Dr. Dinee C. Simpson visits WIRED to answer the internet's burning questions about transplant surgeries.
Director: Justin Wolfson
Director of Photography: Charlie Jordan
Editor: Richard Trammell
Expert: Dr. Dinee C. Simpson
Line Producer: Joseph Buscemi
Associate Producer: Brandon White
Production Manager: Peter Brunette
Production Coordinator: Rhyan Lark
Casting Producer: Nicholas Sawyer
Camera Operator: Caleb Weiss
Sound Mixer: Sean Paulsen
Production Assistant: Sonia Butt
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Rachel Kim
Supervising Editor: Christina Mankellow
Additional Editor: Jason Malizia
Assistant Editor: Billy Ward
Director: Justin Wolfson
Director of Photography: Charlie Jordan
Editor: Richard Trammell
Expert: Dr. Dinee C. Simpson
Line Producer: Joseph Buscemi
Associate Producer: Brandon White
Production Manager: Peter Brunette
Production Coordinator: Rhyan Lark
Casting Producer: Nicholas Sawyer
Camera Operator: Caleb Weiss
Sound Mixer: Sean Paulsen
Production Assistant: Sonia Butt
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Rachel Kim
Supervising Editor: Christina Mankellow
Additional Editor: Jason Malizia
Assistant Editor: Billy Ward
Category
🤖
TechTranscript
00:00I'm Dr. Danae Simpson, abdominal transplant surgeon, and I'm here today to answer your
00:04questions from the internet. This is Transplant Support.
00:11At Mr. Annie11 asks, how much do you think I can get for my kidneys? I suddenly need money.
00:19In the United States, getting money or any other type of gift or coercion to donate is illegal.
00:27You cannot get a raise. You can't get a brand new car. You can't get a house. You can't get
00:33a money gift to donate an organ. We don't want people to feel pressured to donate their organs.
00:40And actually, in the case of living donation, when a living donor comes forward to any transplant
00:45center thinking about donation, they actually have to meet separately with a psychiatrist and
00:50a living donor advocate to determine if there is any coercion going on behind the scenes.
00:57Unfortunately, outside of the United States, that's not always true. Coercion or even deception
01:03to donate organs is fairly common. A Reddit user asks, how long does the process of liver
01:10transplant last from when the doctors decide to go the liver transplant route to the actual
01:14surgery? Why does it always seem like we're rushing in the movies when we decide to go
01:19for a transplant? Organs don't last forever, even when they're on ice. There is a certain
01:24amount of time that we need to be working against to get that organ into a body, into a warm
01:29environment where oxygenated blood is flowing through that organ. Otherwise, the organ starts
01:34to die and it's no longer usable. That amount of time varies by organ, believe it or not. Kidneys
01:40can stay out of the body on ice or on a pump machine, we'll get to that later, for up to 36,
01:47sometimes even 48 hours. On the opposite end, however, hearts and lungs, only four to six hours.
01:55Now I mentioned a pump and pump technology is changing the face of transplantation. This is
02:00an exciting technology that kind of mimics being in a body. So you can hook a liver, you can hook
02:06a heart or lungs up to this pump and blood is pumped through the organ, thereby extending the
02:13amount of time until we have to transplant it. The Only Kid asks, if a body rejects an organ
02:19transplant, can that organ be used by someone else or is it no longer usable? It's no longer usable
02:25because what rejection means is that our immune system attacks that organ and causes damage that
02:30makes it no longer usable. Now depending on the organ though, what we do with it varies. With
02:35kidneys, we can just leave it there and then transplant a new kidney into a new spot. We're
02:40all born with two kidneys. You get your third kidney when you get your first transplant. If you
02:45have rejection over time, you can get a fourth kidney, you can get a fifth. I've had a patient
02:49who had six kidneys in his body. Only one of them was working. The other five were not. Two, it's
02:56exer's nexer. Do donated organs age according to the donor's age or do they adapt to the age of
03:03the new body? The age of the organ does matter somewhat. So if you get an organ from a younger
03:09donor, you can expect the lifespan of that organ to maybe be a little bit longer, particularly
03:14in the case of organs that don't have the ability to heal themselves like the liver. However, getting
03:19an organ from somebody who's very, very young does not mean that you get 20, 30 extra years on your
03:26life per se. PWTI007 asks, is there an organ shortage? The short answer is yes. When we think
03:34about all the number of people who need organ transplants and the number of people who are
03:39either willing to give organ transplants in living donation, which you can do with liver and kidney,
03:44or people who pass away and are donor designated on their driver's license, we don't have enough
03:50to go around. In fact, there are over 100,000 men, women, and children currently awaiting an organ
03:56transplant. Micah Fox-Long asks, how do organ transplants actually work? How do we connect them
04:03to the body of the recipient? I love this question because whenever I talk to my patients about
04:08transplant, I always say that I, as a surgeon, am basically a plumber. If I were going to take
04:13a sink and bring it into the room, it's not going to work unless I connect it to pipes that bring
04:17water in and out of the sink. And a transplant is the same thing. I'll take the liver here,
04:21for example. These are our pipes. The red is the artery. The blue is the vein. These bring
04:26oxygenated blood to the organ and deoxygenated blood away from the organ. And we need to connect
04:32those pipes in order for the organ to work. And the third pipe we connect is the functional pipe
04:36of the organ. In this case, it's the bile duct, which brings bile from the liver to the intestine,
04:42which helps us to digest our fatty foods. And the way we connect them is with stitches. So we use
04:47microscopic threads. We have to wear glasses with magnifying lenses on the end. And we will
04:52painstakingly, but quickly, sew those pipes together. Saccharin000 asks, I want to ask my
05:01microbiology professor so badly if the fecal transplant episode of South Park is real,
05:08but I can't. What is a fecal transplant? It's a poop transplant, believe it or not. What this
05:14involves is taking fecal matter from a healthy individual that has all the good bacteria that
05:21we want in it and transplanting that into the intestine of someone who needs it. So the case
05:29where this is often used is if someone has a really bad infection of their colon called C. diff.
05:36And so Clostridium difficile is the bacterium there that causes a terrible, terrible infection
05:41in the colon that can sometimes result in the entire colon needing to be removed. The way that
05:47C. diff works is that it replaces all the good bacteria essentially in the colon. So only the
05:54C. diff are there and they're just causing a mess. To try to push those out, you want to get good
05:58bacteria in there. And so you basically, it's like a poop shake. It gets put down into the
06:03intestine and does its job. Selfmanifesto asks, how do surgeons connect nerves to donated organs?
06:11Well, for our solid organs, we actually don't, believe it or not. And nerve regeneration will
06:16happen slowly over time. And so solid organs refer to things like the liver, the kidney. But
06:21when you're thinking about transplanting a limb, such as hand transplant, or even face transplant,
06:28that is a case where nerve connection does become important. SoupBullerChris asks, now that a penis
06:34transplant is a thing, can I get on that list? I love my old penis, but it's retired and ready to
06:40move on. You can't get a penis transplant just because you're tired of your old one. The usual
06:45reason for a penis transplant is because there's been trauma to the penis that has required it to
06:51be removed, such as cancer or a burn or some other type of trauma. Atlastthingyouforget asks,
07:00can I get a brain transplant? Please, pretty please. Although brain transplant has yet to be
07:06successful, the nature of this question makes me think that maybe there is a pretty big need for
07:11brain transplant. The short answer is no. ChironXC asks, at what point will stem cell research just
07:18allow us to grow clones of our own organs for transplantation? Surely this is the way to do it.
07:24I couldn't agree more. This would certainly solve our organ shortage issue. The good news is, is that
07:30researchers are working on this every day. I once worked with a researcher who was doing a lot of
07:36work in this area, and he had actually managed to grow a kidney with stem cells that made what we
07:42called bland urine. And by bland urine, I mean just water, meaning the kidney's not doing the job to
07:48filter out any of the other toxins that it's supposed to. So it didn't do all the functions
07:52that a kidney should do, but at the very least it was making some liquid. And that's mind-boggling
07:57to me. I've been told that organs that are grown with stem cells are just a few years off, but that
08:04was a few years ago. So we'll see. Acorauser asks, what was the first human organ to be successfully
08:10transplanted? Well, that was the kidney. In 1954, Dr. Joseph Murray did the first successful kidney
08:17transplant between two twin brothers in Boston, Massachusetts. What I find really cool about this
08:22is that transplant is such a young field that I actually had the privilege of meeting Dr. Murray
08:28when I was a resident at Brigham and Women's Hospital, which is where he practiced and trained.
08:33Sakthavignesh88 asks, what is xenotransplantation and what role is it going to play in the future?
08:41Xenotransplantation is a fancy word for saying you're getting a transplant from some animal that
08:47is not a human. And I do think that it has a big role for the future. There is an organ shortage,
08:52so we have to find creative ways to solve that problem. And xenotransplantation just may be the
08:58answer. Ed Krasen asks, would you allow doctors to put a pig heart into your body? If I was on
09:05death's door and I was not going to have an offer for a human heart anytime soon, yes. Both kidneys
09:13and hearts have been successfully transplanted into humans. However, long-term success still
09:20has not been shown. There's still a lot that's unknown and needs to be developed, but it holds a
09:25lot of promise. In1990 asks, why are all the engineered body parts for humans always made
09:31from pigs? What is it about pigs? Well, pig anatomy is very similar to human anatomy. When I
09:38talk about transplant, I say that we're like plumbers. We have to connect pipes to pipes.
09:43Human pipes and pig pipes are quite similar, so the connections are similar. And that makes the
09:49actual technical aspect of the transplant a lot easier. The other thing is that scientists can
09:55alter the genes of pigs such that they can raise the chances that that transplant will be a success.
10:03A quarter user asks, who decides which patient gets an organ transplant first? What factors go
10:10into that decision? Deciding who is eligible for an organ transplant is a really complicated process,
10:15and it involves a committee or a group of individuals, sometimes as many as 30 to 40
10:21people, who will decide whether the patient is suitable for organ transplant. And there's a lot
10:27of factors that go into it. The patient's health, whether or not they can handle the stress of such
10:32a big surgery, whether or not we think that they can take the anti-rejection medication that they
10:36need to take every day for the rest of their lives, how sick they are. So patients who are
10:43only mildly sick or at the beginning stages of their illness, or patients who are really sick
10:48and in the ICU and on death's door, and also is dependent on the organ that they're being listed
10:53for. In the case of kidney, your place on the list depends on how long you've been on dialysis.
10:59People who have been on dialysis longer will be near the top of the list. Other things that are
11:03taken into account is how far the donor organ is from the hospital where it's being transplanted.
11:09And there's many other factors. Age does play a little bit of a part in where a patient is on
11:15the list in that pediatric patients get priority. A Reddit user asks, can getting a heart transplant
11:22change your personality? The short answer is no. But one thing I can say is that receiving a gift
11:28that someone has given in death or in living, if it's a liver or kidney transplant, that saves you
11:34from death and changes your life forever certainly must have an effect on how you look at life and
11:40how you live life every day. So I would say from that perspective, yes, it can change your personality.
11:46U4 got smoke and lamp. I'm not surprised. Face transplants are a real thing. And these sickos
11:52will do anything to continue to look young. Face transplants are not what this person thinks.
11:57Face transplants are not used to help people look young or look different. Face transplants are a
12:03really big operation. You have to be on anti-rejection for the rest of your life. And
12:07most importantly, you have to qualify. And these are people who have had extreme disfiguring events
12:13such as burns, animal maulings that disfigure their face so horribly that a face transplant
12:20is warranted. Environmental Sorbet 3 asks, how long will a transplanted kidney last? Well,
12:28unfortunately, they don't last forever. And there's a few reasons why they don't. The kidney
12:33specifically, unlike the liver, does not have the ability to heal itself. The liver is unique and it
12:40has a regenerative capacity so that if you cut a piece of liver off, it will regrow similar to how
12:46a starfish regenerates its arm. With a kidney specifically, since it doesn't have the ability
12:51to heal itself, over time it will collect damage that will shorten its lifespan. That damage may
12:57come from infection. That damage actually sometimes or oftentimes comes from the anti-rejection
13:03medication itself. So immunosuppression or what we call anti-rejection medication, unfortunately,
13:09while it helps our bodies not to reject the kidney, it does cause a low level of injury to the kidney
13:16over time. If somebody gets a kidney from somebody who's passed away or a deceased donor, as we call
13:22it, we can expect that kidney to last on average 9 to 12 years. If somebody gets a kidney from a
13:28living donor, someone who shares and gives one of their spare kidneys, then we can expect those
13:34kidneys to last 15 to 20 years or sometimes longer. As for a liver, because they do have that ability
13:41to heal themselves, they last a lot longer. Most patients who get a liver transplant are outlived
13:48by their liver. Peej asks, what determines a match for a kidney transplant? All organs require a match.
13:57There's two different things that we look at. The blood type and then we look at immune system. Blood
14:03type is the first thing that we look at and so in order for you to be a match for blood type, you
14:09have to have an organ that either comes from your same blood type or the blood type O. O is considered
14:16the universal donor, which means that anybody can receive an O. There are four different blood types.
14:22You have O, A, B, and AB. AB is the universal recipient, which means that it can receive an organ from
14:31A, blood type B, blood type AB, or blood type O. The immune system matching is a lot more complex.
14:39Basically, what you're looking for is whether or not your immune system will recognize parts of
14:44that organ and react to it immediately. Our immune system's job is to kick out anything that's in our
14:52bodies that it doesn't recognize or that it wasn't born with and not supposed to be there. So that's
14:56the case for infection and it's also the case for transplanted organs and that's why patients need to
15:02be on anti-rejection medication or immunosuppression as we call it in transplantation.
15:07Werderlan asks, if the recipient of an organ donation dies before the donor, could the donated
15:14organ be returned to the donor? In theory, yes. A patient can have an organ out and put back into
15:21them. I haven't heard of a time where a transplant recipient passes away and that organ is taken back
15:27out and returned to its donor. There is something worth mentioning though. If somebody receives an
15:33organ transplant, particularly a heart or a liver, and for some reason, some complication, or if the
15:40patient was too sick, they pass away early, say within days or a couple weeks, that organ can be
15:46removed and transplanted into someone new. It's not very common but it has been known to be done.
15:52Steph Shaw asks, we need to do something about kidneys. Why does everyone always need new ones?
15:57Why they fail so fast? Kidney is the most frequently transplanted organ by a long shot.
16:02And the reason for that is the top two causes of kidney disease are high blood pressure and
16:08diabetes. And those are actually things that we can do something about. The way that we eat,
16:12exercise, those play important roles in the development of diabetes and high blood pressure.
16:18So healthy living can actually drive those numbers down. A Reddit user asks, could a donor organ live
16:24forever if constantly donated before each person's death? That's a great question that we do not have
16:30the answer to. I would say in the case of most organs, the answer is no. The one that makes me a
16:36little curious maybe is the liver. And that's because of the liver's ability to heal itself.
16:40The fact that many patients who get a liver transplant die with a still working liver makes
16:47us wonder just how long could that liver last. But we don't know the answer. Ameritransplant asks,
16:53any advice to those who are considering becoming a living donor? What's life like after your
16:58donation? There is a shortage of organs and one of the ways that we can help mitigate that shortage
17:04is through living donation. Kidneys and liver can be donated through living donation. You can
17:10give one of your kidneys or you can actually have your liver cut in half. The half that goes to
17:16the transplant patient will grow to be the size of a normal liver in about six weeks. And the half
17:22that the donor is left with will also grow to be the size of a normal liver in about six weeks.
17:27It's amazing. The bottom line is that we have to be very, very careful with anybody who's considering
17:33a living donation because they get no medical benefit from that surgery. So we put them through
17:39a number of tests to ensure that their risk is extremely low. In doing that, we are actually
17:46guaranteeing that the donor will have pretty much a normal life after living donation. They can have
17:53children. They can get back to the gym. They can go back to work. They can do all the things that
17:58they did before they donated. Because if they couldn't, we wouldn't allow them to donate because
18:03that wouldn't be ethical. Rope Bracelet asks, what's your transplant or donation hot take or
18:11unpopular opinion? My hot take, which may be unpopular to some surgeons, is that I'd love to
18:17see myself put out of a job. There's so much that we can be doing on the pre-transplant side to
18:23reduce the burden of disease so that we don't have this organ shortage. Now, don't get me wrong. I'll
18:28never be put out of a job. There'll always be a reason to have organ transplants. But we can have
18:33less and we can have less of an organ shortage issue. Kidney disease, for example. Top two causes
18:38are high blood pressure and diabetes. We can do something about that. Our neighborhoods, how
18:43they're set up, if people live in food deserts, if they're eating unhealthy foods or living in
18:47food swamps, that will impact the development of those diseases. And actually, CDC data shows us
18:53that neighborhoods that have food deserts or food swamps, a predominance of food swamps,
19:00have much higher rates of high blood pressure or diabetes and therefore kidney disease. For the
19:06liver, let's think about alcoholism or hepatitis C from IV drug use. Two things that we really can
19:13make a difference on if we had public health initiatives to really focus on those things.
19:18And we do have initiatives. But if we spent more time and resources on those things, we could really
19:23make an impact on the transplant side. Well, that's it. That's all the questions. I hope you
19:28guys learned something. Until next time.