From Big Medical Encyclopedia

The TRANSPLANTOLOGY (Latin of transplantare to replace + Greek logos the doctrine) — the industry of biology and medicine studying problems of transplantation, developing methods of conservation of bodies and fabrics, creations and uses of artificial organs.

A possibility of replacement struck patol. process or the damaged fabrics and bodies healthy attracted interest of people within many centuries. References of organ transplantation from animals to the person are available in the Greek mythology. Legends and national legends tell about successful changes of a nose and even extremity from one person to another. E.g., the bible «Gold legend» narrates about sons of the Sicilian doctor Kosmas and Damianus, to-rye replaced the lower extremity of the Moor to the white abbot and were executed for it. There is a legend that the Chinese surgeon Hua in 2 century AD replaced healthy instead of the affected internals. Attempts of transplantation of fabrics with accidental success at the time of the Middle Ages are known. In the treatise «De curtorum chirurgia per insitionem» published in 1597, G. Tagliacozzi described a technique of change of a rag of tissue of upper extremity for the purpose of recovery of a shape of a nose, known in a crust, time as the Italian method of skin plastics. He also found it possible to use face muscles of one person for reconstruction of a nose of another.

Bases of scientific T. were put at the beginning of 19 century. In 1804 Mr. of G. Baronio reported about successful autotransplantation of skin at sheep and about results of numerous successful experiments on skin transplantation from one animal to another of the same or other look.

However attempts of a number of researchers to reproduce its experiments on allotransplantation were not crowned with success. For the first time about successful a wedge, transplantations of skin were reported by Byunger (Biinger, 1823) who recovered a part of a nose at the woman by means of change of a free transplant. Results of numerous experiments on transplantation, including on skin transplantation and other fabrics from one animal to another of the same or other look were given in P. Bert's thesis «About transplantation of tissues of animals» (1863). Significant contribution to development of T. brought in this period N. I. Pirogov, 10.

K. Shi Manovsky, K. K. Shtraukh, F. F. Fey-gin, V. M. Antonevich, K. M. Sape-zhko, P. I. Karpinsky, P. Ya. Pya-setsky, etc. In 1869. Zh. Reve-rden described cases of a successful covering of the granulating surfaces small pieces of epidermis, and in 1874 Tirsh (To. Thiersch) studied gistol. a picture of engraftment of a transplant at its close contact with a bed of the recipient. Further Tirsh suggested to close not healing body surfaces of the patient with thin pieces of the split skin that was widely adopted further in a wedge, practice (see. Skin plastics). The provided data demonstrate that T. long time developed hl. obr. within the plastic surgery applying preferential not free plastics, i.e. movement of the fabrics connected with an organism.

Next period of development of T. it is caused by progress of surgery (see), opening of an anesthesia (see), implementation in a wedge, practice of an asepsis (see) and antiseptic agents (see), development of the equipment of a vascular seam (see). For the first time change of renal allotransplant with anastamosing of renal vessels with the main blood vessels of a neck in an experiment on a dog was carried out in 1902 by E. CUmann, and soon after it A. Karrel. In the subsequent experiences of A. Karrel who carried out a large number of similar operations, the autograft at a dog well functioned within two years, and allotransplant kept life to a cat within 36 days after a bilateral nephrectomy. An important role the researches of viability of various fabrics conducted by P. I. Bakhmetyev (1899 — 1912), F. A. Andreyev (1913), N. P. Krav-kov (1924) played development of immunology in studying of a possibility of organ and tissue transplantation (see), discovery of transplant immunity (see Immunity transplant). Essential value in development of T. had A. A. Kulyabko (1902) works on recovery of activity of the isolated heart taken from a corpse of the person, V. N. Shamov's works (1928) and


of S. S. Yudin (1930), for the first time in the world proved a possibility of transfusion of fibrinolizny cadaveric blood (on the substance of transplantation of cadaveric fabric), and also successful keratoplasties of a corpse V. P. Filatov (1931), a cadaveric cartilage of H. M. Mikheljson (1935), the experiments on change of various vitals made by N. P. Sinitsyn (1945) and Accusative De-mikhovym (1947). In 1933 Yu. Yu. Black for the first time in the world carried out change of a cadaveric kidney to the person for the purpose of an artificial hemodialysis at mercury poisoning and an acute renal failure. The USSR's first successful transplantation of a kidney in a wedge, conditions was made in

1965 by B. V. Petrovsky. In a crust, time are carried out also transplantation of heart, lungs, a liver, a pancreas and nek-ry other bodies (see Change of a lung, Liver transplantation, Renal transplantation, Heart transplantation).

Modern T. includes clinical and experimental sections, develops methods of conservation of bodies and fabrics (see), and also creations and uses of artificial organs (see). In a crust, time particularly important became establishment of the reliable criteria allowing to define degree of viability of a transplant (see), prevention and suppression of reaction biol. incompatibility of fabrics (see Incompatibility immunological, the Immunotherapy), treatment of immunodepressive states (see).

The special place in T. occupies a number of all-medical, legal, moral and ethical problems, sharpness to-rykh increases in process of implementation in practice of transplantation of vitals. The greatest value was gained by a so-called problem of the donor, the Crimea at transplantation of especially unpaired vitals (heart, a liver, a pancreas, etc.) the corpse of the person is. Progress sovr. resuscitation (see) introduce amendments in assessment of criteria of biological death of the person, to-rye include not only fading of action of the heart and the termination of breath, but also death of a brain (see Death; Death in the medicolegal relation). Scientific establishment of criteria of biological death is a question at issue of modern T. In a number of the countries in, quality of the main criterion allowing to use for transplantation bodies and tissues of the person the condition of so-called brain death — the irreversible termination of activity of a brain against the background of the breath supported by means of artificial ventilation of the lungs and the kept cordial activity is (see Death of a brain). In other countries this question remains debatable. In the USSR the solution of this question is dictated by originally humane ideology of socialist society approving a duty of the doctor more exhaustively to use all available means in struggle for life of the person, and is based on the special Resolution of Council of People's Commissars of the USSR «About an order of carrying out medical operations» (1937). In development of this resolution of Narkomzdrav of the USSR, and then M3 of the USSR approved a number of the instructive provisions regulating withdrawal of fabrics and bodies from a corpse for transplantation. In «The temporary instruction for the definition of biological death and conditions allowing withdrawal of a kidney for transplantation» approved by M3 of the USSR in 1977 it is emphasized that withdrawal of a kidney from the donor is possible only at indisputable establishment of biological death after ascertaining of its signs (if resuscitation actions were begun after approach of clinical death, but despite carrying out all their complex were ineffectual) or after a cardiac standstill (on condition of establishment of signs of the biological death which came against the background of use of a full complex of resuscitation actions).

The fact of biological death of the donor is determined by the medical commission (the manager of the intensive care unit, the neuropathologist, the doctor holding resuscitation events, and court. - the medical expert) with execution of the special act. The decision on withdrawal of a kidney from a corpse for the purpose of its transplantation is made the manager of the intensive care unit and court. - the medical expert, participating in establishment of the fact of biological death. Withdrawal of a kidney from the donor is also made out the special act and make the corresponding record in the history of a disease of the dead and in the act court. - medical necropsies. Removal of organs and fabrics from a corpse can be interfered by suspicion or detection at the donor of signs inf. a disease or inflammatory process, a tumor, poisoning (except alcoholic), and also if withdrawal of a transplant can lead to a disfiguration of visible parts of a body or create an obstacle for full court. - medical researches.

Important measure in improvement of legal aspects of organ transplantation in our country was the organization in 1973. The all-Union center of preservation and a tinirova-niya of bodies which is a part of scientific research institute of transplantology and artificial organs of M3 of the USSR — head scientific institution on problems T. Creation of this center allowed to centralize system of preparation, tipirovannya and distributions of the transplanted bodies, based on strict observance of legal, moral and ethical and social norms. It is a part of the international European center of a number of the socialist countries of «Intertransplant» organized in 1980. The similar transplant centers in Europe are «Evrotransplant» and «Skan-dinavtransplant».

Researches on problems T. in the USSR conduct apprx. 100 research establishments. At Presidium of the USSR Academy of Medical Sciences the Scientific council on transplantology and artificial organs functions. As a part of All-Union scientific about-va surgeons the section of transplantology is created. The All-Union conferences devoted to problems of organ transplantation and fabrics are periodically held. International about-in on transplantology it is organized in

1966. Since the same time the international transplantological congresses are carried out. Questions T. light Transplantation and Transplantation Reviews magazines, and also other periodicals.

See also Transplant, Transplantation.

Bibliography: Gorelik I. I. Right

to the Vyya aspects of organ transplantation and fabrics, Minsk, 1971; Prescription of an origin of processes and objects of forensic medical examination and questions of a perezhivayemost of fabrics and bodies, under the editorship of V. M. Smolya-ninov and BB. JI. Melnikova, page 39, M., 1973; Millers Yu. L. and Sharov V. V. Medicolegal problems of transplantation of a cadaveric kidney, Urol. and nefrol., No. 6, page 34, 1968; M and r-with to and y M. B. Achievements of the Soviet transplantology, M., 1979, bibliogr.;

Messes of F, D. History of organ transplantation, the lane with English, M., 1973;

Organ transplantation and fabrics at the person, under the editorship of, F. Rapaporta and Zh. Dosse, lane with English, M., 1973; Petrovsky B. V. Chosen lectures on clinical surgery, M., 1968; Petrovsky B. V., etc., Renal transplantation, M. — Warsaw, 1969; Prozorovsky V. I., etc. Topical issues of transplantation and medico-legal aspects of its regulation, Court. - medical examination, t. 22, No. 3, page 7, 1979; Shumakov V. I., etc., the Syndrome of rejection at transplantation of a kidney, M., 1982; Fox R. Page of a. S w and-z e at J. P. The courage to fail, a social view of organ transplants and dialysis, Chicago, 1978; Simmons R. G. a. Cro-s n i e r J. Ethical and social considerations in transplantation, Transplant. Proc., v. 13, p. 1281, 1981.

V. I. Shumakov; Yu. L. Melnikov (court.