20 facts about organ donation around the world

Organ transplants save thousands of lives every year. Increasingly sophisticated procedures, governed by bioethics laws, have been made possible by ongoing medical advances. Faced with a lack of available organs, however, transplants depend, above all, on the generosity of potential donors.




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Transplants by the numbers

Tens of thousands of patients are waiting for a last-resort, life-saving transplant to replace an organ that has failed irreparably. In 2018, of the 146,840 transplants performed worldwide, nearly two thirds involved kidneys. According to a recent study, the COVID-19 pandemic has since caused a drop in the number of organ transplants.




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Organ and tissue transplants

Transplants involve either organs (kidney, heart, lung, liver, intestine, etc.) or tissues (skin, bone, cornea, veins, etc.). From a surgical standpoint, the major difference between the two is that, unlike organs, tissues can be retrieved from the donor several hours after blood flow has stopped, making them easier to transplant.




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Donors of all ages

There’s no age limit for organ donation so long as the removed organ is in good condition. Quebec’s oldest donor was 92 years old, while the youngest was 48 hours old. Between 2011 and 2020, 18 kidney donors in France were over 90 years old. One 96-year-old even donated his liver. In Switzerland, 40.7% of donors are 60 years old and up. Age can, however, be a factor in the choice of organ recipient.




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Post-mortem donations

Most organ transplants are performed through post-mortem donations. Organs are recovered when the donor is in a state of brain or cardiac death. The body is then maintained in an artificially functioning state until the organs are recovered. Methods of donor consent and the number of organs that can be retrieved vary by country.




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Living donors

A healthy adult can freely choose to make a donation during their lifetime. In the majority of cases, a kidney or a lobe of the liver is donated. Typically, a relative or loved one will make this kind of donation, but some countries allow anonymous, altruistic donations. In Canada and the United States, this option has given rise to living-donor organ donation chains in which an individual donates their kidney to a stranger while waiting for another anonymous donor to save their loved one.




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Unpaid donations

To prevent the body from being considered an object and make it inseparable from the notion of dignity, bioethics promotes the principle of non-ownership of the human body. While Europe and North America observe this principle, other countries have legalized or tolerate donor payment.




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Organ allocation

For a transplant to be successful, the medical team must perform rigorous testing before matching a donor to a recipient. The allocation of organs depends on several biological factors, such as the donor and the potential recipient’s blood types, antigen compatibility, weights, and heights.




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Discovery of skin grafting

Scientists have been attempting to cure patients through transplants since the 19th century. In 1869, Swiss surgeon Jacques-Louis Reverdin discovered how to treat burns with a skin graft.




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First corneal transplant

In 1886, German ophthalmologist Arthur R. von Hippel performed the first corneal transplant. The procedure, a lamellar keratoplasty, transplanted just the anterior layers of the cornea. It wasn’t until 1905, however, that the first successful full-thickness corneal transplant was performed by Austrian Eduard K. Zirm (photo).




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First organ transplant: kidney





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Heart transplant

For many, the heart symbolizes life. The first transplant of this vital organ caused a huge stir, even though the patient only survived the operation for 18 days. South African surgeon Christiaan Barnard (photo) performed the procedure in Cape Town in December 1967. A few months later, French surgeon Christian Cabrol performed the first heart transplant in Europe.




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Face transplant

Facial transplantation is a particularly spectacular procedure due to its visibility. In 2005, Isabelle Dinoire of France was the first person to receive a partial face transplant after being bitten by her dog. After several years of treatment, however, she lost her facial graft in 2015 due to chronic rejection. Several dozen people around the world have since received partial or total face transplants. Nevertheless, the practice can cause psychological anguish because of the link between a person’s identity and their face.




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Immunosuppressant drugs

The human immune system’s ability to detect foreign proteins makes rejection a major problem during transplants. In fact, transplant recipients must take immunosuppressants for the rest of their lives. Dosage depends on the compatibility between recipient and donor. However, by weakening the immune system to reduce its response to the foreign organ, immunosuppressant drugs make patients more vulnerable to illness.




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Nobel Prize

Several scientists working in the field of transplantation have received the Nobel Prize in Physiology or Medicine. In 1912, Alexis Carrel was recognized for his work on vascular suture as well as blood vessel and organ transplantation. Jean Dausset (photo) was awarded the Nobel Prize in 1980 for his discoveries involving HLA antigens, increasing our understanding of compatibility between donors and recipients. In 1990, Joseph Murray and Edward Donnall Thomas were recognized for their discoveries involving transplantation and immunological rejection.




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Lack of available organs

Waiting lists for post-mortem donation are very long due to a chronic shortage of organs available for transplantation. In effect, a donor must die under certain circumstances while in a hospital, consent must be confirmed quickly, and the donor must be checked for compatibility with the recipient. In the United States, where potential donors must explicitly express consent prior to death, nearly 107,000 people were on the transplant waiting list in 2020, yet only 39,000 transplants were performed.




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Embryonic stem cell research

The human embryo is an inexhaustible reservoir of stem cells that can be differentiated into healthy specialized cells. Theoretically, such cells could be injected into a patient to regenerate an organ or restore its function. Stem cell therapy remains at the research stage. Moreover, the required destruction of an embryo raises ethical questions.




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Xenografts

One response to the shortage of available organs may be xenografts, the transplantation of an organ from a different biological species. Research is particularly concerned with grafts from pigs, whose immune systems are quite similar to ours. Such procedures, however, carry uncertain biological risks due to anatomical and physiological differences between the animal and human.




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Illegal organ trade

The shortage of bioethically obtained, transplantable organs has spawned a flourishing black market. According to data from the World Health Organization (WHO), in 2007 approximately 5% to 10% of transplants worldwide were conducted illegally. This figure includes medical tourism, typically used by patients from wealthy countries; organ sales; and forced removals from vulnerable individuals.




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