Medical Doctor

Medical Doctor 12/18/2009

Resource of Medical Health Disease conditions and Prevention.

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Heart doctor

12/18/2009 02:39

Cardiovascular diseases are the world’s largest killers, claiming 17.1 million lives a year. Tobacco use, an unhealthy diet, physical inactivity and harmful use of alcohol increase the risk of heart attacks and strokes.

Key messages to protect heart health
1.Heart attacks and strokes are major–but preventable–killers worldwide.
2.Over 80% of cardiovascular disease deaths take place in low-and middle-income countries and occur almost equally in men and women. Cardiovascular risk of women is particularly high after menopause.
3.Tobacco use, an unhealthy diet, and physical inactivity increase the risk of heart attacks and strokes.
4.Cessation of tobacco use reduces the chance of a heart attack or stroke.
5.Engaging in physical activity for at least 30 minutes every day of the week will help to prevent heart attacks and strokes.
6.Eating at least five servings of fruit and vegetables a day, and limiting your salt intake to less than one teaspoon a day, also helps to prevent heart attacks and strokes.
7.High blood pressure has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked regularly.
8.Diabetes increases the risk of heart attacks and stroke. If you have diabetes control your blood pressure and blood sugar to minimize your risk.
9.Being overweight increases the risk of heart attacks and strokes. To maintain an ideal body weight, take regular physical activity and eat a healthy diet.
10.Heart attacks and strokes can strike suddenly and can be fatal if assistance is not sought immediately.

Med doctor

12/18/2009 02:40

WHO/ISH Hypertension guidelines
Hypertension is already a highly prevalent cardiovascular risk factor worldwide because of increasing longevity and prevalence of contributing factors such as obesity. Whereas the treatment of hypertension has been shown to prevent cardiovascular diseases and to extend and enhance life, hypertension remains inadequately managed everywhere.

Multiple guidelines for the more effective management of hypertension have been published. Guidelines, to be useful in clinical practice, must be evidence-based and up-to-date. The 1999 WHO/ISH guidelines for the management of hypertension were updated both to respond to some specific concerns and to address a number of issues for which considerable new evidence has been obtained from epidemiological surveys and therapeutic trials.

As to concerns about the 1999 guidelines, one relates to their possible lack of applicability to less developed societies with limited resources since WHO guidelines should be directed towards a global audience. A second concern relates to their strong advocacy of more intensive blood pressure lowering with the implication of the need for more pharmacological (drug) therapy with intimations that financial support to the committee from pharmaceutical marketers may have influenced this advocacy. A third concern addresses the lack of documentation of the evidence base for the 1999 guidelines. And lastly, concerns that expert committees may not reflect the needs of practitioners and patients.

Four policies were used to strengthen the scientific validity and credibility of the 2003 update: 1) an explicit evidence based process was used for the development of evidence based recommendations; 2) the expert group was composed of general practitioners, a physician who has worked with consumer groups, a nurse practitioner and specialists to ensure that the recommendations are fully compatible with usual clinical practice; 3) all potential conflicts of interest were fully disclosed; and 4) all expenses incurred in the preparation of the guidelines were paid by the WHO alone.

This revision specifically, addresses the following issues: 1) the ascertainment of global cardiovascular risk to establish both the thresholds for initiation of treatment and the goals of treatment for hypertensives overall and for various subgroups; 2) the appropriate treatment strategies for both non-drug and drug therapies; and 3) the costs of evaluation and treatment in order to optimize the application of guidelines in less developed societies with limited resources that must be most effectively utilized.

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Heart doctor

12/18/2009 02:44

Research and global partnership initiatives
The Cardiovascular Health Research Initiative in developing countries
The CVD Research Initiative began in November 1998 as a joint programme of WHO and the Global Forum for Health Research. The partnership has since expanded to include the Institute of Medicine (USA); World Heart Federation; National Public Health Institute (Finland); World Hypertension League; International Obesity Task Force; International Institute for Health and Development (Australia); Institut Universitaire de Médecine Sociale et Préventive (Switzerland); Centres for Disease Control (USA); and National Institutes of Health (USA). The Initiative has developed six multicentre collaborative research projects on capacity assesssment, surveillance, community-based interventions, clinical management and global information networks.

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Doc

12/18/2009 02:45

Air travel and venous thoromboembolism

WHO convened a consultation of international experts to review the evidence on air travel and venous thromboembolism. The group unanimously decided that further research to investigate possible association should be undertaken as soon as feasible, under the auspices of WHO and the International Civil Aviation Organization, and supported by an independent scientific committee. It was also recommended that the International Air Transport Association and commercial airlines should be collaborators in the research. Research protocols for a set of multicentre collaborative studies have since been developed by the Scientific Committee and are ready for implementation.

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Med doctor

12/18/2009 02:47

Asthma

Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. During an asthma attack, the lining of the bronchial tubes swells, causing the airways to narrow and reducing the flow of air into and out of the lungs.

The causes of asthma are not completely understood. However, risk factors for developing asthma include inhaling asthma “triggers”, such as allergens, tobacco smoke and chemical irritants. Asthma cannot be cured, but appropriate management can control the disorder and enable people to enjoy a good quality of life.

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Med doctor

12/18/2009 02:51

Chronic respiratory diseases

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung. Some of the most common are asthma, chronic obstructive pulmonary disease (COPD), respiratory allergies, occupational lung diseases and pulmonary hypertension.

The most important risk factors for preventable chronic respiratory diseases are:

•Tobacco smoking
•Indoor air pollution
•Outdoor pollution
•Allergens
•Occupational risks and vulnerability

WHO chronic respiratory diseases Programme
The aim of the WHO chronic respiratory diseases programme is to support Member States in their efforts to reduce the toll of morbidity, disability and premature mortality related to chronic respiratory diseases, and specifically, asthma and chronic obstructive pulmonary disease (COPD).

Programme objectives:

•Better surveillance to map the magnitude of chronic respiratory diseases and analyse their determinants with particular reference to poor and disadvantaged populations, and to monitor future trends.
•Primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco, poor nutrition, frequent lower respiratory infections during childhood, and environmental air pollution (indoor, outdoor, and occupational).
•Secondary and tertiary prevention to strengthen health care for people with chronic respiratory diseases by identifying cost-effective interventions, upgrading standards and accessibility of care at different levels of the health care system.

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Med doctor

12/18/2009 02:52

Bronchiectasis

Bronchiectasis is an abnormal widening of one or more airways. Normally, tiny glands in the lining of the airways make a small amount of mucus. Mucus keeps the airways moist and traps any dust and dirt in the inhaled air. Because bronchiectasis creates an abnormal widening of the airways, extra mucus tends to form and pool in parts of the widened airways. Widened airways with extra mucus are prone to infection.

The cause of bronchiectasis is often not clear. Some conditions that affect or damage airways can cause the disease, for example:

•Some inherited conditions. For example, a condition called primary ciliary dyskinesia affects the cilia so they do not 'move' correctly to clear the mucus. Cystic fibrosis is another condition that affects the lungs and causes bronchiectasis.

•Inhaled objects can become stuck and block an airway. This may lead to local damage to that airway. Acid from the stomach that is regurgitated and inhaled can damage airways as well as inhaling poisonous gases.

•Severe lung infections such as tuberculosis (TB), whooping cough, pneumonia or measles can damage the airways at the time of infection. Bronchiectasis may then develop.
The main symptom of bronchiectasis is a cough which produces a lot of sputum, tiredness and poor concentration as well as wheeziness. A lung scan and other lung and sputum tests help to confirm the diagnosis. Treatment includes regular physiotherapy, which helps coughing up and clearing the mucus, and courses of antibiotics. Surgery is occasionally needed.

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Med doctor

12/18/2009 02:54

Obstructive sleep apnoea syndrome

Obstructive sleep apnoea syndrome is a clinical disorder marked by frequent pauses in breathing during sleep usually accompanied by loud snoring. These pauses cut off the oxygen supply to your body for a few seconds and halt the removal of carbon dioxide. As a result of this, your brain briefly wakes you up, re-opens the airways and re-starts breathing. This can occur many times during the night and makes proper sleep impossible. During the day you may experience excessive daytime sleepiness, difficulty in concentrating or headaches. At night, snoring is the most common feature.

Obstructive sleep apnoea syndrome is diagnosed through polysomnography, a method of recording body activity during sleep; and pulse oximetry, which measures the amount of oxygen in the blood at any time. Obstructive sleep apnoea syndrome is not a life-threatening condition in itself, but it can result in serious problems such as cardiovascular and cerebrovascular diseases. The disease can impact on the quality of life, but can be easily managed. One of the treatments is continuous positive airway pressure, which forces air through a mask into the airways so that they do not close.

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Med doctor

12/18/2009 02:55

Allergic rhinitis and sinusitis

Allergic rhinitis, or hay fever, happens when you breathe in something to which you are allergic, and the inside of your nose becomes inflamed and swollen.

Sinusitis is an inflammation of the lining inside the sinuses which can be acute or chronic. When the sinuses become blocked and fill with fluid, germs can grow and cause symptoms such as headache and nasal yellowish secretions. Blocked sinuses can be caused by the common cold, hay fever or nasal polyps (small lumps inside the nose).

Allergic rhinitis and sinusitis are linked to each other, because allergic rhinitis causes your nose to become blocked, and in turn blocks the sinuses.

Allergic rhinitis is triggered by allergens. Allergens can be found both outdoors and indoors. When allergic rhinitis is caused by outdoor allergens, e.g., mould or trees, grass and weed pollens — it is often referred to as seasonal allergies, or “hay fever”. Allergic rhinitis may also be triggered by allergens found in the home, such as animal dander, indoor mould, or house dust mites. The most current classification of allergic rhinitis, tough, takes into consideration the intensity of symptoms and the impact on quality of life. According to these characteristics it may be mild or moderate/severe.

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Acute sinusitis usually subsides without any need for specific treatment. Chronic sinusitis may require antibiotics, decongestants or steroid nasal sprays.

Med doctor

12/18/2009 02:55

Pulmonary hypertension

Pulmonary hypertension is a condition in which there is high blood pressure in the lung arteries. How the disease starts is not always clear, but the arteries become narrow and there is less room for the blood to flow. Over time, some of the arteries may stiffen and become completely blocked. The narrowing of the pulmonary arteries causes the right side of heart to work harder to pump blood through the lungs. Over time, the heart muscle weakens and loses its ability to pump enough blood for the body's needs. The extra stress causes the heart to enlarge and become less flexible. Heart failure is one of the most common causes of death in people who have pulmonary hypertension.

In some cases, pulmonary hypertension is caused by schistosomiasis, a worm infection which is common in Africa and Latin America; and sickle cell disease, a genetic abnormality of blood which is common in persons of African origin.

Difficulty in breathing or shortness of breath is the main symptom of pulmonary hypertension. Other symptoms are fatigue, dizziness, swelling in the ankles or legs (edema), bluish lips and skin (cyanosis), chest pain, racing pulse and palpitations.

Allergic rhinitis and sinusitis

Allergic rhinitis, or hay fever, happens when you breathe in something to which you are allergic, and the inside of your nose becomes inflamed and swollen.

Sinusitis is an inflammation of the lining inside the sinuses which can be acute or chronic. When the sinuses become blocked and fill with fluid, germs can grow and cause symptoms such as headache and nasal yellowish secretions. Blocked sinuses can be caused by the common cold, hay fever or nasal polyps (small lumps inside the nose).

Allergic rhinitis and sinusitis are linked to each other, because allergic rhinitis causes your nose to become blocked, and in turn blocks the sinuses.

Allergic rhinitis is triggered by allergens. Allergens can be found both outdoors and indoors. When allergic rhinitis is caused by outdoor allergens, e.g., mould or trees, grass and weed pollens — it is often referred to as seasonal allergies, or “hay fever”. Allergic rhinitis may also be triggered by allergens found in the home, such as animal dander, indoor mould, or house dust mites. The most current classification of allergic rhinitis, tough, takes into consideration the intensity of symptoms and the impact on quality of life. According to these characteristics it may be mild or moderate/severe.

www.hospitalfamily.com

Africa

12/18/2009 02:58

HIV and AIDS

The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further.

HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding.

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Doctor

12/18/2009 02:58

Fact 1
HIV (human immunodeficiency virus) infects cells of the immune system and destroys or impairs their function. Infection results in the progressive deterioration of the immune system, breaking down the body's ability to fend off infections and diseases. AIDS (Acquired immune deficiency syndrome) refers to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or related cancers.

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Doctor

12/18/2009 02:59

Fact 2
HIV can be transmitted through unprotected sexual intercourse (vaginal or anal) or oral sex with an infected person; transfusions of contaminated blood; and the sharing of contaminated needles, syringes or other sharp instruments. It can also be transmitted between a mother and her baby during pregnancy, childbirth and breastfeeding.

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Doctor

12/18/2009 03:00

Fact 3
33.4 million people live with HIV/AIDS worldwide, the vast majority of whom are in low- and middle-income countries. An estimated 2.7 million people were newly infected with the virus in 2008.

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Doctor

12/18/2009 03:00

Fact 4
HIV/AIDS is the world’s leading infectious killer claiming—to date—more than 27 million lives. An estimated 2 million people die every year from HIV/AIDS.

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Doctor

12/18/2009 03:01

Fact 5
Combination antiretroviral therapy (ART) prevents the HIV virus from multiplying in the body. If the reproduction of the HIV virus stops, then the body's immune cells are able to live longer and provide the body with protection from infections.

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Doctor

12/18/2009 03:01

Fact 6
About 4 million HIV-positive people had access to antiretroviral therapy (ART) in low- and middle-income countries in 2008. This is a 36% increase in treatment coverage compared to 2007 and a tenfold increase over five years. Despite these gains, global coverage of ART is still low, reaching only 42% of the estimated 9.5 million people who need it.

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Doctor

12/18/2009 03:02

Fact 7
More than 2 million children are living with HIV/AIDS, according to 2008 figures. Most of the children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Almost 1200 children become newly infected with HIV each day. The number of children receiving ART increased from about 75 000 in 2005 to 276 000 in 2008.

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Doctor

12/18/2009 03:03

Fact 8
Mother-to-child-transmission is almost entirely avoidable, but access to preventive interventions remains low in most developing low- and middle-income countries. However, progress has been made. In 2008, 45% of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of the virus, up from 10% in 2004.

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Doctor

12/18/2009 03:04

Fact 9
In 2007, more than 450 000 deaths from tuberculosis occurred among people living with HIV. This is equal to nearly a quarter of the estimated 2 million deaths from HIV in that year. The majority of people living with both HIV and TB reside in sub-Saharan Africa (about 80% of cases worldwide), of whom around one quarter are in South Africa.

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Doctor

12/18/2009 03:05

Fact 10
Some key ways to prevent HIV transmission:

•abstain from sex, or practice safe sexual behaviors such as using condoms;
•get tested and treated for sexually transmitted infections, including HIV;
•avoid injecting drugs, or if you do, always use new and disposable needles and syringes; and
•ensure that any blood or blood products that you might need are tested for HIV.

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Odoctor

01/02/2010 08:21

Organ Transplant

Sixty years ago, scientists were on the cusp of a revolutionary scientific breakthrough. In the preceding decades, researchers had had some success transplanting organs in animals, and there had even been a few failed attempts at human organ transplants. Numerous studies showed that human organ transplantation was feasible, and that it would be enormously beneficial to thousands of patients, but nobody had been able to make it work.

Success finally came in the early 1950s, when several kidney transplants within a few years gave new life to ailing patients. In the following decades, doctors learned how to transplant other organs successfully, and they dramatically improved recovery rates. Today, most organ transplants are relatively safe, routine procedures, and transplantation is considered to be the best treatment option for thousands of patients every year.

Unfortunately, doctors and patients now face a new obstacle: The demand for transplants has far surpassed the supply of donated organs. Simply put, there aren't enough organ donors, so patients must wait months, even years, for their chance at recovery.

he Screen, the List and the Match
Organ transplants are one option when a particular organ is failing. Kidney failure, heart disease, lung disease and cirrhosis of the liver are all conditions that might be effectively treated by a transplant. For problems with the heart, the lungs and other highly sensitive organs, a transplant is typically the course of last resort. But if all other avenues have been explored and the patient is willing and able, transplantation is a good, viable option.

Kidneys and livers may be transplanted from a living donor, since people are born with an extra kidney and the liver is regenerative. Even a lung can be transplanted from a living donor, but this is still very rare. For these procedures, a patient will generally find a willing donor in a friend or family member. If the donor is a match, they can proceed directly to the surgery stage. A smaller number of living transplants come from charitable people donating for the general good.

If a patient needs a heart transplant, a double lung transplant, a pancreas transplant or a cornea transplant, they will need to get it from a cadaverous (deceased) donor. Generally, acceptable donors are people who are brain dead but on artificial life support. Even though they are technically dead, their body is still functioning, which means the organs remain healthy. Organs will deteriorate very quickly after the body itself expires, making them unusable for transplant.

In the United States, a patient who wants an organ transplant from a cadaverous donor must become part of an elaborate nationwide organ distribution system. This system, known collectively as the Organ Procurement and Transplantation Network (OPTN), is operated by the United Network for Organ Sharing (UNOS), an independent nonprofit organization working under contract with the U.S. Department of Health and Human Services.

UNOS maintains a database of eligible transplant patients awaiting organs as well as detailed information on all the organ transplant centers around the country. Additionally, the UNOS board of directors, primarily made up of transplant doctors, transplant patients and organ donors, establishes the policies that decide who will get which organs.

Getting on the List

To be included on the national waiting list, a patient must first find a transplant team that will treat him or her. The transplant team, a group of surgeons, nurses and other health professionals at a hospital, evaluates the patient to decide whether he or she is a good candidate for transplantation. In addition to assessing the patient's physical condition, the team will consider the patient's attitude, psychological state and history of drug abuse, among other factors. Donated organs are a rare and precious commodity, so doctors don't want to proceed unless they are confident that a patient is physically and mentally prepared for the procedure, as well as life after the procedure. For the most part, patients who are unwilling to give up unhealthy drugs, including cigarettes and alcohol in many situations, will be automatically disqualified.

If the transplant team feels that a patient is a good candidate for transplant, they will contact the UNOS Organ Center in Richmond, VA, in order to put the patient on the national waiting list. The Organ Center operators record all relevant information about the patient, including his or her physical condition, blood type, tissue type and age. This information is entered into the national database.

When an organ becomes available (when an organ donor is pronounced brain dead at a hospital, typically), the local organ procurement organization (OPO) will gather all relevant information about the donor and enter this data into a program maintained by the UNOS Organ Center. Based on the criteria e

Odoctor

01/02/2010 08:22

The Surgery

When a donor's family authorizes the removal of organs, several surgical teams immediately begin work recovering the organ. (While the term harvesting is still in use, many organizations now prefer the term recovery because it is more sensitive to the donor family.) To understand what is involved in this procedure, let's focus on a particularly harrowing operation: the heart transplant.

Organs from Overseas
The shortage of donated organs in the United States is so severe that many patients are seeking out transplants in other countries. In some countries, notably China, foreigners can buy the organs they need instead of waiting at home. These organs typically come from executed prisoners who have not volunteered to donate organs.

This situation is extremely controversial in the organ transplant community. Paying for organs is considered unethical in most Western nations, as is the recovery of organs if the donor has not agreed to donate them. Furthermore, there is strong indication that execution schedules are being modified to meet patient demand.

The first step for all the harvesting teams is to cut open the donor's chest. Next, a surgeon saws through the breast bone and pulls the ribs outward to reveal the heart. While other teams are working on other parts of the body, the heart team clamps the different blood vessels leading into the heart and pumps in a cold, protective chemical solution. This solution stops the heart from beating and helps preserve it during transportation.

The surgeons then sever the vessels and remove the heart from the body, placing it in a bag filled with a preservative chemical. This bag is then packed in an ordinary cooler filled with ice, which is rushed to the recipient's hospital, often via plane or helicopter.

Meanwhile, the recipient is fully anesthetized and his or her chest is shaved. He or she is wheeled into the surgery room and covered in sterile cloths, leaving only the chest exposed. Typically, the surgery won't actually begin until the heart arrives, just in case there is some problem in transport.

When the donated heart has arrived, the transplant team begins the procedure. First, they hook up an IV and inject an anticoagulant into the patient's bloodstream. This keeps the blood from clotting during the transplant procedure.

As with the recovery surgery, the team begins the surgery by making an incision in the patient's chest, sawing through the breastbone and pulling back the ribs. The doctors then hook up a heart-lung machine to the patient's body. The heart-lung machine's job, as you might expect, is to act as the patient's heart and lungs temporarily. The machine's plastic tubes are connected to blood vessels leading to and from the heart. Instead of being pumped to the lungs to get rid of carbon dioxide and pick up oxygen, blood returning to the heart is diverted to the machine. The machine drives the blood through a series of chambers to release carbon dioxide and pick up oxygen and then returns it into the body to be re-circulated. This enables the surgical team to remove the heart without disrupting respiration and circulation.

Additionally, the heart-lung machine can be adjusted to warm or cool the blood. During the operation, it is set to cool all the blood that passes through it. This cools the rest the body, which helps protect the other organs during the operation. Typically, the machine will have an attachment to suck up blood from the surgery area and send it directly back into the bloodstream.

When the blood has been effectively diverted around the heart and lungs, the surgeons remove the diseased heart by cutting it loose from the attached blood vessels. The back walls of the atria, the upper chambers of the heart, are actually left in place. The surgeons remove the back walls of the donor heart's atria and suture the donor heart to the remaining tissue of the old heart. Then they suture the blood vessels formerly leading to the diseased heart to the vessels leading out of the donor heart.

After the new heart is in place, the team gradually warms up the blood flowing through the patient's body. As the body warms a little, the heart may start beating on its own. If it does not, the team applies an electrical shock to get it going. The team lets the new heart and the heart-lung machine share the job of circulating blood for some time, giving the heart time to build strength.

If everything is working correctly, the team wires the halves of the breast bone back together and stitches up the patient's chest using dissolving stitches. The patient is hooked up to a ventilator and brought to the recovery room. In a few hours, most patients regain consciousness. They may be ready to leave the hospital within a week.

Odoctor

01/02/2010 08:34

Typically, the entire procedure only takes about five hours. But patients have to work the rest of their lives to make sure the donated organ continues to function. In the next section, we'll find out what is involved in this post-transplant treatment.

Living with a New Organ

As with most other surgeries, recovery from a transplant operation involves additional medication and hospital visits to make sure the incisions heal correctly. But while other surgery patients typically can move on from the experience, most transplant recipients must continue medical treatment for the rest of their lives. This is because of the immune system's reaction to the new organ.

Your immune system comprises all the elements in your body that keep bacteria, microbes, viruses, toxins and parasites from destroying your organs and tissues. In other words, the immune system works to destroy any harmful foreign matter that ends up in your body. When the system is working correctly, it can distinguish most foreign cells from cells produced by the body. (See How Your Immune System Works to find out how it does this.)

A transplanted organ is made entirely of foreign cells, of course, which means the body will attack it if left to its own devices. To minimize the immune response, transplant teams make sure donors and recipients have matching blood and tissue types. But even with a good match, the body will see the new cells as foreign matter and reject the organ (destroy it cell by cell). Only tissue from an identical twin will be fully accepted.

There are three types of rejection that might occur following a transplant:

* Hyperacute rejection occurs as soon as the donated organ is in the body. This only happens if there are already antibodies in the recipient's bloodstream that react to the new organ, which would occur if the blood types of the donor and recipient were incompatible for some reason. This almost never happens, since transplant teams always test for any incompatibility ahead of time. If it were to happen, the recipient would most likely die on the operating table.

* Acute rejection occurs at least a few days after the transplant, after the body has had time to recognize the foreign material. This is the normal immune response to foreign matter.

* Chronic rejection is a very gradual rejection, lasting months or years. It can be so subtle that the patient doesn't notice any ill effects for some time.

Odoctor

01/02/2010 08:34

Acute Rejection

The chief obstacle to living with a transplant is acute rejection. This sort of rejection would happen to nearly all recipients if it weren't for immunosuppressive drugs. As you might expect, immunosuppressive drugs generally suppress elements of the immune system so they do not attack the donor organ. The problem with this is that the drugs also suppress some of the beneficial things the immune system does. A person taking immunosuppressive drugs is much more susceptible to infection and disease.

A new approach may eventually change this course. In a few experimental cases, kidney transplant patients have also received bone marrow transplants from their donors. Bone marrow produces the white blood cells that play a crucial role in guarding the body against foreign matter. The theory behind this new approach is that the white cells from the donor marrow will merge with the recipients's natural cells, allowing the immune system to recognize the new organ as part of the body. The initial experimental results are encouraging. The first test subjects are doing very well without taking any immunosuppressive drugs.

Drugs are still the main course of action, however, and they do yield good results. Typically, a transplant team prescribes specific combinations of drugs to patients in order to achieve the right balance of suppression. The goal is to suppress the system just enough to prevent rejection, while minimizing side effects and the risk of infection. The transplant team usually adjusts the drug prescription over time, fine-tuning it to the patient's needs. In some cases, the patient may eventually be weaned off all drugs as the body adapts to the new organ, but this is extremely rare.

Transplant patients must be vigilant about taking their medication, and they must visit the hospital regularly for follow up tests. But it is worth it in most cases -- patients who have been sick for many years due to a diseased organ may feel completely rejuvenated following a transplant.

Unfortunately, thousands of people never get this chance at a new life. In the next section, we'll find out why this is and look at a few possible solutions.

Improving the System

Forty years ago, countless people died because doctors could not successfully perform a transplant and prevent rejection. The knowledge of immunosuppressive drugs was minimal, and the surgery involved was extremely difficult.

Odoctor

01/02/2010 08:35

Today, science has advanced to the point that most transplant operations are considered relatively low risk. The success rate is phenomenal for kidney transplants, liver transplants, cornea transplants, pancreas transplants -- even heart and lung transplants. But more than 5,000 potential transplant recipients die in the United States every year, not because of scientific obstacles, but because of social ones.

A Fair Trade
The United Network for Organ Sharing is trying out a promising new organ exchange program as an incentive to encourage kidney donation. In this program, someone who wants to donate a kidney to a friend or family member but is not a match can donate to another transplant patient in order to move his or her loved one up on the waiting list.

Donors can either arrange an exchange with a matching family in the same situation or they can donate the organ into the general pool in exchange for a cadaver kidney. Obviously, this arrangement directly benefits the specific recipients, but it also benefits the transplant community as a whole since more kidneys are donated into the system. Check out Initiative May Shorten Wait For Kidney Transplant for more information.

In the United States, the vast majority of the population is in favor of organ donation, but only a small percentage of people actually end up donating their organs when they die. There aren't anywhere near enough organs to meet the demand, which means an average of 16 potential recipients die every day from a curable condition.

This is partly due to human psychology and partly due to donation consent laws. Under current U.S. law, the final decision to donate a deceased person's organs is left to whoever has power of attorney or to the person's family. Organ donor cards or organ donor indications on a driver's license are important legal documents, but the consent of family members takes precedence.

Naturally, most people don't want to dwell on the thought of their own death, so few take the time to discuss their feelings about organ donation with their families. When it comes time to make the decision, the family members aren't sure what to do. They may be so troubled by the thought of surgeons cutting their loved one's body that they decline to donate the organs.

The main problem, then, is that donating organs requires at least two people to take decisive action that may be uncomfortable. The donor must take the initiative to talk to his or her family and the family must take the initiative to adhere to the donor's wishes. If these things don't happen, and in the majority of cases they don't, nobody gets to use those organs.

This has created a national medical crisis in the United States, and hundreds of surgeons, scientists and politicians are clamoring for a solution. One interesting possibility is xenotransplantation, the transplantation of organs between different species. The study of xenotransplantation is still in the early stages, but there have been some promising results. It is not a totally viable alternative at this time for a number of reasons. Chiefly, many scientists are worried that transplants between animals and humans could introduce new diseases into the human population. Xenotransplantation is also problematic ethically, as it would involve killing animals for their organs.

Another interesting avenue is the development of artificial organs. But while there have been tremendous advances in this field over the past decade, artificial organs don't work nearly as well as natural organs for most patients. It is still a very young science.

At this time, many doctors and politicians suggest legal and social changes as the best option. In some European and Asian nations, it is automatically assumed that you are an organ donor unless you notify the government that you do not want to be. Few people take this necessary action, and this has greatly increased the supply of available organs. Many feel that the United States should follow this model, but the idea has met with a lot of resistance. It would mean exerting greater control over people's bodies.

Most experts agree that the ideal solution to the problem would be a shift in national consciousness. To this end, the United Network for Organ Sharing, the American Medical Association, the National Institute of Health and many other organizations have stepped up efforts to educate the public about the benefits of donation. These groups hope that if more people understand the need for organs and the tremendous benefit of donation, they will begin to see donation as their social responsibility. They will understand that organ transplantation is truly one of the most remarkable achievements of modern science, and that organ donation is among the greatest opportunities to serve humanity.

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Odoctor

01/02/2010 08:37

Heart

In the three decades since the first human heart transplant occurred in 1967, the procedure has changed from an experimental operation to an established treatment for advanced heart disease. They are now the the third most common organ transplant operation in the U.S.
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

There are two very different surgical approaches to heart transplantation: the orthotopic and the heterotopic approach. Because the length of this surgery is different for every patient, families should talk with the surgeon about what to expect.

* Orthotopic Approach. The more common of the two procedures, the orthotopic approach, requires replacing the recipient heart with the donor heart. After the donor heart is removed, preserved and packed for transport, it must be transplanted into the recipient within four to five hours. The recipient receives general anesthesia and is placed on a bypass machine to oxygenate the blood while the heart transplant is being performed. After the recipient's heart is removed, the donor heart is prepared to fit and implantation begins.
* Heterotopic Approach. Heterotopic transplantation, also called "piggyback" transplantation, is accomplished by leaving the recipient's heart in place and connecting the donor heart to the right side of the chest. The procedure is rare compared to orthotopic transplantation and is advantageous because the new heart can act as an assist device if complications occur. Your physician can explain why this approach may better suit your needs.

During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:38

Heart/Lung
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

The donated heart and lungs come from a deceased donor. After the donor heart and lungs are removed, preserved and packed for transport, they must be transplanted into the recipient within four to five hours. The recipient receives general anesthesia and is placed on a ventilator and bypass machine to oxygenate the blood while the transplant is being performed. After the recipient's heart and lungs are removed, the donor organs are prepared to fit and implantation begins.

Because the length of this surgery is different for every patient, families should talk with the surgeon about what to expect.
During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:39

Kidney
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

An incision is made in the lower part of one side of the abdomen, the donor kidney is placed in the recipient, and blood vessels and the ureter from the donor kidney are connected to vessels in the recipient. The recipient's kidney is typically not removed unless special circumstances are identified by the surgeon. Once all connections have been made, the incision is closed.

The kidney or renal transplant surgical procedure takes approximately three to four hours to complete. Because the length of this surgery is different for every patient, families should talk with the surgeon about what to expect.
During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:40

Pancreas
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

Although it is possible for a living donor to donate an intestine segment, most intestine transplants involve a whole organ from a deceased donor. In addition, most intestine transplants are performed in conjunction with a liver transplant.

Although it is possible for a living donor to donate a pancreas segment, most pancreas transplants involve a whole organ from a deceased donor. After the donor pancreas is removed, preserved and packed for transport, it must be transplanted into the recipient within twelve to fifteen hours. The pancreas transplant recipient is first given general anesthesia and is placed on a ventilator and an incision is made in the lower abdomen. The diseased pancreas is not removed during the operation. The donor pancreas is inserted in the lower portion of the patient's abdomen and attached to their blood vessels, and intestine or bladder.

The whole organ pancreas surgical procedure takes approximately two to four hours to complete. Because the length of this surgery is different for every patient, families should talk with the surgeon about what to expect.
During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:40

Kidney/Pancreas

Because many patients who suffer pancreas failure also have renal failure, the kidney is frequently transplanted with the pancreas. The clear advantage of this type of dual-organ transplant is that it involves one surgical procedure and uses a single donor, reducing the risk of rejection. In most cases, a kidney/pancreas transplant is performed from a deceased donor, but there have been several transplants performed using a living donor, with one kidney and a pancreas segment being donated.
Arriving at the hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

The surgery begins by removing the kidney from the living donor in an operating room after the donor is anesthetized. If the donor is deceased, the kidney and pancreas are removed at the same time as other organs that are also being used for transplantation. It is customary to transplant both kidney and pancreas together from the same donor. The donor kidney is placed on the lower side of the recipient's abdomen, where it is surgically connected to blood vessels and the bladder. The new pancreas is placed on the lower side of the recipient's abdomen, where it is also surgically connected to nearby blood vessels. Once all connections have been made, the incision is closed. Monitoring is then done for the rejection episodes of both organs via the kidney graft.

The kidney/pancreas transplant surgical procedure takes approximately five to seven hours to complete, but may be different for every patient. Families should talk with the surgeon about what to expect.
During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:41

Liver
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

There are two very different surgical approaches to liver transplantation: the orthotopic and the heterotopic approach, both of which can take up to ten hours to complete. Because the length of this surgery is different for every patient, families should talk with the surgeon about what to expect.

* Orthotopic Approach. The orthotopic approach requires replacing the recipient liver with the donor liver. After the donor liver is removed, preserved and packed for transport, it must be transplanted into the recipient within 12 to 18 hours. The surgery begins by removing the diseased liver from the four main blood vessels and other structures that hold it in place in the abdomen. After the recipient's liver is removed, the new healthy donor liver is then connected and blood flow is restored. The final connection is made to the bile duct, a small tube that carries bile made in the liver to the intestines.
* Heterotopic Approach. In heterotopic liver transplantation, the recipient's liver is left in place and a donor liver is sewn into an ectopic site. Your physician can explain why this approach may better suit your needs.

During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:42

Intestine
Arriving at the Hospital

The process of being admitted and preparing for transplant surgery can vary greatly. Talk to your physician about how your transplant hospital will handle this phase of the process.
The Procedure

Although it is possible for a living donor to donate an intestine segment, most intestine transplants involve a whole organ from a deceased donor. In addition, most intestine transplants are performed in conjunction with a liver transplant.
During Recovery

Postoperative care begins with a team of heath professionals within the hospital. Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from patient to patient. Because individual experience after recovery is so unique, it is important to discuss with your physician what to expect after surgery.

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Odoctor

01/02/2010 08:43

Which Hospital Is Best for You?

When choosing a transplant center, patients should carefully consider these factors:

* The experience of the transplant team and support personnel. It is always important to know how much experience a hospital has with the type of care you need.
* The cost of the procedure and related items. The cost of a transplant, including preliminary testing, the surgery itself and post-operative recovery costs vary across the country by hospital and organ type.
* Insurance coverage. Although many insurance companies offer coverage for transplant costs, the terms and benefits of insurance policies vary widely. Some insurance companies establish network agreements with certain transplant centers; the insurer may pay a higher proportion of costs for centers within their network. In addition, many transplant centers have different policies about the types of insurance they accept for the type of transplant you need.
* Geographical proximity to the program. The travel time to the transplant center is important when you are waiting for an organ and is a key factor considered in organ distribution. More information
* The quality and availability of pre- and post-transplant services. Offering a comprehensive system of support services to meet the special needs of patients and their families is important. Education and emotional support can help you feel informed about your health care decisions.
* A commitment to keeping up with technologic advances. It may be important to identify if a transplant center has a commitment to technology and the latest procedures, both which offer assurance that a program is continually growing.
* Multicultural sensitivity. Does the transplant center have bilingual staff members and/or access to translators if needed? Regardless of treatment, patients should always feel understood and informed throughout the treatment process.
* Availability of friends and family for assistance. More and more, family members and friends are needed to help with the patient's care as an outpatient.

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Odoctor

01/02/2010 08:45

Waiting for Your Transplant

Waiting for a donor organ can be a stressful experience, especially because the amount of time you'll have to wait is unknown. Regardless, there are important steps transplant candidates can take to ensure they are ready for surgery when the important call comes.

* Take care of your health. Try to stay as healthy as possible and take your medicines as they are prescribed. Notify your transplant coordinator if any additional medicines are prescribed or altered or if you are hospitalized for any reason.
* Keep your scheduled appointments with your physicians. Until your transplant, you will need to meet with members of the transplant team in order to evaluate your overall health.
* Participate in support groups. Ask your social worker about support groups and other resources, so you'll have access to more information and other transplant candidates.
* Follow the dietary and exercise guidelines. Weight management is very important while waiting for your transplant. A dietician and physical therapist can work with you to plan and develop a diet and exercise program that will give you the greatest benefit before and after transplantation.
* Occupy yourself by staying involved. Spend time doing what you enjoy and stay as active as your physical condition will permit. Keep up with your work, studies and/or leisure activities, or start a project or hobby that can help distract you and make time pass more quickly.
* Maintain contact with family and friends. Good company will take your mind off of waiting and enrich your life.
* Just relax. Reading or listening to music or relaxation tapes can be helpful in taking your mind off your transplant and avoiding negative thoughts.
* Make sure you are available. It is important for your transplant team to know how to get in touch with you at all times. Pagers, cell phones or remote answering machines may be required by your transplant center. Your transplant coordinator may recommend that you stay within a certain geographic range.
* Be prepared with transportation. When you are placed on the organ waiting list, your first responsibility is to plan how to get to the transplant center as soon as you are notified that an organ is available. Prepare yourself for this call by making the necessary arrangements for transportation well in advance.
* Be prepared by packing your bags in advance. You'll need to be ready to leave as soon as you get the call that an organ is available. Be sure to take your insurance information, an extra 24-hour supply of medication and all other necessities.

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Odoctor

01/02/2010 08:45

Emotional Aspects of Waiting

Waiting for a transplant is a difficult experience for patients and their families. That's because it may be long and stressful because of the uncertainties about whether and when a suitable donor organ will become available. In addition, facing the reality of a serious illness, fearing what is involved and dealing with complex medical information can seem overwhelming.
Learn to manage stress

Learning to manage stress will help patients and their families maintain a positive outlook. There are also other important steps transplant candidates can take to ensure they are ready when the important call comes. If you feel unable to cope, it is important to take action early and seek help that will enable you to cope with the effects of chronic illness and transplantation. Ask your social worker about specific counseling services that can help you. Support groups can also help provide a feeling of security and comfort and assure you that you are "not alone." Go to the support group state listing now *
Positive aspects of waiting

Despite its uncertainty, the waiting period for transplantation may also provide an opportunity for candidates to think about the fact that they need a transplant and life after a transplant. In addition, the waiting period may provide patients the chance to follow a healthy lifestyle or get things done that will make life after transplantation easier.

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01/06/2010 08:45

Diabetes

Diabetes is a life-long disease in which the body does not produce or properly use insulin, a hormone produced by the pancreas that is needed to convert sugar, starches and other food into energy needed for daily life.

The three main types of diabetes are:

* type 1 diabetes
* type 2 diabetes
* gestational diabetes

Type 1 Diabetes

Type 1 diabetes, usually diagnosed in children and young adults, is an autoimmune disease (a disease that results when the body's system for fighting infection turns against a part of the body) in which the body does not produce insulin. Therefore, a person who has type 1 diabetes must take insulin daily to live.

Symptoms of type 1 diabetes usually develop over a short period. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.
Type 2 Diabetes

Typically occurring in adulthood, type 2 diabetes is the most common form. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

Unlike type 1 diabetes, the symptoms of type 2 diabetes develop gradually. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections and slow healing of wounds or sores. Some people do not have any symptoms.
Gestational Diabetes

Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

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01/06/2010 08:46

COPD

Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease of the airways that is characterized by a gradual loss of lung function. The term COPD is used to describe two related lung diseases: chronic bronchitis and emphysema. Chronic bronchitis is inflammation and eventual scarring of the bronchi (airway tubes). Emphysema is enlargement and destruction of the alveoli (air sacs) within the lungs. Many persons with COPD have both of these conditions.

The symptoms of COPD can range from chronic cough and sputum productions to severe shortness of breath.

The diagnosis of COPD is confirmed by the presence of airway obstruction during spirometry testing.

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Ilyas

01/06/2010 08:46

Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a debilitating disease characterized by scarring or thickening of tissues deep in the lung.

IPF belongs to a family of approximately 200 related diseases, called interstitial lung diseases (ILDs), that have similar characteristics and can result in scarring.

IPF gradually interferes with a person’s ability to breathe. It causes shortness of breath and is usually associated with a dry cough. The disease progresses over time, leading to an increase in lung scarring and a worsening of symptoms.

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Mentos

01/06/2010 08:47

Cystic Fibrosis

Cystic fibrosis (CF) is a life-threatening disorder that causes severe lung damage and nutritional deficiencies.

An inherited disease, cystic fibrosis affects the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in cystic fibrosis, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs.

Respiratory failure is the most dangerous consequence of cystic fibrosis. Also, the secretions block pancreatic enzymes that help digest fats and proteins, and they prevent your body from absorbing key vitamins.

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Vista

01/06/2010 08:48

Hypertension

Hypertension is the medical term for high blood pressure. Normally a person’s blood pressure rises and falls during the day. However, when blood pressure constantly stays higher than normal, a person is considered to have hypertension.

Because hypertension can cause damage to the blood vessels and filters in the kidney, it is a leading cause and consequence of kidney disease.

Kidney failure in patients with hypertension has many causes, including hypertensive nephrosclerosis.

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Holi

01/06/2010 08:48

Coronary Heart Disease

Coronary heart disease, also commonly called coronary artery disease, is a narrowing or blockage of the coronary arteries, the arteries that provide the heart muscle with blood.

The disease occurs when these arteries become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque on their inner walls. The buildup of plaque is known as atherosclerosis.

As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs.

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vicha

01/06/2010 08:49

Cardiomyopathy

Unlike heart disease due to heart attacks, where there is a problem with adequate blood flow to the heart, Cardiomyopathy is a disease of the heart muscle itself.

There are many causes of cardiomyopathy, which may include coronary artery disease and heart valve disease.

Cardiomyopathy occurs in three major types—dilated, hypertrophic and restrictive—all of which affect your heart's ability to pump blood and deliver it to the rest of your body.

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aarti

01/06/2010 08:50

Short Gut Syndrome

Short gut syndrome, also known as short bowel syndrome, is condition of nutritional malabsorption related to the surgical removal or disease of a large portion of the small intestine.

In healthy adults, the small intestine has an average length of approximately twenty feet. Short bowel syndrome usually appears when there is less than six feet of the small intestine left to absorb sufficient nutrients.

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hiren

01/06/2010 08:50

Cirrhosis

Cirrhosis refers to scarring of the liver. Scar tissue forms because of injury or long-term disease. It replaces healthy tissue.

Scar tissue cannot do what healthy liver tissue does—make protein, help fight infections, clean the blood, help digest food, and store energy for when you need it. Scar tissue also blocks the normal flow of blood through the liver.

Your symptoms, a physical examination, and certain tests can help your doctor diagnose cirrhosis. A liver biopsy will confirm the diagnosis.

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cirrus

01/06/2010 08:51

Hepatitis

Hepatitis is defined as inflammation of the liver. It is characterized by the destruction of a number of liver cells and the presence of inflammatory cells in the liver tissue.

Hepatitis can be divided into two subgroups according to its duration:

* acute hepatitis - lasting less than six months
* chronic hepatitis - lasting longer than six months

Hepatitis C is a blood-born infection of the liver caused by the hepatitis C virus (HCV), one of the most important causes of chronic liver disease in the United States. Unrelated to any of the other known hepatitis viruses (A, B, D and E), Hepatitis C causes damage to the liver that may lead to permanent liver damage as well as cirrhosis, liver cancer and liver failure.

Chronic hepatitis C varies greatly in its course and outcome, and is spread primarily by contact with blood and blood products.

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01/06/2010 09:33

Transplant glossary

Acute Rejection
The host recognizes the graft as foreign and mounts an immunological attack on the graft tissues. Most acute rejections occur in the first year.

Allocation
The process of determining how organs are distributed. Allocation includes the system of policies and guidelines, which ensure that organs are distributed in an equitable, ethical and medically sound manner.

Allocation Analysis
Review of the allocation of an organ to determine whether the allocation policies were followed. The analysis is performed by the OPTN contractor through the peer review process of the OPTN Membership and Professional Standards Committee.

Allograft
An organ or tissue that is transplanted from one person to another of the same species: i.e. human-to-human. Example: a transplanted kidney.

Anti-Rejection Drugs (immunosuppressive drugs)
Drugs that are used to prevent and/or treat rejection of a transplanted organ.

Antibody
A protein molecule produced by the immune system in response to a foreign body, such as virus or a transplanted organ. Since antibodies fight the transplanted organ and try to reject it, recipients are required to take anti-rejection (immunosuppressive) drugs.

Antigen
An antigen is any substance that causes your immune system to produce antibodies against it. An antigen may be a foreign substance from the environment such as chemicals, bacteria, viruses, pollen, or foreign tissues. An antigen may also be formed within the body, as with bacterial toxins.

Ascites
Build-up of fluid in the abdomen, usually associated with liver disease.

B

Biopsy
A tissue sample from the body, removed and examined under a microscope to diagnose for disease, determine organ rejection, or assess donated organs or tissues.

Blood Vessels
The veins, arteries and capillaries through which blood flows in the body. Certain blood vessels can be donated and transplanted.

Brain Death
Irreversible cessation of cerebral and brain stem function; characterized by absence of electrical activity in the brain, blood flow to the brain, and brain function as determined by clinical assessment of responses. A brain dead person is dead, although his or her cardiopulmonary functioning may be artificially maintained for some time.

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01/06/2010 09:34

Cadaveric
Deceased.

Cadaveric Transplant
The transplant of an organ from a deceased donor. The preferred term is Deceased Donor Transplant.

Candidate
A person registered on the organ transplant waiting list. When an organ is offered on behalf of the candidate, he or she is then referred to as a Potential Transplant Recipient (PTR).

Cardiac
Having to do with, or referring to, the heart.

Center of Excellence
An insurance term for a medical center that will negotiate a discounted price even if that center is not part of the insurance's company's preferred provider network (PPO).

Chronic
Developing slowly and lasting for a long time, possibly the rest of a person's life. For example: chronic kidney failure.

Chronic Rejection
Slow, continuous immunological attack of the host immune system on the transplanted organ usually resulting in progressive loss of organ function.

Cirrhosis
A disease of the liver in which normal, healthy tissue is replaced with nonfunctioning fibrous scar tissue and healthy, functioning liver cells are lost; usually occurs when there is a lack of adequate nutrition, an infection or damage caused by alcohol abuse.

Committees
The OPTN currently maintains approximately 20 standing committees, a fluctuating number of ad hoc committees (established by the President to address a specific issue as it arises), subcommittees and joint subcommittees (created and maintained by standing committees). Committees are comprised of professionals, at least one Patient/ Public representative, Minority Affairs Committee Representative, Pediatric Committee Representative, and one or more SRTR representatives. Permanent Standing Committees also include representatives form each of the 11 Regions. HRSA's OPTN Project Officer and Director of DoT, or their designees, serve as ex-officio non-voting members of all committees. Each committee is provided administrative, policy, analytic, clinical and technical support by one or more committee liaisons from the UNOS staff.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
Federal health coverage protection that requires employers of 20 or more employees to provide employees, and their dependants, the right to continue health insurance benefits when a qualifying event occurs. COBRA lasts for 18 months. OBRA is the federal law that allows an employee to continue health insurance benefits after COBRA, if he/she has elected COBRA coverage due to a Social Security approved disability. OBRA is an 11 month extension of COBRA. See also Omnibus Budget Reconciliation Act (OBRA).

Corticosteroid
A synthetic hormone used to reduce the body's normal immune reaction to infection and foreign tissue, such as a transplanted organ. Prednisone is a corticosteroid.

Criteria (Medical Criteria)
A set of clinical or biologic standards or conditions that must be met.

Cyclosporine
A drug used to prevent rejection of the transplanted organ by suppressing the body's defense system. Considered an immunosuppressant.

D

Deceased Donor
An individual from whom at least one solid organ is recovered or the purpose of transplantation after suffering brain death or cardiac death.

Deceased Donor Transplant
The transplant of an organ from a deceased donor.

Department of Health and Human Services (DHHS or HHS)
The department of the federal government responsible for health-related programs and issues.

Dialysis
A mechanical process designed to partially perform kidney functions, including correcting the balance of fluids and chemicals in the body and removing wastes. See Hemodialysis and Peritoneal Dialysis.

Diastolic Blood Pressure
The bottom number in the blood pressure measurement (80 in a blood presure of 120/80), indicating the pressure in the arteries when the heart is at rest.

Division of Transplantation (DoT)
DoT is the office within HHS/HRSA whose principal responsibilities include the oversight of management of the Organ Procurement and Transplantation Network (OPTN), the Scientific Registry of Transplant Recipients (SRTR) and the National Marrow Donar Program (NMDP) contracts; public education to increase organ and tissue donation; and technical assistance to organ procurement organizations (OPOs).

Domino Transplant
A procedure in which an organ is removed from one transplant candidate and immediately transplanted into a second patient, with the first patient receiving a new organ from a deceased donor.

Donate Life America
Formerly the Coalition on Donation, Donate Life America is a national not-for-profit alliance of local affiliates and corporate partners that have joined forces to inspire all people to Donate Life through organ, eye and tissue donation. At the core of the organization's education efforts are the ongoing qualitative and quantitative research of public attitudes about organ and tissue donation and the development and dissemination of effective, motivating public service campa

01/06/2010 09:35

mmune Response
The body's natural defense against foreign objects or organisms, such as bacteria, viruses or transplanted organs or tissue.

Immune System
The organs, tissues, cells and cell products in your body that work to find and neutralize foreign substances including bacteria, viruses and transplanted organs.

Immunosuppression
Prevention or inhibition of the immune system to respond to foreign substances in the body. Medications often used to prevent a recipient's immune system from rejecting a transplanted organ or tissue include prednisone, methylprednisolone, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, and sirolimus, among others.

Immunosuppressive
Relating to the weakening or reducing of your immune system's responses to foreign material; immunosuppressive drugs reduce your immune system's ability to reject a transplanted organ.

Induction Therapy
Medications given for a short finite period in the perioperative period for the purpose of preventing acute rejection. Though the drugs may be continued after discharge for the first 30 days after transplant, it will not be used long-term for immunosuppressive maintenance.

Infection
A condition that occurs when a foreign substance, such as bacteria, enters your body, causing your immune system to fight the intruder. All transplant recipients can get infections more easily because their immune systems are suppressed. It is more difficult for them to recover from infection (such as urinary tract infections, colds and the flu).

Inflammation
The swelling, heat and redness produced when the body is injured or infected.

Informed Consent
A person's voluntary agreement, based upon adequate knowledge and understanding of relevant information, to participate in research or to undergo a diagnostic, therapeutic, or preventive procedure.

International Normalized Ratio (INR)
A measure of a patient's coagulation (clotting) system. INR is used in the MELD and PELD calculations.

Investigational
A drug or procedure that is not yet Federal Drug Administration (FDA) approved for marketing.

K

Kidneys
A pair of organs that remove wastes from the body through the production of urine. All of the blood in the body passes through the kidneys about 20 times every hour. Kidneys can be donated from living and deceased donors and transplanted into patients with kidney failure.

L

Legislation
A law or group of laws proposed or enacted that have the force or authority of a state or Federal government, or other organization. For transplant-related legislation, see Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), OPTN Final Rule, First Person Consent Legislation, Health Insurance Portability and Accountability Act (HIPAA), National Organ Transplant Act (NOTA), Uniform Anatomical Gift Act, Uniform Brain Death Act, Uniform Determination of Death Act.

Leukocyte
A white blood cell.

Liver
The largest organ in the body, made up of a spongy mass of wedge-shaped lobes. The liver secretes bile, which aids in digestion, helps process proteins, carbohydrates, and fats, and stores substances like vitamins. It also removes wastes from the blood. A living donor can give part of their liver, after which the liver will regenerate itself in both the donor and recipient.

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01/06/2010 09:35

Match
The compatibility between the donor and the recipient. The more appropriate the match, the greater the chance of a successful transplant.

Medicaid
A partnership between the Federal government and the individual states to share the cost of providing medical coverage for recipients of welfare programs and allowing states to provide the same coverage to low-income workers not eligible for welfare. Programs vary greatly from state to state.

Medicare
The program of the Federal government that provides hospital and medical insurance, through social security taxes, to people age 65 and over, those who have permanent kidney failure and certain people with disabilities.

Multiple Listing
Being on the waiting list for the same organ at more than one transplant center.

N

National Organ Transplant Act (NOTA)
The National Organ Transplant Act (1984 Public Law 98-507), approved October 19, 1984 and amended in 1988 and 1990, outlawed the sale of human organs and provided for the establishment of the Task Force on Organ Transplantation; authorized the Secretary of HHS to make grants for the planning, establishment, and initial operation of qualified OPOs; and established the formation of the Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR).

New York Heart Association Functional Classification (NYHA)
An assessment of a patient's heart failure based on the severity of symptoms. Range is Class I-IV.

Noncompliance
1) Failure of patients to follow the instructions of the medical team, 2) Failure of OPTN members to adhere to the policies and bylaws of the OPTN.

O

Organ
A part of the body made up of tissues and cells that enable it to perform a particular function. Transplantable organs are the heart, liver, lungs, kidneys, pancreas and intestines.

Organ Donation
To give an organ or a part of an organ to be transplanted into another person. Organ donation can occur with a deceased donor, who can give kidneys, pancreas, liver, lungs, heart, intestinal organs, and with a live donor, who can give a kidney, or a portion of the liver, lung, or intestine.

Organ Preservation
Methods used to preserve organs while they are out of the body, between procurement from a donor and transplantation into a recipient.

Organ Procurement
The removal or retrieval of organs from a donor for transplantation.

Organ Procurement and Transplantation Network (OPTN)
In 1987, Congress passed the National Organ Transplant Act that mandated the establishment of the OPTN and Scientific Registry of Transplant Recipients. The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. The Act stipulated that the Network be a non-profit, private sector entity comprised of all U.S. transplant centers, organ procurement organizations and histocompatibility laboratories. These members along with professional and voluntary healthcare organizations and the representatives of the general public are governed by a Board of Directors which reports to the Division of Transplantation, HRSA and ultimately HHS. UNOS holds the OPTN contract.

Organ Procurement Organization (OPO)
An organization designated by the Centers for Medicare and Medicaid Services (CMS) and responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation. They are also involved in data folow-up regarding deceased organ donors. As a resource to the community OPOs engage in public educationon the critical need for organ donation. See also Donation Service Area (DSA).

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01/06/2010 09:36

P

Pancreas
Irregularly shaped gland that lies behind the stomach and secretes pancreatic enzymes into the small intestines to aid in the digestion of proteins, carbohydrates and fats. Islet cells within the pancreas secrete glucagon, which regulates blood sugar levels and insulin, which lowers blood sugar levels. If the pancreas fails, the individual becomes diabetic, and may need to take insulin. The pancreas can be donated and transplanted.

Panel Reactive Antibody (PRA)
The percent PRA value is a measure of a patient's level of sensitization to HLA antigens. It is the percentage of cells from a panel of blood donors against which a potential recipient's serum reacts. The PRA reflects the percentage of the general population that a potential recipient makes antibodies (is sensitized) against. For example, a patient with a PRA of 80 percent will be incompatible with 80 percent of potential donors. Kidney patients with a high PRA are given priority on the waiting list. The higher the PRA, the more sensitized a patient is to the general donor pool, and thus the more difficult it is to find a suitable donor. A patient may become sensitized as a result of pregnancy, a blood transfusion, or a previous transplant.

PCO2
A blood gas test is performed to measure the amount of C02 in the blood. When the lung’s ability to exchange oxygen and C02 becomes impaired, the PC02 level may become increased. The candidate’s current PC02 and change in PC02 are both considered in the lung allocation score calculation to reflect worsening PC02 values. PCO2 is used in the Lung Allocation Score.

Peritoneal dialysis
A treatment technique for kidney failure that uses the patient's own body tissues inside of the (abdominal cavity to act as a filter. The intestines lie in the abdominal cavity, the space between the abdominal wall and the spine. A plastic tube called a "dialysis catheter" is placed through the abdominal wall into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washes around the intestines. The lining (peritoneum) of the abdominal cavity and of intra-abdominal organs act as a filter between this fluid and the blood stream. By using different types of solutions, waste products and excess water can be removed from the body through this process.

Plasmapheresis
A process in which plasma is removed from blood and the remaining components, mostly red blood cells, are returned to the donor. The process may be used in transplantation to remove pre-formed antibodies.

Preferred Provider Organization (PPO)
A health insurance plan with an established network of healthcare providers. It provides maximum benefit coverage when services are obtained from provider within the network. Reduced benefits generally apply for using health care providers outside of the network.

Procurement
The surgical procedure of removing an organ from a donor. Also referred to as recovery.

Pulmonary
Having to do with, or referring to, the lungs.

R

Race
See Ethnicity.

Recipient
A person who receives a transplant.

Recovery (Organ)
The surgical procedure of removing an organ from a donor.

Rejection
A phenomenon that occurs when a recipient's immune system attacks a transplanted organ, tissue, or cell. Immunosuppressive drugs help prevent or treat rejection.

Renal
Having to do with, or referring to, the kidneys.

Required Request
Hospitals must tell the families of suitable donors that their loved one's organs and tissues can be used for transplant. This law is expected to increase the number of donated organs and tissues for transplantation by giving more people the opportunity to donate.

Retransplantation
Due to rejection or failure of a transplanted organ, some patients receive another transplant.

Retrieval
The surgical procedure of organ recovery. Also referred to as procurement.

Risk Pools
State-created, nonprofit associations that do not require tax dollars for operational purposes. The risk pools are a temporary stopping place for individuals who are denied health insurance for medical reasons. Risk pools often help individuals who, because of their physical condition, are unable to purchase health insurance at any price.

S

Scientific Registry of Transplant Recipients (SRTR)
As called for by the National Organ Transplant Act (NOTA), the purpose of the SRTR is to provide ongoing evaluation of clinical data about donors, transplant candidates, and recipients, as well as patient and graft survival rates. With oversight and funding from the DoT, the SRTR is currently administered by University Renal Research and Education Association (URREA), in collaboration with the University of Michigan.

Status
An indication of the degree of medical urgency for patients awaiting heart or liver transplants. Examples: status 1A, status 1B, or status 2.

Steroids
Naturally occurring hormones in the body that help control important

01/06/2010 09:37

T

Tissue
An organization of a great many similar cells that perform a special function. Examples of tissues that can be transplanted are blood, bones, bone marrow, corneas, heart valves, ligaments, saphenous veins, and tendons.

Tissue Typing
A blood test that helps evaluate how closely the tissues of the donor match those of the recipient.

U

Uniform Determination of Death Act (UDDA)
The 1981 Uniform Determination of Death Act is a model statute defining "brain death." Versions of this Act have been adopted in 39 states and the District of Columbia. The act states that an individual who has sustained either (a) irreversible cessation of circulatory or respiratory functions or (b) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.

United Network for Organ Sharing (UNOS)
The private, nonprofit membership organization that coordinates the nation's transplant system through HRSA's OPTN contract. As OPTN contractor, UNOS is responsible for meeting all contract requirements. As contractor since the first OPTN contract award in 1986, UNOS has established and continually strives to improve tools, systems and quality processes that support OPTN contract objectives and requirements. These include:

* Managing the national organ transplant waiting list
* Collecting, managing and reporting of sensitive clinical data in a secure, fail-safe environment
* Facilitating an open, inclusive forum for development and continuous refinement of evidence-based policies and standards
* Member and policy performance assessment to ensure equitable, safe treatment of candidates and recipients
* Increasing donation and making the most of every organ that is donated through professional education, outcomes research, patient services and resources and public and professional education
* Continuously improving the care, quality of life and outcomes of organ transplant candidates and recipients

V

Varices (esophageal)
Enlarged and swollen veins at the bottom of the esophagus, near the stomach. A common condition caused by increased venous pressure in the liver. These veins can ulcerate and bleed.

Vascular
Referring to blood vessels and circulation.

Ventilator
A machine that "breathes" for a patient when the patient is not able to breathe properly.

Virus
A group of tiny organisms capable of growing and copying themselves while living within cells of the body.

X

Xenograft
An organ or tissue procured from a different species for transplantation into a human.

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