

How do we connect them to the body of the recipient?

I love this question,

because whenever I talk to my patients about transplant,

I always say that I as a surgeon am basically a plumber.

If I were gonna take a sink and bring it into the room,

it's not gonna work unless I connect it to pipes

that bring water in and out of the sink.

And a transplant is the same thing.

I'll take the liver here for example.

These are our pipes.

The red is the artery, the blue is the vein.

These bring oxygenated blood to the organ,

and deoxygenated blood away from the organ,

and we need to connect those pipes

in order for the organ to work.

And the third pipe we connect

is the functional pipe of the organ.

In this case, it's the bile duct,

which brings bile from the liver to the intestine,

which helps us to digest our fatty foods.

And the way we connect them is with stitches.

So we use microscopic threads.

We have to wear glasses with magnifying lenses on the end,

and we will painstakingly but quickly

sew those pipes together.

Saccharin000 asks,

I wanna ask my microbiology professor so badly

if the fecal transplant episode of South Park is real,

but I can't.

What is a fecal transplant?

It's a poop transplant, believe it or not.

What this involves is taking fecal matter

from a healthy individual

that has all the good bacteria that we want in it,

and transplanting that into the intestine

of someone who needs it.

So the case where this is often used

is if someone has a really bad infection of their colon

called C. Diff,

and so clostridium difficile is the bacterium there

that causes a terrible, terrible infection in the colon

that can sometimes result in the entire colon

needing to be removed.

The way that C. Diff works is that it replaces

all the good bacteria, essentially, in the colon.

So only the C. Diff are there,

and they're just causing a mess.

To try to push those out,

you wanna get good bacteria in there,

and so you basically, it's like a poop shake.

It gets put down into the intestine and does its job.

Self_Manifesto asks,

How do surgeons connect nerves to donated organs?

Well, for our solid organs, we actually don't,

believe it or not,

and nerve regeneration will happen slowly over time,

and so solid organs refer to things like the liver,

the kidney.

But when you're thinking about transplanting a limb,

such as hand transplant or even face transplant,

that is a case where nerve connection does become important.

SoupBowlerChris asks,

Now that a penis transplant is a thing,

can I get on that list?

I love my old penis,

but it's retired and ready to move on.

You can't get a penis transplant

just because you're tired of your old one.

The usual reason for a penis transplant

is because there's been trauma to the penis

that has required it to be removed,

such as cancer, or a burn, or some other type of trauma.

@lastthingu4get asks,

Can I get a brain transplant please, pretty please.

Although brain transplant has yet to be successful,

the nature of this question makes me think

that maybe there is a pretty big need for brain transplant.

The short answer is no.

KhyronXc asks, At what point will stem cell research

just allow us to grow clones

of our own organs for transplantation?

Surely this is the way to do it, I couldn't agree more.

This would certainly solve our organ shortage issue.

The good news is,

is that researchers are working on this every day.

I once worked with a researcher

who was doing a lot of work in this area,

and he had actually managed to grow a kidney with stem cells

that made what we called bland urine.

And by bland urine, I mean just water,

meaning the kidneys not doing the job

to filter out any of the other toxins that it's supposed to.

So it didn't do all the functions that a kidney should do,

but at the very least, it was making some liquid,

and that's mind boggling to me.

I've been told that organs that are grown with stem cells

are just a few years off, but that was a few years ago.

So we'll see.

A Quora user asks, What was the first human organ

to be successfully transplanted?

Well, that was the kidney.

In 1954, Dr. Joseph Murray did the first successful

kidney transplant between two twin brothers

in Boston, Massachusetts.

What I find really cool about this is that transplant

is such a young field that I actually had the privilege

of meeting Dr. Murray when I was a resident

at Brigham and Women's Hospital,

which is where he practiced and trained.

@sakthivignesh88 asks, What is xenotransplantation,

and what role is it going to play in the future?

Xenotransplantation is a fancy word for saying

you're getting a transplant

from some animal that is not a human.

And I do think that it has a big role for the future.

There is an organ shortage,

so we have to find creative ways to solve that problem.

And xenotransplantation just may be the answer.

Ed Krassenstein asks,

Would you allow doctors to put a pig heart into your body?

If I was on death's door and I was not going to have

an offer for a human heart anytime soon, yes.

Both kidneys and hearts have been

successfully transplanted into humans.

However, long-term success still has not been shown.

There's still a lot that's unknown

and needs to be developed, but it holds a lot of promise.

@in19ninety asks, Why are all the engineered body parts

for humans always made from pigs?

What is it about pigs?

Well, pig anatomy is very similar to human anatomy.

When I talk about transplant,

I say that we're like plumbers.

We have to connect pipes to pipes.

Human pipes and pig pipes are quite similar,

so the connections are similar,

and that makes the actual technical aspect of the transplant

a lot easier.

The other thing is that scientists

can alter the genes of pigs

such that they can raise the chances

that that transplant will be a success.

A Quora user asks,

Who decides which patient gets an organ transplant first?

What factors go into that decision?

Deciding who is eligible for an organ transplant

is a really complicated process,

and it involves a committee or a group of individuals,

sometimes as many as 30 to 40 people,

who will decide whether the patient

is suitable for organ transplant.

And there's a lot of factors that go into it.

The patient's health, whether or not they can handle

the stress of such a big surgery,

whether or not we think that they can take

the anti-rejection medication that they need to take

every day for the rest of their lives, how sick they are.

So patients who are only mildly sick

or at the beginning stages of their illness,

or patients who are really sick and in the ICU

and on death's door,

and also is dependent on the organ

that they're being listed for.

In the case of kidney, your place on the list

depends on how long you've been on dialysis.

People who have been on dialysis longer

will be near the top of the list.

Other things that are taken into account

is how far the donor organ is

from the hospital where it's being transplanted,

and there's many other factors.

Age does play a little bit of a part

in where a patient is on the list,

in that pediatric patients get priority.

A Reddit user asks,

Can getting a heart transplant change your personality?

The short answer is no.

But one thing I can say is that receiving a gift

that someone has given in death or in living,

if it's a liver or a kidney transplant,

that saves you from death and changes your life forever,

certainly must have an effect on how you look at life

and how you live life every day.

So I would say from that perspective, yes,

it can change your personality.

@U4gotsmokinlamp, I'm not surprised,

face transplants are a real thing

and these sickos will do anything

to continue to look young.

Face transplants are not what this person thinks.

Face transplants are not used to help people look young

or look different.

Face transplants are a really big operation.

You have to be on anti-rejection for the rest of your life

and most importantly, you have to qualify.

And these are people who have had extreme disfiguring events

such as burns, animal maulings, that disfigure their face

so horribly that a face transplant is warranted.

EnvironmentalSorbet3 asks,

How long will a transplanted kidney last?

Well, unfortunately, they don't last forever,

and there's a few reasons why they don't.

The kidney specifically, unlike the liver,

does not have the ability to heal itself.

The liver is unique and it has a regenerative capacity

so that if you cut a piece of the liver off, it will regrow,

similar to how a starfish regenerates its arm.

With a kidney specifically,

since it doesn't have the ability to heal itself,

over time, it will collect damage

that will shorten its lifespan.

That damage may come from infection.

That damage actually sometimes or oftentimes

comes from the anti-rejection medication itself.

So immunosuppression,

or what we call anti-rejection medication,

unfortunately, while it helps our bodies

not to reject the kidney,

it does cause a low level of injury

to the kidney over time.

If somebody gets a kidney from somebody who's passed away,

or a deceased donor, as we call it,

we can expect that kidney to last, on average,

nine to 12 years.

If somebody gives a kidney from a living donor,

someone who shares and gives one of their spare kidneys,

then we can expect those kidneys to last 15 to 20 years,

or sometimes longer.

As for a liver,

because they do have that ability to heal themselves,

they last a lot longer.

Most patients who get a liver transplant

are outlived by their liver.

Peeeeeeeeeej asks,

What determines a match for a kidney transplant?

All organs require a match.

There's two different things that we look at,

the blood type, and then we look at immune system.

Blood type is the first thing that we look at.

And so in order for you to be a match for blood type,

you have to have an organ

that either comes from your same blood type

or the blood type, O.

O is considered the universal donor,

which means that anybody can receive an O.

There are four different blood types.

You have O, A, B and AB.

AB is the universal recipient,

which means that it can receive an organ from A,

blood type B, blood type AB, or blood type O.

The immune system matching is a lot more complex.

Basically what you're looking for

is whether or not your immune system

will recognize parts of that organ

and react to it immediately.

Our immune system's job is to kick out anything

that's in our bodies that it doesn't recognize,

or that it wasn't born with and not supposed to be there.

So that's the case for infection,

and it's also the case for transplanted organs,

and that's why patients need to be

on anti-rejection medication or immunosuppression,

as we call it in transplantation.

warterland asks, If the recipient of an organ donation

dies before the donor,

could the donated organ be returned to the donor?

In theory, yes, a patient can have an organ out

and put back into them.

I haven't heard of a time

where a transplant recipient passes away

and that organ is taken back out and returned to its donor.

There is something worth mentioning, though.

If somebody receives an organ transplant,

particularly a heart or a liver,

and for some reason, some complication,

or if the patient was too sick, they pass away early,

say within days or a couple weeks,

that organ can be removed and transplanted into someone new.

It's not very common, but it has been known to be done.

@Stephshot asks, We need to do something about kidneys.

Why does everyone always need new ones?

Why they fail so fast?

Kidney is the most frequently transplanted organ,

by a long shot, and the reason for that

is the top two causes of kidney disease

are high blood pressure and diabetes.

And those are actually things

that we can do something about.

The way that we eat, exercise, those play important roles

in the development of diabetes and high blood pressure.

So healthy living can actually drive those numbers down.

A Reddit user asks,

Could a donor organ live forever

if constantly donated before each person's death?

That's a great question that we do not have the answer to.

I would say in the case of most organs, the answer is no.

The one that makes me a little curious maybe is the liver,

and that's because of the liver's ability to heal itself.

The fact that many patients who get a liver transplant

die with a still working liver makes us wonder,

just how long could that liver last?

But we don't know the answer.

@AmerTransplant asks, Any advice to those

who are considering becoming a living donor?

What's life like after your donation?

There is a shortage of organs,

and one of the ways that we can help mitigate that shortage

is through living donation.

Kidneys and liver can be donated through a living donation.

You can give one of your kidneys,

or you can actually have your liver cut in half.

The half that goes to the transplant patient

will grow to be the size of a normal liver

in about six weeks,

and the half that the donor is left with will also grow

to be the size of a normal liver in about six weeks.

It's amazing.

The bottom line is that we have to be very, very careful

with anybody who's considering a living donation

because they get no medical benefit from that surgery.

So we put them through a number of tests

to ensure that their risk is extremely low.

In doing that, we are actually guaranteeing

that the donor will have

pretty much a normal life after living donation.

They can have children, they can get back to the gym,

they can go back to work, they can do all the things

that they did before they donated,

because if they couldn't,

we wouldn't allow them to donate

because that wouldn't be ethical.

RopeBracelet asks, What's your transplant or donation

hot take or unpopular opinion?

My hot take, which may be unpopular to some surgeons,

is that I'd love to see myself put out of a job.

There's so much that we can be doing

on the pre-transplant side to reduce the burden of disease

so that we don't have this organ shortage.

Now, don't get me wrong, I'll never be put out of a job.

There'll always be a reason to have organ transplants,

but we can have less,

and we can have less of an organ shortage issue.

Kidney disease, for example,

top two causes are high blood pressure and diabetes.

We can do something about that.

Our neighborhoods, how they're set up,

if people live in food deserts,

or if they're eating unhealthy foods

or living in food swamps,

that will impact the development of those diseases.

And actually, CDC data shows us that neighborhoods

that have food deserts,

or food swamps or predominance of food swamps,

have much higher rates of high blood pressure or diabetes,

and therefore, kidney disease.

For the liver, let's think about alcoholism,

or hepatitis C from IV drug use,

two things that we really can make a difference on

if we had public health initiatives

to really focus on those things, and we do have initiatives,

but if we spent more time

and resources on those things,

we could really make an impact on the transplant side.

Well, that's it.

That's all the questions.

I hope you guys learned something.

Until next time.

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