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Factoid Friday

Transplant surgeons at the University of Pennsylvania performed the first ex vivo lung perfusion transplantation in 2012. The new technique repairs donor lungs that are damaged and unusable, allowing for successful transplantation of the reconditioned lungs. In this photo, Penn surgeons work on donor lungs in a sterile plastic chamber before transplantation into a patient.

Early transplant history: Russian surgeon Yu Yu Voronoy performed six human kidney allografts between 1933 and 1949 - in a bizarre twist, the attempted kidney transplants went into the thigh of the patient. The first 'successful' human-human kidney transplant lasted a mere 48 hours. The recipient was a 26-year-old woman who was admitted in a coma after swallowing mercury chloride in an attempted suicide. Voronoy retrieved the kidney from a 60-year-old man who had died from a fracture at the base of the skull.

Teddy Roosevelt's diary entry from the day his wife Alice died of kidney failure. Alice died two days after their daughter was born from undiagnosed kidney disease (in those days called Bright's disease), which had been masked by the pregnancy.

Yes, a dark thought for a Friday afternoon, but medicine has come a long way since 1884.

This March is Kidney Month -- we urge everyone to please take a moment to consider signing your donor card. You could save a life.

The kidney is the most common organ donated by living donors, though sometimes a living donor can donate part of their liver and in very rare cases part of their lung. The solid organs which can be donated by deceased donors are the heart, the liver, the pancreas, kidneys, the lungs and intestines.

Check out this interactive map and graph for organ donation rates by country. Adding together the DBD (brain death donors) and DCD (cardio-circulatory death) rates yields a country's total deceased organ donation rate.

Canada's rate was 14.7 PMP in 2012. We have a long way to go! Have you registered?

Hippocrates (400 B.C.) described bubbles on the surface of the urine as indicating kidney disease and a long illness. Physicians inspected patient urine religiously for many centuries, carrying on with very little scientific evidence until the late 1700s. In 1655, Dr. Thomas Brian challenged the practice in his tract ‘The Pisse Prophet’. It was Richard Bright who conclusively demonstrated the association between proteinuria, dropsy and fatal kidney disease in 1827, and in doing so laid the ground for the specialty of nephrology.

Nephrology (NEPHRO+OLOGY): a branch of medicine concerned with kidney function and diseases.

NEPHRO-: before vowels, nephr-, word-forming element meaning "kidney, kidneys," from nephro-, comb. form of Greek nephros "kidney".

-OLOGY: word-forming element indicating "branch of knowledge, science," now the usual form of -logy.

First known use of "Nephrology": circa 1842.

The success rate following kidney transplantation depends upon the closeness of the tissue match between donor and recipient. A kidney from a brother or sister with a “complete” match has a 95% chance of working at the end of one year. A kidney from a parent, child, or “half-matched” sibling has an 85% chance of working for at least one year. Finally, a cadaver donor kidney has an 80% change of working at least one year. All of these statistics assume this is your first transplant, and that you will be taking the anti-rejection drugs. For repeat transplants, the success rate becomes 10%-15% less.

The first home hemodialysis patient in Seattle, WA. The Kiil dialyzer pictured here was used for overnight, unattended hemodialysis, which was developed in Seattle by Dr. Belding Scribner.

Perhaps the biggest problem in the early days of dialysis was an ethical one. Given the limited availability of facilities, how were the few patients who could receive treatment to be chosen from the many who needed it to stay alive? For several years, a committee composed of a minister, housewife, lawyer, banker, state government official, labour leader and surgeon were given the task of deciding which applicants would be admitted to the kidney centre. The committee came to be known as the "Life or Death Committee." They dissolved in 1967 (their function was no longer necessary as home dialysis became more common).

In 1960, kidney failure was a death sentence. Dialysis was mainly experimental and only used for a few days at a time. Dr. Belding Scribner of the UW School of Medicine took something that was fatal and turned it into 90 percent survival - literally overnight. "I woke up in the middle of the night with the idea of how we could save these people" recalled Scribner. The invention involved inserting a Teflon tube into the patient's vein and keeping access open by hooking the tubes together to allow a high blood flow "shunt".

Did you know:

Nearly 98% of all kidney transplants, 90% of liver transplants and 85% of heart transplants are successful! -Kin Canada

Myth: "I'm too old to be an organ donor."

Nicholas Crace, 83, became the oldest living organ donor when he donated one of his kidneys in 2012. Medical tests revealed that Mr. Crace's kidneys functioned as well as those of someone in their 40s.

In 1902, Dr. Alexis Carrel demonstrated the surgical joining of blood vessels to make organ transplantation feasible for the first time. The joining of blood vessels is one of many surgical techniques pioneered by the French doctor, who was awarded the Nobel Prize for Medicine in 1912.

6 in 10 Americans will develop kidney disease in their lifetime. Government estimates show 18 people die each day waiting for a transplant and every 10 minutes someone is added to the transplant list. Yearly costs for treating a patient on dialysis are nearly triple the costs for treating a transplant patient.

The five stages of kidney disease:

STAGE 1: Normal kidney function but urine findings, structural abnormalities or genetic traits point to kidney disease
STAGE 2: Mildly reduced kidney function and other findings (as for stage 1) point to kidney disease
STAGE 3: Moderately reduced kidney function
STAGE 4: Severely reduced kidney function
STAGE 5: Very severe, or end stage kidney failure

Most patients who are newly diagnosed with poor kidney function have a longterm condition which changes slowly. Acute renal failure occurs when there is a decline in renal function over hours or days - sometimes due to injury, bladder obstruction or drug use.

In the news: Tom Hanks reveals he has diabetes. So do millions of Americans. Did you know that diabetes is one of the most common, and often preventable causes of kidney failure? Or that people can lose up to 80% of their kidney function without knowing? There's an estimated 7 million Americans living undiagnosed with diabetes and 79 million who might be considered prediabetic.

Did you know...

Kidneys maintain your body's metabolism (by regulating the levels of water and minerals).

Kidneys produce hormones, such as those that regulate blood pressure. If your kidneys shut down, you could die within days.

If diagnosed early, the progression of kidney disease can often be stopped.

Without medical intervention (dialysis or a kidney transplant) a person with kidney failure would die.

1 in 10 Canadians has kidney disease.

The number of Canadians being treated for kidney failure has tripled over the last 20 years.

The cost of treating kidney disease in Canada is over 2 billion dollars per year.

Human kidneys filter the body’s total blood supply about 12 times per hour.

A person may be born with one kidney, but it can adjust to filter as much as two kidneys would normally. If one kidney is missing from birth, the single kidney can grow to reach a size similar to the combined weight of two kidneys.

A very small number of people (approximately 0.07% of the population) are born with more than two kidneys. Two Latvian brothers found to have four kidneys each said it explained why they were able to drink their friends under the table.

Kidneys were once regarded as the seat of the conscience and reflection, and a number of verses in the Bible state that God searches out and inspects the kidneys of humans.

Chinese texts from 4th century BC contain the first account of organ transplantation, performed by surgeon Tsin Yue-Jen. According to the texts, the hearts of two soldiers were successfully exchanged - one with a strong spirit but a weak will and the other with the reverse - to cure the disequilibrium in their energies.

The basic concepts of nephrology and dialysis go back many centuries. In 100 AD, the citizens of Rome tried steaming in hot baths to sweat out toxins when they had a build-up of urea in their bodies.

Of the roughly 2 million Americans who die annually, less than 1% provide organs healthy enough for transplanting.

In the 16th century, the Italian plastic surgeon Gasparo Tagliacozzi performed successful skin autografts, but he failed consistently with allografts (skin from a different donor). Gasparo was the first to observe the immune response which his successors would come to recognize as transplant rejection.

Some famous people afflicted by kidney disease:

WOLFGANG AMADEUS MOZART, composer, died 1791 from likely kidney failure
EMILY DICKINSON, poet, died 1886 of Bright's disease
SARAH BERNHARDT, actress, died 1923 of kidney failure
JULIA CHILD, chef, died 2004 of kidney failure
NORMAN MAILER, author, died 2007 of acute kidney failure
MANUTE BOL, basketball player/activist, died 2010 of acute kidney failure
OSCAR PETERSON, jazz musician, died 2007 of kidney failure
BOBBY FISCHER, chess master, died 2008 of kidney failure
BARRY WHITE, singer, died 2003 of kidney failure
ART BUCHWALD, columnist and writer, died 2007 of kidney failure and diabetes

The world record for most people to sign up as organ donors in eight hours is 4,135! This was achieved by Dharmsinh Desai University in Nadiad, Gujarat, India, on January 1, 2013. The most people to sign up as organ donors in a single hour is 1,981, a record achieved by Antalya Provincial Directorate of Health in Antalya, Turkey, on March 1, 2013.

One organ donor can save up to EIGHT lives and enhance many more through tissue donation.

The current record for longest time spent on dialysis belongs to Brian Tocher, who has received haemodialysis for 33 years and continues 3 times a week. He began haemodialysis on June 13, 1966 and had two kidney transplants during this time which were unsuccessful.

Federal law bans the buying and selling of organs for transplantation; however it has not exclusively banned the use of organs for research, education and commercial endeavors. Advancements in biotechnology have generated new uses for human tissues. Cells and by-products have commercial value because human-made organisms may be patented, according to a 1980 ruling by the U.S. Supreme Court. The growth of the biotechnology industry and genetic research (not to mention the sale of hair, sperm and blood) has created a market for human parts despite the notion that "human body parts should not be viewed as commodities."

Image: Insulin crystals

Wait times for organs and tissues across Canada vary so much that some provinces have lists two to three times longer than in other regions (Albertans wait an average of three years vs. the eight year average in Ontario). This is because Canada does not have an integrated national registry - matching donors is done regionally and organs are seldom sent out of province. It is unlikely that this scenario will improve given the geography and the logistics of allocating organs in a country as large as Canada - especially because there is such a short window of opportunity for transplanting a cadaver organ.

table source:

Organ donation rates by country.

The "Organización Nacional de Trasplantes" of Spain has an "opt-out" system for organ donation, and the highest number of deceased donors in the world. Experts question whether the "Spanish Model" would produce similar results if applied in other countries or if culture might be a better indicator of success (Greece also has an opt-out system and sits near the bottom of the list).

"KIDNEY DISEASE, CURE IT!" In the late 1800s, if a person were taken sick with kidney disease, his physician would consider their responsibilities at an end, for medical authorities admitted that the disease was incurable. However, this did not stop newspapers from advertising an array of "scientifically proven" miracle pills claiming to cure the disease.

Pressure Cooker Artificial Kidney - Inouye & Engleberg, 1952: A simplified artificial dialyzer and ultrafilter (previous models were bulky and weighed over 100lbs). Dr. Inouye took the original concept and miniaturized it by wrapping cellulose acetate tubing around a beaker and separating the layers with fiberglass screening. This coil was enclosed in a Presto Pressure Cooker to control the temperature. With the use of a vacuum he was able to draw excess water from the patient's blood. The device was used clinically and when it was used in a closed circuit, one could determine the exact amount of fluid removed.

The world’s first successful single-lung transplant was performed in Toronto in 1983, followed by the first double-lung transplant in 1986. Both transplants were performed by Dr. Joel Cooper of The University of Toronto. Canada is highly regarded for lung transplantation and the country’s lung transplantation rate is 5.3 per million population (PMP), compared to 4.7 PMP in the United States and 2.9 PMP in France.

Photo: Tom Hall (centre), world’s first single-lung recipient; Monica Assenheimer (left), second single-lung recipient; Ann Harrison (right), world’s first double-lung recipient

In 1983, Virginia physician H. Barry Jacobs proposed an International Kidney Exchange program. Jacobs wrote letters to 7500 hospitals outlining his plan to purchase kidneys for people on transplant lists, arguing that a voluntary donor system is to blame for the severe shortage in organ donors. His plan was met by widespread outrage. The National Kidney Foundation declared it "immoral and unethical". There were some parties however who supported the idea, such as Fortune magazine: "that's what markets are for - to give people, desperate or otherwise, a chance to optimize their own situations. Most people don't need two kidneys but do need to pay the rent occasionally."

The New York Times, November 1903: "$5,000 will be paid for right ear, 2 1/2 inches long, 1 1/4 inches wide, with perfect curves and full lobe; the ear may be from male or female, and must be from a person in perfect health; offers by mail considered."

The very next day, German's Ear to be Bought" appeared in The New York Times.

"Skin Grafting" The Washington Post, Mar 25 1903

In 1891 a nurse at a San Francisco hospital, recently widowed, was compensated $100 when she allowed surgeons to scrape off 45 square inches of skin to treat a badly burned railway clerk. By 1903, skin had emerged as an "article of commerce" in several US cities including NY and Philadelphia. One reporter stated, "there is no reason why healthy men and women should not sell the article" after learning of a case in which a surgeon paid $5 for skin to help a badly burned child.

When South African surgeon Christiaan Barnard transplanted the heart of a "Cape coloured man" into the body of a white dentist in 1968, many noted the irony that the "coloured man's heart" could now enter hundreds of places still restricted to whites only. The operation aroused racial controversy in the U.S. as well. There was concern that doctors - already feared for using black patients as experimental subjects - would hasten the deaths of black patients so that their organs could be harvested for wealthy, white recipients.

In the early 20th century, occasional rumours circulated about the selling of solid tissue – skin, ears, and especially male generative glands. The first expressions of concern about traffic in organs arose in the 1920s. Authors and filmmakers began to incorporate the sale of body parts into fiction and film. In 1984, US Congress passed the 'National Organ Transplant Act' which outlawed the buying and selling of human organs.

2005: Johns Hopkins Medical Center pioneers the "domino chain" method of organ donation. The procedure takes a group of incompatible donor-recipient pairs (recipients who visit a hospital with a willing donor who is not compatible by blood or tissue) and matches them with other pairs in a similar predicament. Last year, a record sixty-person domino chain was completed.

Mary Shelley's Frankenstein describes a morally and physically superior creature constructed with parts from graveyards; this creature turns to violence only when his fictional creator rejects him. This is the first positive and negative depiction – in literature and "media" – of the use of organs and parts from dead people.

In the 1960's, Dr. Folkert O. Belzer developed a perfusion preservation machine that allowed organs to be kept viable longer. In 1987 he helped develop the "UW solution," a fluid that could keep donated organs viable from 18 to 30 hours. The extra time allowed for better matching of organs and recipients - thus decreasing the chance of rejection.

Dr. Karl Landsteiner is the first to classify human blood into the groups A, B, O, and AB, thus enabling physicians to transfuse blood - and later to transplant organs - without endangering a patient′s life. Individuals with the blood group AB are referred to as 'universal recipients' and those with blood group O are known as 'universal donors'.

In the 18th century, before dentures, it was common for affluent Europeans to replace lost or rotten teeth with healthy teeth purchased from another person. The sellers were typically impoverished and desperate, and the practice faced criticism. Modern dentistry has eliminated the market for human teeth, but the selling of human body parts is a flourishing global industry. For some, moral condemnation is relative - especially when it's a matter of life or death.

Dr. Joseph E. Murray performed the first successful organ transplant in 1954, when he removed a healthy kidney from a 23-year-old man to save the man’s ailing identical twin.

The first practical dialysis machine was developed in 1943 by Dutch physician Dr. Willem Kolff.