In 2021, 4781 transplants were performed in Spain, making it a leader in Europe and a global example in this field. To give us an idea, in Spain there are 40.2 donors per million inhabitants while in the rest of Europe this rate drops to less than half (18.4 d.m.p.). Organ donation generated a debate in its beginnings, especially with the donation of organs from dead people. Fortunately, science managed to reconcile with public opinion and laws were drawn up to regulate transplants, which until then had been in a legal limbo that could sometimes cause problems for the avant-garde doctors who performed them.

It is currently estimated that approximately 2 million people a year need a transplant, although unfortunately more than 90% of them do not receive one. However, in Spain the situation is quite the opposite: more than 90% of the people who need a transplant will receive it. This technique that saves so many lives a year is relatively new and today in Life Length we are going to tell you how it has evolved since its birth:

We do not know whether to talk about an idea or a dream, but the concept of exchanging organs between different living beings is much older than its practical materialization. The oldest existing record dates back to the 3rd century B.C. and recounts the exploits of the Chinese physician Pien Ch’iao, who was able to exchange defective organs for those of healthy people. The writings narrate how he managed to transplant the hearts of two people who, in his interpretation, were complementary. One was strong of spirit and weak of will while the other, conversely, was strong of spirit and possessed a weak will. This entirely fictitious feat was motivated by the respectable, but innocent, quest for balance.

Another culturally closer story that evidences the human desire for transplants is that of the Miracle of Saints Cosmas and Damian. These two men were twin brothers who were born in Arabia in the third century A.D. and dedicated their lives to God and medicine. The story tells that Justinian, sacristan of a Roman basilica, had a pathology in his leg that caused it to become gangrenous, causing him severe pain. One night he dreamed that these two characters assisted him, replacing his defective leg with that of an Ethiopian servant who had died the day before. When he awoke from the dream his leg was healed. When he went to his servant’s grave he found his mutilated leg in it.

Moving away from stories and entering more tangible fields we have to talk about Sushruta, an Indian healer who collected in a book called “Sushruta- Samita” a series of techniques and tools of surgery. In this text he describes how to reconstruct a patient’s nose using his own skin. This is the first transplant in humans on record. Since it is an autotransplant, there is no risk of rejection, which is a problem that had not yet been contemplated.

On the other hand, the Bolognese physician Gaspare Tagliacozzi set out in his work a series of guidelines and protocols for performing transplants. These texts even mention the possibility of performing this practice between two different patients. In fact, to explain the rejection he states that it is the “force and power of individuality” that makes it impossible to graft the tissues of another person.

We have to go back to the 20th century, when the Austrian ophthalmologist Eduard Zirm managed to perform the first transplant from a cadaver to a person. His greatest feat was to restore sight to a man who had lost it when quicklime accidentally fell into his eyes. He performed a cornea transplant on an 11-year-old boy who had died the day before. The most amazing thing about this story is that this process was performed without anesthesia, advanced surgical tools, antibiotics and, of course, without the hygiene and sterilization protocols used today.

In 1912, Alexis Carrell received the Nobel Prize in Medicine for his advances in blood vessel joining, tissue preservation and transplantation. Although his figure generates a great deal of controversy due to his close relationship with Nazism, it is true that his advances in the field of health are indispensable. He developed a suturing technique that made it possible to join a blood vessel that had been cut. At the same time, he managed to keep alive and prolonged tissues that had been separated from the organism, demonstrating that it was possible under the right conditions.

There had been several attempts before the first successful transplant between individuals, i.e. one in which the recipient survived in the long term, was performed in 1954. This was because both donor and recipient were identical twins. This nuance avoided the big problem that was occurring at the time: rejection by the immune system.

The first lung transplant was performed in 1963 and the first heart transplant in 1967, both patients died after 18 days due to rejection. But they were a major breakthrough and demonstrated the possibilities of this technique. By the end of the 1970s, the most performed transplants were kidney transplants, but more than 30% of the recipients died within a year of the operation. In other words, about 1 in 3 patients died after one year.

Fortunately, in the 1980s cyclosporine was discovered, which, when used together with other immunosuppressants, made it possible to overcome the problem of rejection and greatly increase the success rate of these donations. Surgical techniques have also improved notably, becoming more sophisticated and safer, which has a direct positive impact on the success of this exercise. Since then it has become a widespread procedure, always open to innovation, at the forefront of surgery. Without going any further, in 2022 a pig’s heart was transplanted (after being genetically modified) into a terminally ill patient who survived the operation and, as of February 25 of the same year, is still alive.

 

Transplants save thousands of lives a year and solve health problems that until not too long ago were insurmountable. We are far from being immortal and unfortunately there are still incurable diseases for today’s medicine, but little by little we are abolishing the death penalty that certain pathologies that can now be solved with a transplant.

 

Links:

https://elpais.com/sociedad/2022-01-21/los-trasplantes-de-organos-en-espana-superan-el-bache-de-la-covid-y-aumentan-un-8-en-2021.html 

https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/sanidad14/Paginas/2021/160821_donacion2020.aspx 

https://www.nationalgeographic.es/ciencia/2021/05/espana-lider-mundial-en-trasplante-de-organos-durante-28-anos 

https://www.nationalgeographic.es/ciencia/national-geographic-estrena-ciencia-de-la-vida-trasplantes 

https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/sanidad14/Paginas/2021/160821_donacion2020.aspx 

https://pubmed.ncbi.nlm.nih.gov/24610608/ 

https://www.larazon.es/lifestyle/la-razon-del-verano/desde-cuando-se-plantean-los-transplantes-de-organos-OJ19233827/ 

https://lariojaturismo.com/noticia/la-leyenda-del-primer-trasplante/57387d45-63f9-4816-b67b-7cca2c55f24f 

http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016-38132006000500012 

https://temas.sld.cu/trasplante/historia-del-trasplante-breves-resenas/#:~:text=En%201954%2C%20el%20ri%C3%B1%C3%B3n%20fue,en%20la%20d%C3%A9cada%20de%201980. 

http://www.ont.es/home/Paginas/HistoriadelosTrasplantes.aspx 

https://www.lavanguardia.com/vida/20220128/8017622/cocaina-trasplante-de-corazon-cerdo-hombre-nbs.html