로딩 중...
영어학습소
영어학습소
홈
테디잉글리시
수능
Shadowing
재생 속도
0.5x
0.75x
1x
1.25x
1.5x
시작 지점을 클릭하세요
0:00
I'm Dr. D.A. Simpson, abdominal transplant surgeon, and I'm here today to answer your questions from the internet.
0:03
This is Transplant Support at.
0:10
Mr. Annie1 asks, "How much do you think I can get for my kidneys?"
0:16
"I suddenly need money."
0:19
In the United States, getting money or any other type of gift or coercion to donate is illegal.
0:26
You cannot get a raise, you can't get a brand new car, you can't get a house, you can't get a money gift to donate an organ.
0:33
We don't want people to feel pressured to donate their organs.
0:39
And actually, in the case of living donation, when a living donor comes forward to any transplant center thinking about donation, they actually have to meet separately with a psychiatrist and a living donor advocate to determine if there is any coercion going on behind the scenes.
0:54
Unfortunately, outside of the United States, that's not always true.
1:00
Coercion or even deception to donate organs is fairly common.
1:04
A Reddit user asks, "How long does the process of liver transplant last from when the doctors decide to go the liver transplant route to the actual surgery?
1:14
"Why does it always seem like we're rushing in the movies when we decide to go for a transplant?"
1:20
Organs don't last forever, even when they're on ice.
1:22
There is a certain amount of time that we need to be working against to get that organ into a body, into a warm environment where oxygenated blood is flowing through that organ, otherwise the organ starts to die and it's no longer usable.
1:34
That amount of time varies by organ.
1:37
Believe it or not, kidneys can stay out of the body on ice or on a pump machine, we'll get to that later, for up to 36, sometimes even 48 hours.
1:49
On the opposite end, however, hearts and lungs only 4 to 6 hours.
1:52
Now, I mentioned a pump and pump technology is changing the face of transplant.
2:00
This is an exciting technology that kind of mimics being in a body.
2:02
So you can hook a liver, you can hook a heart or lungs up to this pump and blood is pumped through the organ, thereby extending the amount of time until we have to transplant it.
2:14
The only kid asks, "If a body rejects an organ transplant, can that organ be used by someone else or is it no longer usable?"
2:22
It's no longer usable.
2:24
Because what rejection means is that our immune system attacks that organ and causes damage that makes it no longer usable.
2:31
Now, depending on the organ though, what we do with it varies.
2:33
With kidneys, we can just leave it there and then transplant a new kidney into a new spot.
2:40
We're all born with two kidneys.
2:40
You get your third kidney when you get your first transplant.
2:44
If you have rejection over time, you can get a fourth kidney, you can get a fifth.
2:48
I've had a patient who had six kidneys in his body, only one of them was working, the other five were not.
2:55
To its exer nexer, "Do donated organs age according to the donor's age or do they adapt to the age of the new body?"
3:04
The age of the organ does matter somewhat.
3:06
So if you get an organ from a younger donor, you can expect the lifespan of that organ to maybe be a little bit longer, particularly in the case of organs that don't have the ability to heal themselves like the liver.
3:23
However, getting an organ from somebody who's very, very young does not mean that you get 20, 30 extra years on your life, per se.
3:26
PWT I7 asks, "Is there an organ shortage?"
3:30
The short answer is yes.
3:32
When we think about all the number of people who need organ transplants and the number of people who are either willing to give organ transplants and living donation, which you can do with liver and kidney, or people who pass away and are designated on their driver's license, we don't have enough to go around.
3:49
In fact, there are over 100,000 men, women, and children currently awaiting an organ transplant.
3:56
Miker Fox Long asks, "How do organ transplants actually work?
3:59
"How do we connect them to the body of the recipient?"
4:04
I love this question because whenever I talk to my patients about transplant, I always say that I as a surgeon am basically a plumber.
4:10
If I were going to take a sink and bring it into the room, it's not going to work unless I connect it to pipes that bring water in and out of the sink, and a transplant is the same thing.
4:20
I'll take the liver here, for example.
4:21
These are our pipes.
4:21
The red is the artery, the blue is the vein.
4:24
These bring oxygenated blood to the organ and deoxygenated blood away from the organ, and we need to connect those pipes in order for the organ to work.
4:32
And the third pipe we connect is the functional pipe of the organ, in this case it's the bile duct, which brings bile from the liver to the intestine, which helps us to digest our fatty foods.
4:42
And the way we connect them is with stitches.
4:44
So we use microscopic threads, we have to wear glasses with magnifying lenses on the end, and we will painstakingly but quickly sew those pipes together.
4:54
Sacarin 0000 asks, "I want to ask my microbiology professor so badly if the fecal transplant episode of South Park is real, but I can't.
5:13
"What is a fecal transplant?"
5:13
It's a poop transplant, believe it or not.
5:13
What this involves is taking fecal matter from a healthy individual that has all the good bacteria that we want in it and transplanting that into the intestine of someone who needs it.
5:13
So the case for this is often used is if someone has a really bad infection of their colon called C. diff.
5:13
And so Clostridium difficile is the bacteria in there that causes a terrible, terrible infection in the colon that can sometimes result in the entire colon needing to be removed.
5:13
The way that C. diff works is that it replaces all the good bacteria, essentially, in the colon.
5:13
So only the C. diff are there and they're just causing a mess.
5:54
To try to push those out, you want to get good bacteria in there, and so you basically, it's like a poop shake, it gets put down into the intestine and does its job.
6:03
Self Manifesto asks, "How do surgeons connect nerves to donated organs?"
6:09
Well, for our solid organs, we actually don't, believe it or not.
6:14
And nerve regeneration will happen slowly over time.
6:16
And so solid organs refer to things like the liver, the kidney, but when you're thinking about transplanting a limb such as hand transplant or even face transplant, that is a case where nerve connection does become important.
6:31
Soup Buler Chris asks, "Now that a penis transplant is a thing, can I get on that list?
6:36
"I love my old penis, but it's retired and ready to move on."
6:40
You can't get a penis transplant just because you're tired of your old one.
6:43
The usual reason for a penis transplant is because there's been trauma to the penis that has required it to be removed such as cancer or a burn or some other type of trauma.
6:55
At last thing you forget asks, "Can I get a brain transplant, please, pretty please?"
7:03
Although brain transplant has yet to be successful, the nature of this question makes me think that maybe there is a pretty big need for brain transplant.
7:11
The short answer is no.
7:11
Chiron XC asks, "At what point will stem cell research just allow us to grow clones of our own organs for transplantation?
7:23
"Surely this is the way to do it."
7:23
I couldn't agree more.
7:24
This would certainly solve our organ shortage issue.
7:27
The good news is that researchers are working on this every day.
7:31
I once worked with a researcher who was doing a lot of work in this area, and he had actually managed to grow a kidney with stem cells that made what we called bland urine.
7:41
And by bland urine, I mean just water, meaning the kidney is not doing the job to filter out any of the other toxins that it's supposed to.
7:50
So it didn't do all the functions that a kidney should do, but at the very least it was making some liquid, and that's mind-boggling to me.
7:56
I've been told that organs that are grown with stem cells are just a few years off, but that was a few years ago, so we'll see.
8:09
A Quora user asks, "What was the first human organ to be successfully transplanted?"
8:11
Well, that was the kidney in 1954.
8:11
Dr. Joseph Murray did the first successful kidney transplant between two twin brothers in Boston, Massachusetts.
8:18
What I find really cool about this is that transplant is such a young field that I actually had the privilege of meeting Dr. Murray when I was a resident at and Women's Hospital, which is where he practiced and trained.
8:39
Saak the Vigez 88 asks, "What is xenotransplantation and what role is it going to play in the future?"
8:39
Xenotransplantation is a fancy word for saying you're getting a transplant from some animal that is not a human, and I do think that it has a big role for the future.
8:49
There is an organ shortage, so we have to find creative ways to solve that problem, and xenotransplantation just may be the answer.
8:59
Ed Cren asks, "Would you allow doctors to put a pig heart into your body if I was on death's door and I was not going to have an offer for a human heart anytime soon?"
8:59
Yes.
8:59
Both kidneys and hearts have been successfully transplanted into humans, however, long-term success still has not been shown.
8:59
There's still a lot that's unknown and needs to be developed, but it holds a lot of promise.
8:59
In 1990 asks, "Why are all the engineered body parts for humans always made from pigs?
8:59
"What is it about pigs?"
9:32
Well, pig anatomy is very similar to human anatomy.
9:35
When I talk about transplant, I say that we're like plumbers, we have to connect pipes to pipes.
9:42
Human pipes and pig pipes are quite similar, so the connections are similar and that makes the actual technical aspect of the transplant a lot easier.
9:51
The other thing is that scientists can alter the genes of pigs such that they can raise the chances that that transplant will be a success.
10:06
A Quora user asks, "Who decides which patient gets an organ transplant first?
10:08
"What factors go into that decision?"
10:11
Deciding who is eligible for an organ transplant is a really complicated process, and it involves a committee or a group of individuals, sometimes as many as 30 to 40 people, who will decide whether the patient is suitable for organ transplant.
10:29
And there's a lot of factors that go into it: the patient's health, whether or not they can handle the stress of such a big surgery, whether or not we think that they can take the anti-rejection medication that they need to take every day for the rest of their lives, how sick they are, so patients who are only mildly sick or at the beginning stages of their illness or patients who are really sick and in the ICU and on death's door.
10:29
And also is dependent on the organ that they're being listed for.
10:47
In the case of kidney, your place on the list depends on how long you've been on dialysis.
10:58
People who have been on dialysis longer will be near the top of the list.
11:02
Other things that are taken into account is how far the donor organ is from the hospital where it's being transplanted.
11:08
And there's many other factors.
11:10
Age does play a little bit of a part in where a patient is on the list in that pediatric patients get priority.
11:19
A Reddit user asks, "Can getting a heart transplant change your personality?"
11:21
The short answer is no.
11:23
But one thing I can say is that receiving a gift that someone has given in death or in living, if it's a liver or kidney transplant that saves you from death and changes your life forever, certainly must have an effect on how you look at life and how you live life every day.
11:41
So I would say from that perspective, yes, it can change your personality.
11:50
You forgot smoking lamp, "I'm not surprised face transplants are a real thing and these sickos will do anything to continue to look young."
11:47
Face transplants are not what this person thinks.
11:56
Face transplants are not used to help people look young or look different.
12:01
Face transplants are a really big operation, you have to be on anti-rejection for the rest of your life, and most importantly, you have to qualify.
12:09
And these are people who have had extreme disfiguring events such as burns, animal maulings that disfigure their face so horribly that a face transplant is warranted.
12:20
Environmental Sorbet 3 asks, "How long will a transplanted kidney last?"
12:27
Well, unfortunately, they don't last forever, and there's a few reasons why they don't.
12:32
The kidney specifically, unlike the liver, does not have the ability to heal itself.
12:41
The liver is unique in that it has a regenerative capacity so that if you cut a piece of the liver off, it will regrow, similar to how a starfish regenerates its arm.
12:46
With a kidney specifically, since it doesn't have the ability to heal itself, over time it will collect damage that will shorten its lifespan.
12:54
That damage may come from infection, that damage actually sometimes or often times comes from the anti-rejection medication itself.
13:03
So immunosuppression, or what we call anti-rejection medication, unfortunately, while it helps our bodies not to reject the kidney, it does cause a low level of injury to the kidney over time.
13:15
If somebody gets a kidney from somebody who's passed away, or a deceased donor as we call it, we can expect that kidney to last on average 9 to 12 years.
13:24
If somebody gets a kidney from a living donor, someone who shares and gives one of their spare kidneys, then we can expect those kidneys to last 15 to 20 years or sometimes longer.
13:36
As for a liver, because they do have that ability to heal themselves, they last a lot longer.
13:44
Most patients who get a liver transplant are outlived by their liver.
13:47
PE asks, "What determines a match for a kidney transplant?"
13:54
All organs require a match.
13:57
There's two different things that we look at: the blood type and then we look at immune system.
14:01
Blood type is the first thing that we look at, and so in order for you to be a match for blood type, you have to have an organ that either comes from your same blood type or the blood type O.
14:13
O is considered the universal donor, which means that anybody can receive an O.
14:19
There are four different blood types, you have O, A, B, and AB.
14:21
AB is the universal recipient, which means that it can receive an organ from a blood type B, blood type AB, or blood type O.
14:31
The immune system matching is a lot more complex.
14:38
Basically what you're looking for is whether or not your immune system will recognize parts of that organ and react to it immediately.
14:45
Our immune system's job is to kick out anything that's in our bodies that it doesn't recognize or that it wasn't born with and not supposed to be there.
14:55
So that's the case for infection, and it's also the case for transplanted organs, and that's why patients need to be on anti-rejection medication or immunosuppression as we call it in transplantation.
15:12
Word Land asks, "If the recipient of an organ donation dies before the donor, could the donated organ be returned to the donor?"
15:15
In theory, yes, a patient can have an organ out and put back into them.
15:20
I haven't heard of a time where a transplant recipient passes away and that organ is taken back out and returned to its donor.
15:27
There is something worth mentioning though, if somebody receives an organ transplant, particularly a heart or a liver, and for some reason some complication or if the patient was too sick, they pass away early, say within days or a couple weeks, that organ can be removed and transplanted into someone new.
15:46
It's not very common, but it has been known to be done.
15:51
Steph Sha asks, "We need to do something about kidneys.
15:54
"Why does everyone always need new ones?
16:00
"Why do they fail so fast?"
15:58
Kidney is the most frequently transplanted organ by a long shot.
16:02
And the reason for that is the top two causes of kidney disease are high blood pressure and diabetes, and those are actually things that we can do something about.
16:10
The way that we eat, exercise, those play important roles in the development of diabetes and high blood pressure, so healthy living can actually drive those numbers down.
16:19
A Reddit user asks, "Could a donor organ live forever if constantly donated before each person's death?"
16:27
That's a great question that we do not have the answer to.
16:30
I would say in the case of most organs, the answer is no.
16:32
The one that makes me a little curious, maybe, is the liver, and that's because of the liver's ability to heal itself.
16:38
The fact that many patients who get a liver transplant die with a still working liver makes us wonder just how long could that liver last, but we don't know the answer.
16:50
AER transplant asks, "Any advice to those who are considering becoming a living donor?
16:55
"What's life like after your donation?"
16:57
There is a shortage of organs, and one of the ways that we can help mitigate that shortage is through living donation.
17:04
Kidneys and liver can be donated through living donation.
17:08
You can give one of your kidneys, or you can actually have your liver cut in half.
17:19
The half that goes to the transplant patient will grow to be the size of a normal liver in about six weeks, and the half that the donor is left with will also grow to be the size of a normal liver in about six weeks.
17:19
It's amazing.
17:13
The bottom line is that we have to be very, very careful with anybody who's considering a living donation because they get no medical benefit from that surgery.
17:36
So we put them through a number of tests to ensure that their risk is extremely low.
17:42
In doing that, we are actually guaranteeing that the donor will have pretty much a normal life after living donation.
17:50
They can have children, they can get back to the gym, they can go back to work, they can do all the things that they did before they donated, because if they couldn't, we wouldn't allow them to donate because that wouldn't be ethical.
18:04
Rope Bracelet asks, "What's your transplant or donation hot take or unpopular opinion?"
18:09
My hot take, which may be unpopular to some surgeons, is that I'd love to see myself put out of a job.
18:17
There's so much that we can be doing on the pre-transplant side to reduce the burden of disease so that we don't have this organ shortage.
18:26
Now, don't get me wrong, I'll never be put out of a job, there'll always be a reason to have organ transplants, but we can have less and we can have less of an organ shortage issue.
18:37
Kidney disease, for example, top two causes are high blood pressure and diabetes, we can do something about that.
18:37
Our neighborhoods, how they're set up, if people live in food deserts, if they're eating unhealthy foods or living in food swamps, that will impact the development of those diseases.
18:37
And actually, CDC data shows us that neighborhoods that have food deserts or food swamps, a dominance of food swamps, have much higher rates of high blood pressure or diabetes and therefore kidney disease.
18:37
For the liver, let's think about alcoholism or hepatitis C from IV drug use, two things that we really can make a difference on if we had public health initiatives to really focus on those things.
18:37
And we do have initiatives, but if we spent more time and resources on those things, we could really make an impact on the transplant side.
18:37
Well, that's it, that's all the questions.
18:37
I hope you guys learned something.
18:37
Until next time.