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.
