Graft (medicine)

See also: Clerc's Office

In Medicine, a Clerc's Office or transplantation is a Surgical operation consisting in replacing a sick Organe by a body healthy, called graft and coming from a donor.

Types of Clerc's Offices

There exist several types of Clerc's Offices. They can be classified according to the origin of the graft:

  • Autograft: the graft belongs to the donor. They are primarily fabrics or cells.

  • Isogreffe : the graft belongs to the true twin of the receiver, case essentially extremely rare.
  • Allogreffe : the donor and the receiver belong to the same species. It is the most frequent case.
  • Xénogreffe : the donor is of a species different from the receiver. The xénogreffes are for the moment primarily experimental.

Grafted bodies

The most frequent Clerc's Offices are the clerk'ss office of the Rein. Clerc's Offices are also practiced Liver, Heart, Lung, block heart/lung, Pancreas, and more rarely of the Internal . One can also graft fabrics: osseous Marrow, Cornea, Os, cardiac valves or Blood-vessels. There exist also experimental techniques of composite fabric Clerc's Offices (hand, part of the face).

Certain grafts make it possible to save a Vie, others to avoid heavy treatments (the kidney transplant makes it possible for example to avoid the Dialyze).

The blood Transfusion is not regarded as a Clerc's Office because it does not pose the same problems: the blood of the donor requires only one compatibility of blood group and no treatment Immunosuppresseur is necessary, the blood elements transfused being to only make it possible there to the patient to pass a course and being gradually replaced by those of this last.

Once grafted, the organization of the receiver regards the new body as a foreign object. The patient will have to thus follow a immunosuppressor treatment to life to avoid the Rejet graft (except for the cardiac valves, which is treated before transplantation not to cause a rejection, and the Cornée).

The donor must have a Blood group compatible with that of the receiver. The compatibility HLA is less and less essential, taking into account progress of the treatments Immunosuppresseur S. Nevertheless, when it is large, the treatment can be reduced…

Taking away of body

On patient in encephalic death

See also: Donation of organs

The bodies are taken on the subjects in a state of encephalic Mort, in final cardiac arrest, or in certain cases (kidney, portion of liver, pulmonary lobe) on an alive person. In France, the donation of organs rests on the principle of the supposed assent: each one among us is regarded as a potential donor after its death unless being itself opposite there of alive sound. In practice, when a taking away of bodies is considered, if the medical team is not informed directly of the will of the late one, it must endeavor to collect from its close relations his opposition to the donation of organs possibly expressed of alive sound, by any means.

starting from an alive donor

A person in good health with the possibility of giving a body of alive sound. It is the case for example kidney, of part of the liver or very seldom of the lung. One can indeed live with only one kidney, part of the liver (because it is a body which is regenerated quickly) or part of the lungs.

This gift is not possible that if the donor is major and very near to the receiver. The law of bioethics fixes the list of the people who can give a body of their alive. It is of the father, the mother, the spouse, the brother, the sister, the son, the girl, the grandparents, the uncle, the aunt, (of) the cousin (E) German (E), of the spouse of the father or the mother, or any person being the proof of a common life of at least two years with the receiver.

The Clerc's Offices of donor living most frequent relate to the kidney, the risk for the donor being extremely weak. They have moreover much advantages for the receiver: they function in general better and longer than the Clerc's Offices of kidney starting from donor deceased. Moreover, they make it possible to shorten or remove the difficult period of waiting in dialysis, which comprises considerable advantages on the family levels, personal and professional. For the liver and the lung, the risks for the donor are much more important.

The sale of bodies

The sale of bodies, although posing a problem of ethics and public health, is a practice which develops: nearly 5% of transplantations would be made on this basis (purchase of a body of a “donor”, primarily resulting from a poor country). Nearly 10% of the Clerc's Offices of kidney on a world level would also be done by this skew.

On patient after final cardiac arrest

See also: Taking away of bodies in heart stopped

Under certain quite precise conditions (temporal constraints in particular) the bodies (kidney, liver, lung) people in cardiac arrest and respiratory final can be taken. It is known today that the results of the Clerc's Offices of these bodies are as good as those coming from donors in encephalic death. Programs of this type started in France at the end of 2006. It is estimated that they could result in increasing approximately 30% the number of grafts available.

The death is pronounced after two to five minutes of observation of the cardiac arrest. The taking away is then carried out ideally as soon as possible (in half an hour for the liver, in the hour for the kidneys).

The donor could have been also deceased for a few hours (gift of cornea).

History

  • on December 7th 1905 took place the first Clerc's Office of cornea successfully, by the doctor Eduard Zirm (1863 - 1944). The donor was young a 11 year old boy having to undergo an enucleation of a wounded eye but with the intact cornea. Other attempts were described previously but outcome with failures.
  • the first transplantation renal took place in 1952 on the young person Marius Renard by the team of Louis Michon with the Hôpital Necker in Paris, the nephrologic continuations being ensured by Jean Hamburger. The young man died 21 days later.
  • the first transplantation of Foie took place in 1957.
  • the first Transplantation of marrow was made in 1957 by Thomas.
  • the heart first Transplant took place in 1967 by the professor Christian Barnard in South Africa. Survival was not whereas 18 days. In France, one can quote the case of Emmanuel Vitria which lived with such a transplantation of 1968 to 1987.
  • the first clerk's office of the lung took place in Belgium in 1968.
  • the first Clerc's Office of larynx succeeded took place in 1998 by Pr Marshall Strome (Cleveland, Ohio) on the patient Timothy Heidler who thus recovered the use of the word. First Clerc's Office of body nonessential with survival.
  • the first transplantation of osseous Moelle took place in 1968.
  • the first double transplantation of hands (with front armlever) took place in January 2000 (pr. Dubernard).
  • In 2003 take place the first Clerc's Office of Language to Vienna.
  • the first transplantation partial of face took place in France in November 2005 on Isabelle Dinoire.
  • In 2006, the first Clerc's Office of Pénis is carried out at the hospital of Guangzhou (China) by the team of Doctor Weilie Hu. In spite of the absence of signs of rejection, the patient asked for the ablation of the graft after 14 days.
  • October 2006: first Clerc's Office of Trachea realized in March 2005 by the team of Professor Wurtz to Lille, the graft being a segment of Aorta according to the technique developped at the point by Professor Martinod in the laboratory of Professor Carpentier in Paris,

Assessment of the Clerc's Offices

4237 Clerc's Offices of solid bodies were carried out in France in 2005. In same time, nearly 12000 patients needed a transplantation… Other data: 1371 subjects were taken during the same period in France (a donor giving regulates several bodies of them), but the number of potential donors reaches more of the double. This imbalance between supply and is not clean in France: In 2006, Great Britain, nearly 3000 transplantations were made whereas the waiting list comprises more of the double of patients.

The most important cause of not-taking away remains the opposition of the family in nearly a third of the cases.

These figures illustrate a problematic phenomenon: that of the shortage. Indeed, the number of bodies given is not enough to meet the needs. Thus, of many patients find themselves in waiting list and have patience of long month or long years before receiving the saving Clerc's Office. Number of them die because they did not receive Clerc's Offices in time.

Taking into account its advantages, the Clerc's Office of kidney starting from an alive donor has progressed for a few years. But France remains very in withdrawal compared to other countries (Norway, the USA, etc). Taking into account the weak risks incurred by the donors, the ethical questions which it raises are less acute than for the liver or the lung.

Research turns to the Xénogreffe, in particular starting from the pig. The objective is to modify genes of the animal so that its bodies are not rejected immediately, but other risks are related, in particular of transmission of Virus of the animal to the man.

The results of the graph prove that the choices of company and political voluntarism can have a great impact on the number of Clerc's Offices carried out in a country.

The results of the Clerc's Offices improve regularly, it is today a reliable and validated technique. Some grafted are it now since nearly 40 years, which enabled them to practically live the integrality of a life.

Grafted famous

See too

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