Are we involved in organ or tissue transplantation?

Issue: Issue 6 2008

Christian, a patient of mine, recently went into “knee failure.” His lateral meniscus was torn beyond repair several years ago after a football injury. Even though his ruptured ACL had mended accordingly — the tibialis anterior allograft tendon had successfully been integrated – the removal of his lateral meniscus was too much of an injury to be taken for granted. He wanted to pursue an active lifestyle, but even though he had a slim physique, he could not perform required work.

René Verdonk

Ultimately, his “knee organ” was failing. He needed a meniscal transplant.

We knew meniscal allografts were a valid option for that surgery because of our extensive experience using the grafts. I contacted Eurotransplant and asked if they could provide me with a correct-sized “fresh” allograft.

Indeed, this organization retrieves and connects organs and donors for transplantation throughout Europe with great success. Matching a donor with the recipient is performed with the ultimate precision in less than a moment’s notice so that life-saving surgery can be performed in a matter of hours.

Menisci help

I thought that because menisci are part of an organ – the knee joint – Eurotransplant, with its vast experience, may be an organization that would be beneficial to orthopaedic patients.

In fact, knee failure may lead to osteoarthrosis. Osteoarthrosis, being an “organ failure” and similar to other organ failures (eg, liver or kidney), is a final common pathway induced by several causes.

However, Eurotransplant and its organization could not help, even though I inquired about a “viable, fresh meniscus.”

Imagine how many donor tissues go unused for orthopaedic purposes. Imagine how many ligament allografts may be banked (deep frozen), allowing for individual use in patients and avoiding autograft harvesting and potential idiopathic-induced issues.

Allogenic cartilage cell transplants, meniscal bodies and massive allografts and major joint allografts are lost each year. Tissue banking is, of course, available and ready for use in many hospitals throughout Europe. Laws on the matter span many boundaries and are almost available, yet viable meniscal allografts and deep frozen allografts remain scarce.

Living vs. orthopaedic organs

I may not plead for “living” organs to be mixed up with “orthopaedic” organs. They are designed for different purposes, but why not make it clear to decision makers that upgrading orthopaedic “organ” banking may relieve much pain and discomfort as well as improve the way of life and work in the active population.

All of this is somehow partly on the way, but Christian will still be placed on the local waiting list for his meniscal allograft in order to avoid organ failure leading to osteoarthritis.

It appears that orthopaedic graft users and the tissue banks, as leaders, will need to connect throughout Europe to create more opportunities to collaborate with organ transplantation organizations such as Eurotransplant if we want to improve care for our patients in the old continent.

For more information:

René Verdonk, MD, PhD, is head of the department of orthopaedic surgery and traumatology at Ghent University Hospital, Gent, Belgium. He is also the chairman of the Orthopaedics Today Europe Editorial Board for 2008. He can be reached at +32-9-240-22-48; e-mail: rene.verdonk@ugent.be.