First US Penis Transplant Successfully Carried Out on Massachusetts Man

All those spam emails are about to come true…

A Boston man who lost most of his penis in a fight with cancer has become the first US patient to receive a penis transplant.

Thomas Manning, 64, a bank courier from Halifax, Massachusetts, received the new organ from a deceased donor in a 15 hour-long operation conducted at Massachusetts General Hospital in Boston on May 8 and 9. The procedure involves doctors hooking up nerves, veins, and arteries between the recipient and donor organ. So far, Manning’s doctors are “cautiously optimistic” that he will recover urinary and sexual function in the coming weeks and months.

Source: First US penis transplant successfully carried out on Massachusetts man

I’m sure some potential donors would say their organ would have to be taken from “their cold, dead hands”. Everyone hopes to go out doing something they love… 😉

I believe Russia’s approach to organ donation is that it is an opt-out policy – otherwise your participation is assumed.  I don’t know if that is true, but I personally like the idea.

Organ Transplants Between HIV-Positive Patients Begin At Johns Hopkins

Organ transplants between HIV-positive patients will begin as soon as the candidates are available, surgeons at Johns Hopkins Medical Center said.

Source: Organ Transplants Between HIV-Positive Patients Begin At Johns Hopkins

That HIV/AIDS is almost entirely preventable is a fact. That a little personal responsibility is all that’s needed to prevent it is not.

Children get it from their parents. People get it from bad medical practices. People who make the ‘right choices’ all of their lives get it from spouses who had it and didn’t know it, or from partners who picked it up while cheating. People get it because they live in a place with virtually no Sex Ed beyond “sex is bad, don’t do it unless you’re married to a person of the other sex,” and then make bad choices due to misinformation. And yes, some people who should know better make shitty life choices.

But even in the last case, it’s not something that should cause us to turn our backs on a person.

Husband Saves Wife’s Life by Donating Kidney After Dieting and Exercising to get his Blood Pressure Low Enough for Surgery

In sickness and in health 🙂

A man has spent a year losing 70lbs so he could donate his kidney to his wife.

PJ Spraggins was delighted when he discovered he was a perfect match for wife Tracy, who was told her life-long battle with Lupus would kill her if she didn’t get a transplant. The waiting list is seven years long.

Source: Husband saves wife’s life by donating kidney after spending a year dieting and exercising to get his blood pressure low enough for surgery

Probably saved his life too.

Diabetic Woman Becomes First in the World to Receive Pancreas Transplant Because of Needlephobia

A British woman has become the first person in the world to have a pancreas transplant because of a severe needle phobia, her doctors have said.

Sue York – who has had type-1 diabetes since she was seven – would shake uncontrollably and vomit when injecting herself with insulin.

Source: Needle-phobic pancreas transplant ‘world first’

I’m glad she was able to get the surgery and end her suffering.

The article doesn’t mention it, but I thought most transplants required the patient to take anti-rejection drugs for the rest of their lives. These drugs are generally oral, but require regular blood testing to ensure correct levels. That doesn’t seem to be the case here, or she would just be swapping one kind of needle for another (albeit less frequent), somewhat defeating the purpose of the surgery.  A blood test once or twice a month isn’t really comparable to the daily contact diabetics have with needles.

I was recently waiting for my turn to test my INR, listening to someone’s child who was freaking out about getting a needle for some reason.  That would have been me until I was put on warfarin/coumadin.  Weekly testing eradicated the issue for me, but I clearly did not suffer like this woman.  For me, testing weekly meant alternating arms.  Daily testing is awful, but I find it odd that she managed for so long.

Transgenic Pigs Shatter Transplant Records, Potential for Unlimited Organ Supply

Cheap liver replacement? I’ll drink to that! 😉

With the financial aid of a biotechnology executive whose daughter may need a lung transplant, U.S. researchers have been shattering records in xenotransplantation, or between-species organ transplants.

The researchers say they have kept a pig heart alive in a baboon for 945 days and also reported the longest-ever kidney swap between these species, lasting 136 days. The experiments used organs from pigs “humanized” with the addition of as many as five human genes, a strategy designed to stop organ rejection.

Source: Surgeons Smash Records with Pig-to-Primate Organ Transplants

It’s a race to see which will work and come out on top – this, or scaffolding.  Organ donation/harvesting from pigs has been on the radar for decades because our genes are quite similar.  But as the article points out, there are important differences that they are working on addressing.

Could a Dead Heart Save Your Life?

In October 2014, multiple headlines reported that a heart had stopped beating and been revived, before being transplanted into a living recipient. Scientists in Australia told the story of how they had transplanted the ‘dead’ heart. Could this be the answer to the shortage of donor hearts? Oscar Howard ‘Bud’ Frazier and his colleague Dr William ‘Billy’ Cohn of the Texas Heart Institute don’t think so.

Source: Could a Dead Heart Save Your Life?

I wish the article gave more information about the three minute window for a heart transplant.  There’s mention of packing organs in ice, but why not just ship the entire body?  The idea isn’t without its complications, but when such are the constraints of medicine currently – what choice is there?

As They Lay Dying: Terminally Ill and Organ Donation

…W.B.’s life was turned upside down by the diagnosis. But once the initial shock passed, he began researching his condition intensively. He learned that he was unlikely to survive five years, and that in the meantime his quality of life would diminish dramatically. With limited options, many patients retreat. But, quite bravely, W.B. had other ideas. After much consideration, he decided that if he was going to die, he would like to try to save another person’s life in the process, even if that person was a stranger. And so last May he approached the University of Wisconsin’s transplant program, where we are surgeons, as a prospective organ donor.

…From the earliest days of transplantation, surgeons subscribed to an informal ethical norm known as the “dead-donor rule,” holding that organ procurement should not cause a donor’s death. In practice, this meant waiting until patients were by all measures completely dead—no heartbeat, no blood pressure, no respiration—to remove any vital organs. Unfortunately, few organs were still transplantable by this point, and those that were transplanted tended to have poor outcomes by today’s standards.

Source: As They Lay Dying

The medicine, the US in this article particularly, operates in a strange paradox – we uphold the right to patient autonomy in nearly every situation… Except when an otherwise (legally) competent individual chooses a care option that involves the outcome of death/disability by intervention. Physician-aid-in-dying and this particular case are examples of decisions made by terminally-ill people where we interfere with their right to self-determination.

I don’t stand on a political soapbox – everyone gets an opinion and a vote – but rather an ethical one.

If we can not cure, what are the boundaries of what we do to palliate? What if we are able to simultaneously palliate (psychologically or physically) one patient, while providing an invaluable service to another? Is it truly against the spirit of the Hippocratic oath to provide psychologically and spiritually meaningful interventions at the expense of the physical body?

I personally am of the mind that if the patient and physician enter into a trusting and respectful relationship, that these questions can only be answered/defined within the context of that particular relationship.

Kidney Transplants Don’t Necessarily Mean the Old/Bad One is Removed

Your native kidneys are in the back – the new kidney is put in the front. The artery and vein on the kidney are usually connected into the main artery and vein in the front right groin (ileacs), and the ureter is patched on the side or top of the bladder. The old/diseased kidney stays usually connected.

Meet the new boss, same as the old boss

See for yourself

Why?  Old/diseased kidneys aren’t typically removed because they still work. They can still filter blood, but at maybe up 10-20% of what healthy kidneys can do. A donated kidney can do upwards of 50%, assuming the transplant works perfectly.  Then factor in the additional time and resources for surgery to remove the old/diseased kidney(s), which increases the chance that something goes wrong.

That’s not to say this is always the case.  Kidneys can increase in size for a variety of reasons, so removal might be necessary to make room.  There are also cases where transplanted kidney(s) have failed, but there was no room so removal would have to be done first.

What about the Donor?  Could the Empty Space Hold My Valuables?

Have you considered a career as a drug mule?

When you donate a kidney, your existing kidney increases size to compensate for the loss and all your other organs shift to fill the void.  On average, the remaining kidney increases to 1.5 times the original size within months of donation.

What’s an Auto Transplant?

Auto transplant is for pain that can’t be fixed, so they basically cut it out to remove all the nerves and then put it back in again.  You are your own donor…  I’d suggest changing your name to “Ship of Theseus“.

I organ donation

I organ donation

Researchers Grow Human Lungs in Lab

OK, they didn’t “grow” lungs – they took parts from two sets of lungs, assembled them, and caused the lung cells to replicate until the whole structure was functional.  Still, pretty impressive.

Lungs are a notoriously delicate organ. That makes useable donor lungs hard to come by—in 2010, just 1,800 lung transplants took place in the United States. However, researchers are getting closer to addressing the shortage by growing lungs, for the first time, in the lab. Although these lungs haven’t been actually transplanted, the technology could someday help shorten the list of people waiting for donors.

…In the past, washing a donor organ of its cells could take up to four months to accomplish, but the latest study introduced a device that sped that process up to three days. The resulting lungs are eggshell white, because of the lack of blood flowing in the new organ.

…it will take at least 10 years before they are ready for people in need of a transplant.

Source: Scientists Grow First Functioning Human Lungs

The proof of concept used portions of lungs from deceased children – cadaveric donation is nothing new.  Next step is testing in pigs…

This is actually hope for cystic fibrosis (CF) patients. CF patients get on a waiting list for a maximum of two lung transplants (regardless of if their bodies reject the lungs or not) in their lifetimes, beginning when their pulmonary function tests reach a certain percent of normal lung capacity. The average life expectancy of CF patients is 37 years, but lungs that match their DNA and reduce risk of rejection show promise for greatly increasing this life expectancy.

How is this better than a regular lung transplant?

Besides the lack of viable donor organs, the main issue with transplants today is chronic rejection. If you receive a lung transplant, you’re put on immunosuppressants to stop your immune system from attacking those donor lungs, yet in the long run it usually does just that anyhow. The immune system begins to attack the donor lungs and eventually they’re so damaged that most lung transplant patients end up needing another transplant after a few years.  The life expectancy of lung transplant recipients is 6 years on average before dying either from chronic rejection or one of the side effects of immunosuppression (cancer, opportunistic infections, kidney/liver failure).

With the technique described, rejection and in turn the need for immunosuppression (and all associated negative consequences of being immunocompromised) might be avoided entirely. Doctors could one day take the lung of a deceased donor, reduce it to only the scaffolding, then “rebuild” the lung itself using material from the prospective recipient.  The result would be lungs that are as good as new and genetically identical to the recipient’s own lungs – thus invisible to the recipients’ immune system.

This is an important step towards growing solid organs from scratch. Right now they need to strip down a real lung, but one day it might be possible to 3d-print such a structure without requiring a donor organ. This would solve the organ shortage, eliminating the organ donation waiting lists.  But then the bottleneck will be hospital beds and staff…

The Math of Organ Donation: Kidneys are an NP-hard Problem

We’re bilaterally symmetric organisms—we’ve got matching bits on our left and right side. But many critical organs are present in only a single copy (hello heart) or we need both to function optimally (see: lungs). The kidneys are rare exceptions, as your body gets by just fine with only a single one. That has enabled people to become living kidney donors, with both the donor and recipient continuing life with one kidney.

Often, in cases where someone needs a transplant, there is a relative willing to make this sacrifice, but unable to do so because they aren’t a close enough tissue match, which would lead to the organ’s rejection by its new host’s immune system. Separately, there are some rare individuals who are simply willing to donate a kidney to an unknown recipient. So the medical community has started doing “donation chains,” where a group of donor-recipient pairs are matched so that everyone who receives a kidney has a paired donor that gives one to someone else.

That, as it turns out, has created its own problem: given a large pool of donors and recipients, how do you pull a set of optimized donor chains out? It turns out that the optimization belongs to a set of mathematical problems that are called NP-hard, making them extremely difficult to calculate as the length of the chain goes up. But now, some researchers have developed algorithms that can solve the typical challenges faced by hospitals with the processing power of a desktop computer.

Source: The math of organ donation: kidneys are an NP-hard problem

This is an article for why you did that math in high school/post-secondary 😉