American doctors have declared that they have successfully performed the first ever full eye transplant, completing a groundbreaking 21-hour operation. Although the recipient, Aaron James, who is 46 years old, is currently unable to see through his new eye and may not be able to in the future, the transplanted organ is showing signs of being healthy. This achievement marks a significant advancement in the field of transplantation.

This is the most recent of many remarkable breakthroughs in this field. In the previous year, the first transplant of a genetically modified pig heart was carried out, and a second patient was treated. There have also been successful cases of modified pig kidneys functioning in the human body. The availability of womb transplants has increased, with the first UK procedure announced in August, as well as hand and arm transplants and intestine transplants. Additionally, scientists have created new methods to revitalize donated organs that would have previously been considered unusable.

“We are currently in a very thrilling time,” stated Dr. Liza Johannesson, the head physician of the uterus transplant team at Baylor University Medical Center in Dallas, Texas. She is also a member of the team responsible for the world’s first successful transplantation procedure in Sweden.

The surgery for the eye transplant was extremely intricate due to the small blood vessels in the organ and its intricate connection to the brain via the optic nerve, which is a part of the central nervous system. However, Johannesson noted that the improvement in surgical abilities has not been the primary factor in progress. She explained, “Microsurgical techniques have already been honed over many years for hand surgeries. Surgeons are accustomed to working with tiny nerves and blood vessels, often utilizing microscopes for precision.”

In comparison, medical research is advancing greatly in understanding the causes of immune rejection, methods for detecting early warning signs in patients, and developing medications to control the body’s reaction to a transplanted organ.

For pig organs, researchers genetically altered the hearts and kidneys by removing pig genes that cause rapid rejection and adding human genes to promote acceptance by the body. This resulted in successful acceptance of the organs in both heart cases.

Researchers are also improving the methods of immunosuppressant therapies, aiming to decrease the immune reaction to the transplanted organ while minimizing interference with other immune functions.

Peter Friend, a transplant professor at the University of Oxford and vice-president of the Royal College of Surgeons, stated that progress is being made in understanding how to regulate the immune response.

Due to the negative impacts of immunosuppressant medications, this may decrease the criteria for transplants that are considered medically necessary. According to Friend, for non-essential transplants, there must be a consideration of the potential risks associated with these drugs, such as kidney toxicity and increased risk of cancer and viral infections. When there are multiple options available, a careful evaluation of the benefits and drawbacks must be made.

There is minimal reason to perform a leg transplant since prosthetics are typically successful in restoring function. However, restoring the function of a lost hand or arm is more difficult and the NHS has implemented a specialized transplant program for this purpose.

Truly pioneering procedures often pose such ethical dilemmas. Both recipients of the genetically modified pigs hearts have since died, with uncertainty over whether the deaths were linked to the experimental procedures. However, in both these cases, patients had terminal illness before the surgery and would not have been candidates for conventional heart transplants – their families were prepared for the possibility that the procedures might not be successful.

Johannesson stated that the initial case may not have all the advantages that will be present in later cases. There may be failures and less-than-ideal outcomes, but these cases are crucial for building skills and acquiring knowledge.

Johannesson reported that there has been a widespread practice of being careful and implementing strict ethical measures following the scandal surrounding Paolo Macchiarini, an Italian surgeon who was initially praised for his pioneering work in performing synthetic windpipe transplants. However, seven out of eight of his patients passed away and he was later found guilty of causing physical harm. It was also revealed that his scientific research was fraudulent.

Johannesson stated that the entire field experienced a significant setback. While ethical permissions are important, they also trust that individuals have good intentions. This obstacle has caused a delay, but they must continue moving forward and discover alternative methods, as this is how new treatments are discovered.

Source: theguardian.com