HOUSE: What's Worse Than Rejection?

I have received several comments recently that I should devote less space to plot synopsis and more text to specific medical issues that arise (erupt) during an episode of House,M.D.

It appears that I picked a great week to skip the plot synopsis because this week's episode ("Not Cancer") was already spinning out of control during the first segment.

Most viewers probably want to know: Can I acquire an organ donor's illnesses? The answer is a definite 'Yes'. If a donor has the corneal condition keratoconus (extreme irregular astigmatism) and the corneas are harvested for transplantation, the recipient will have keratoconus. It happens! Not only can transplant recipients develop the same illnesses that were present in the donor, the transplantation itself can generate some new ones. Let me explain.

Infected organs that are transplanted can quickly spread the infection elsewhere in the recipients body. Fortunately, today's rigorous organ screening procedures greatly limit this possibility. Typically, only healthy dead people (an oxymoron?) and healthy living people are acceptable donors.

A scriptwriting oversight deserves clarification. There are different types of transplantations: solid organ (heart, liver, etc.), tissue (tendons, corneas, skin), and bone marrow. They made a big deal that math professor Apple's cornea transplant was safer because the cornea has no blood vessels. That statement is meaningless. In the past cornea recipients contracted rabies from deceased donors. Somebody forgot to tell the morgue staff, "Don't harvest any donor tissue on this corpse!" Today that does not happen - end of story.

Solid organ transplantation requires extensive immunosuppression in the recipient to prevent the recipient's immune system from fighting the stranger's tissue, thereby causing organ rejection. You can see the problem here: profound immunosuppression makes the recipient highly vulnerable to opportunistic infections. Cytomegalovirus (CMV) is one such example. Most organ recipients with no prior CMV exposure take antiviral drugs after transplantation to prevent CMV infection.

Powerful immunosuppressive drugs can also cause problems. Individuals who contract Epstein-Barr virus infection (same bug that causes mononucleosis) while immunosuppressed may develop a lymphoma-type condition that is controlled, not by chemotherapy, but by reducing the level of immunosuppression.

Yep, organ transplantation is serious business. Besides hoping for a good tissue match and healthy acceptance of the new organ, transplant patients have to deal with the challenges of a compromised immune system, unexpected dangerous infections, and other complications that threaten the survival of both the transplanted organ as well as the life of its recipient. Having said that, organ transplantation means hope for a new life.

Hey, don't forget to become an organ donor - and notify your loved ones of your decision. Over half of all folks needing an organ transplantation die without getting it.

One final thought. Livers and kidneys aside, like an unwanted organ, Wilson continues to reject House!

Related Topics:

• Living With an Organ Transplant
• Donating Organs and Tissue: Giving the Gift of Life