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11 Nissan 5761 - April 4, 2001 | Mordecai Plaut, director Published Weekly
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Home and Family
Your Medical Questions Answered!

by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

We now end our discussion of autoimmune diseases, that is diseases where the body attacks itself, with a short discussion on transplants.

Alot has occurred since 1968 when Dr. DeBakey transplanted the first heart into Louis Warshawsky, a patient from South Africa. The transplant was thought to be a success. However, the patient lived only for a month and died from pneumonia. Soon more transplants were tried, but a serious effect called rejection basically stopped this. Rejection is when the body recognizes the transplant as a foreigner and attacks it. An even worse problem is Graft versus Host disease where the new transplant actually attacks the body it has been transplanted into.

One way to avoid these problems is to make a perfect match. That is, pick a transplant that is so similar to the body that it is being transplanted into that rejection won't occur. This is only possible in most organs when the donor is an identical twin or a close relative. This is often the case with bone marrow transplants and kidney transplants. Sometimes we can make a perfect match even in strangers, because we know exactly which parts of the cell are recognized as foreigners. This is the case with blood transfusions, where rejection is rare.

Sometimes, a transplant can be done without worrying too much about rejection because the organs being transplanted have minimal blood supply and don't elicit a rejection response. This is the case with skin and corneal (the covering of the eye that lets us see) transplants. They can even be taken from people who have died years before and had these organs preserved.

Nowadays, hearts and kidneys are transplanted routinely. Lungs, liver, and pancreases can also be transplanted. We have overcome the problem of rejection by the discovery of a wonder drug in 1980 called cyclosporine which blunts the rejection response. The path is still rocky, as people taking this drug are susceptible to various serious infections, but at least people with end-stage diseases can live somewhat normal lives. Research on the transplantation of animal organs and machines such as the mechanical heart are still ongoing.

I have of course not spoken about the halachic ramifications of transplants. This interesting field has led to literally thousands of shailos. Please consult your local halachic authority if this interests you. Write me in care of the Yated.

A message from Glaxo, sponsor of this column. Zinnat is a strong antibiotic which can help in serious infections of the respiratory and urinary tract. It is safe in pregnancy and in children, which is a distinct advantage.

 

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