WEBVTT - Lab 056: The Right Match: Organ Transplants 0:00:00.360 --> 0:00:01.639 I don't know if I told you about this show. 0:00:01.680 --> 0:00:04.320 It's called Raised by Wolves, but the second season of 0:00:04.360 --> 0:00:06.360 it just came out. It's Raised by Wolves too. Is 0:00:06.360 --> 0:00:09.160 it a movie, No, it's a series, okay, But it's 0:00:09.160 --> 0:00:13.039 basically living in three thy ninety nine. Okay, it's very different. 0:00:13.160 --> 0:00:15.280 And it really made me think, like, all the stuff 0:00:15.320 --> 0:00:17.840 that they're doing in that show, I'm like. 0:00:17.800 --> 0:00:20.160 Could this really be possible? What are they doing? 0:00:20.400 --> 0:00:23.799 They're using like droid robot things, but they look like 0:00:23.880 --> 0:00:27.040 people and they're able to do all these biological functions. 0:00:27.320 --> 0:00:29.800 And it reminded me of where we saw that pig 0:00:29.840 --> 0:00:32.320 heart transplant story a couple weeks ago. 0:00:32.360 --> 0:00:34.760 Do you remember? Yes, I do remember. 0:00:34.960 --> 0:00:37.240 And that kind of blew me away because I remember 0:00:37.280 --> 0:00:39.199 back in the day when they put the ear on 0:00:39.240 --> 0:00:40.520 the back of the rat and that. 0:00:40.600 --> 0:00:43.280 Was really big. Yes, that was in all the textbooks. 0:00:43.440 --> 0:00:48.760 Yes, But putting a pig heart into Homo sapien rte 0:00:50.200 --> 0:00:52.680 I was like, Man, we are really making leaps and 0:00:52.920 --> 0:00:54.480 bounds in our lifetime. 0:00:54.720 --> 0:00:56.840 I thought Raised by Wolves was three thousand ninety nine, 0:00:56.880 --> 0:00:58.320 but maybe it's twenty ninety nine. 0:00:58.920 --> 0:01:00.279 Maybe it's close with it, And I. 0:01:00.240 --> 0:01:29.600 Thought, welcome to dop Labs, a weekly podcast that mixes 0:01:29.640 --> 0:01:32.880 hardcore science, pop culture, and a healthy does of friendship. 0:01:33.000 --> 0:01:33.240 T T. 0:01:33.440 --> 0:01:35.759 I know I mentioned that I saw a pig heart 0:01:35.760 --> 0:01:38.880 transplant and that it feels like we are living in 0:01:38.920 --> 0:01:42.240 the year three thousand, that sci fi is upon us. 0:01:42.520 --> 0:01:43.200 But I feel like. 0:01:43.160 --> 0:01:45.080 I'm really blown away, Like how do we get here 0:01:45.080 --> 0:01:47.720 with all these new transplants and all of this technology. 0:01:47.920 --> 0:01:49.520 That wasn't the only one I saw. That's only one 0:01:49.560 --> 0:01:51.280 I can remember right now. I think we got to 0:01:51.320 --> 0:01:52.120 get to the bottom of it. 0:01:52.280 --> 0:01:52.920 Absolutely. 0:01:53.280 --> 0:01:56.840 This week we're talking about organ transplants specifically. We really 0:01:56.880 --> 0:01:59.080 want to know more about the process of getting approved 0:01:59.080 --> 0:02:02.960 for a transplant and how transplants actually work. Let's get 0:02:02.960 --> 0:02:15.040 into the recitation, So let's start with what we know. 0:02:15.320 --> 0:02:18.440 I feel like everything that I know about transplants is 0:02:18.480 --> 0:02:21.239 based off of what I've seen in movies in television. 0:02:21.440 --> 0:02:23.160 I think that's fine, is it. 0:02:23.320 --> 0:02:25.400 I think that's an okay starting point because then we 0:02:25.440 --> 0:02:29.760 can figure it out. Well now I feel empowered. I 0:02:29.840 --> 0:02:31.960 think one of the things that I think I know 0:02:32.360 --> 0:02:35.280 is that getting a transplant is not as easy as 0:02:35.360 --> 0:02:37.360 saying that I need this new organ. There is a 0:02:37.440 --> 0:02:41.160 process you have to see a number of doctors and 0:02:41.200 --> 0:02:42.320 then be put on a list. 0:02:43.200 --> 0:02:44.720 I think considering that list. 0:02:45.000 --> 0:02:48.239 Sometimes getting a transplant is easy, though some people get 0:02:48.240 --> 0:02:50.800 it from family members. But some people can't match with 0:02:50.840 --> 0:02:52.959 their family members. So I don't know a lot about 0:02:53.160 --> 0:02:57.000 the matching process. I know sometimes it's easy, or you know, 0:02:57.040 --> 0:03:00.160 if you have family members who match with you. But 0:03:00.160 --> 0:03:01.800 I got to save this for the next section because 0:03:01.840 --> 0:03:03.080 I don't know how you match. 0:03:05.000 --> 0:03:06.800 One of the things that I know is that not 0:03:06.840 --> 0:03:11.040 all transplants are created equal, and so getting a heart 0:03:11.080 --> 0:03:15.440 transplant and getting a kidney transplant are two very different beasts. 0:03:15.680 --> 0:03:17.840 The other thing I know is that there are a 0:03:17.880 --> 0:03:22.680 lot of rumors about transplants and the medical system. I 0:03:22.720 --> 0:03:25.440 think one of the most damaging things that has happened 0:03:25.480 --> 0:03:28.800 when it comes to organ transplants is the myth and 0:03:28.919 --> 0:03:31.480 rumor that went around that if you put that you 0:03:31.520 --> 0:03:34.760 were an organ donor on your driver's license, that the 0:03:34.840 --> 0:03:36.280 paramedics wouldn't try to save you. 0:03:36.280 --> 0:03:36.960 Do you remember this? 0:03:37.720 --> 0:03:41.200 Yes, I remember this, and I hate to say it frihim, 0:03:41.200 --> 0:03:43.160 but I was actually one of those people who believed 0:03:43.160 --> 0:03:44.120 it for a little while. 0:03:44.280 --> 0:03:47.600 That's all right, you were not alone but it is 0:03:48.000 --> 0:03:50.280 just that it's a myth, you know. I'm looking at 0:03:50.280 --> 0:03:53.280 this page from penn Medicine, so the University of Pennsylvania, 0:03:53.440 --> 0:03:56.760 the Perlman School of Medicine, and they're saying that you 0:03:56.800 --> 0:03:58.960 would have to be in the hospital on a ventilator 0:03:59.000 --> 0:04:02.080 and then pronounce dead in order to donate your organs. 0:04:02.440 --> 0:04:05.640 So it's not even that your organs are harvested if 0:04:05.640 --> 0:04:07.600 you're in a car accident, you know what I mean. 0:04:07.720 --> 0:04:11.280 That myth plays on people's fears of not having adequate care, 0:04:11.560 --> 0:04:14.360 but there are so many additional steps before you get 0:04:14.440 --> 0:04:18.480 to the donation of your organs. Another myth is that 0:04:18.839 --> 0:04:21.000 your family will be charged if you donate organs. 0:04:21.120 --> 0:04:23.440 I've never heard that one, but I can understand why 0:04:23.480 --> 0:04:24.440 people would think. 0:04:24.279 --> 0:04:26.919 That because it's an additional process right. 0:04:26.760 --> 0:04:29.320 Absolutely, And the medical care system it feels like a 0:04:29.320 --> 0:04:31.920 black box. Sometimes you go to the doctor or you 0:04:31.960 --> 0:04:33.880 have to rush to the hospital, and next thing you know, 0:04:33.920 --> 0:04:36.159 you have this huge bill and you don't know where 0:04:36.440 --> 0:04:38.359 these charges came from. You don't know how you're going 0:04:38.400 --> 0:04:40.360 to pay for it. So I can definitely understand where 0:04:40.360 --> 0:04:41.720 that confusion comes from. 0:04:41.920 --> 0:04:43.239 So what do we want to know though? 0:04:43.440 --> 0:04:46.760 What I want to know is how do they determine 0:04:46.800 --> 0:04:50.600 whether or not somebody is able to receive a transplant? 0:04:50.640 --> 0:04:52.240 Because I know, I mean, I don't know a lot 0:04:52.279 --> 0:04:54.600 about this stuff, but I see on TV that there 0:04:54.600 --> 0:04:57.000 are some folks who, you know, they get a transplant 0:04:57.400 --> 0:05:00.240 and their body rejects it or something like that. I know, 0:05:00.680 --> 0:05:02.919 what are the criteria that doctors are looking for to 0:05:02.960 --> 0:05:06.880 determine whether or not someone is able to get a transplant? 0:05:07.160 --> 0:05:07.440 Yes? 0:05:07.720 --> 0:05:11.159 And along those same lines, are those criteria the reason 0:05:11.240 --> 0:05:14.320 the waiting lists are so long? Why are there ninety 0:05:14.320 --> 0:05:17.080 thousand people waiting for a kidney but then a little 0:05:17.120 --> 0:05:19.919 over ten thousand four other organs? Is it related to 0:05:20.080 --> 0:05:23.960 the difficulty of replacing the organ, the surgery, the tools 0:05:23.960 --> 0:05:27.480 that are required, the costs. I'm just curious about, like 0:05:27.560 --> 0:05:30.080 why the lists are so long and were they always 0:05:30.080 --> 0:05:32.599 this long? Or is this like a backup from you know, 0:05:32.920 --> 0:05:34.360 delays in our medical system. 0:05:34.520 --> 0:05:36.000 Right, that's a good question. 0:05:36.360 --> 0:05:39.200 I think Another thing that we're both curious about is 0:05:39.760 --> 0:05:42.200 because we always are interested in it, and that is 0:05:42.680 --> 0:05:46.400 new technology. So what is the new technology and innovations 0:05:46.400 --> 0:05:47.799 in transplant sciences? 0:05:47.880 --> 0:05:49.400 Yeah, I'm sure they're not doing it the way they 0:05:49.400 --> 0:05:51.159 always used to. Now they can't be. 0:05:51.320 --> 0:05:54.080 Everything I know about how transplants work is pretty much 0:05:54.120 --> 0:05:54.800 based on John Q. 0:05:55.040 --> 0:05:55.920 You remember that movie. 0:05:56.120 --> 0:06:00.279 Yes, that's all I know, and I know I don't 0:06:00.279 --> 0:06:02.000 know if it was accurate, but that's what I feel like. 0:06:02.040 --> 0:06:05.039 I know Denzel was young in that movie. So young, Denzil. 0:06:05.160 --> 0:06:06.360 I'm expecting some changes. 0:06:06.440 --> 0:06:09.960 That age is a let's jump into the dissection. 0:06:10.560 --> 0:06:23.960 Yep, but its absolute. Our guest for today's lab is 0:06:24.000 --> 0:06:25.440 doctor Dave low Hi. 0:06:25.480 --> 0:06:27.599 My name is Dave low and I work for Thermo 0:06:27.680 --> 0:06:33.360 Fisher Scientific and I am head of research and development 0:06:33.880 --> 0:06:36.039 in our transplant diagnostics business. 0:06:36.360 --> 0:06:39.719 Thermo Fisher is a supplier of laboratory equipment and supplies. 0:06:39.880 --> 0:06:42.760 Me and Zekiah know them very well from all of 0:06:42.839 --> 0:06:47.360 our years in the lab. Their transplant diagnostics business focuses 0:06:47.400 --> 0:06:50.880 on developing and producing products with applications in both the 0:06:50.920 --> 0:06:54.440 clinical and the research side of organ transplants. 0:06:54.680 --> 0:06:57.800 Doctor Lowe's specialty is in histo compatibility, which is a 0:06:57.839 --> 0:07:00.240 word that isn't typically used, so we asked to to 0:07:00.279 --> 0:07:01.520 explain what it means. 0:07:01.960 --> 0:07:04.040 It's a hell of a mouthful, isn't it. 0:07:04.120 --> 0:07:07.520 If you've ever watched a medical drama on TV and 0:07:07.600 --> 0:07:11.000 somebody needs a transplant and they run around and they say, Okay, 0:07:11.000 --> 0:07:13.440 we've got a match. Then that's kind of the histo 0:07:13.520 --> 0:07:15.120 compatibility bit right there. 0:07:15.240 --> 0:07:19.000 Histo Compatibility means tissue matching, that the tissues of different 0:07:19.080 --> 0:07:22.360 individuals will be compatible. And by compatible, we mean that 0:07:22.560 --> 0:07:26.560 fusing tissues from two different people, so your donor and 0:07:26.600 --> 0:07:30.680 your recipient won't trigger a reaction from the immune system. 0:07:30.800 --> 0:07:32.440 I think it's important for people to remember when we 0:07:32.480 --> 0:07:35.960 talk about tissues. Tissues are just superstructures of cells. We 0:07:36.000 --> 0:07:38.640 can think about individual cells, but tissues are just a 0:07:38.680 --> 0:07:41.760 conglomerate of individual cells, and so at a cell to 0:07:41.800 --> 0:07:44.160 cell level, if those cells are not going to be compatible, 0:07:44.400 --> 0:07:47.080 then definitely those tissues aren't going to be compatible. And 0:07:47.120 --> 0:07:49.880 the thing that brings those tissues the nutrients that they 0:07:49.960 --> 0:07:52.640 need in the oxygen that they need to stay alive, 0:07:52.760 --> 0:07:55.239 that's the blood system, right. So you need your blood 0:07:55.320 --> 0:07:58.120 to match between your donor and your recipient. All of 0:07:58.120 --> 0:08:01.120 these things are physically interacting. You also need your tissues 0:08:01.240 --> 0:08:03.360 or the cells that make up the tissues to match 0:08:03.400 --> 0:08:05.760 between the donor and recipient too. And once you have 0:08:05.840 --> 0:08:07.960 all those things in your body, your immune system may 0:08:08.000 --> 0:08:10.200 recognize that donor tissue and in the case of a 0:08:10.200 --> 0:08:12.600 transfusion donor blood and say okay, I'm not going to 0:08:12.640 --> 0:08:16.200 attack it. Essentially, that's what histo compatibility is. They get 0:08:16.240 --> 0:08:17.480 together and they get along. 0:08:17.760 --> 0:08:21.360 Doctor Lowe's laboratory essentially develops and provides the tools that 0:08:21.440 --> 0:08:25.040 labs use to figure out how risky a transplant would 0:08:25.040 --> 0:08:27.800 be for each patient and how easy it would be 0:08:28.000 --> 0:08:29.280 to get them a transplant. 0:08:29.480 --> 0:08:33.720 So histel compatibility has multiple components, and one way that 0:08:33.800 --> 0:08:37.480 we already think about compatibility is in blood type, so 0:08:37.600 --> 0:08:42.720 ABO and then AB and O can be positive or negative. 0:08:43.040 --> 0:08:46.680 Blood type compatibility is certainly important for transplants, but there's 0:08:46.760 --> 0:08:50.600 a lot more to it with transplants. Compatibility or being 0:08:50.600 --> 0:08:53.040 a match is really framed in the context of the 0:08:53.280 --> 0:08:57.800 HLA system or human leukocyte antigens, and that's all about 0:08:57.880 --> 0:08:58.680 tissue matching. 0:08:58.880 --> 0:09:02.040 When we have people told about getting a match or 0:09:02.120 --> 0:09:05.920 not being a match, we're really talking about these specific 0:09:06.040 --> 0:09:10.240 antigens and what they are are proteins that are present 0:09:10.440 --> 0:09:13.560 on pretty much all of our cells and tissues, but 0:09:13.840 --> 0:09:17.440 they're highly diverse. Some of them are very common, and 0:09:17.600 --> 0:09:21.240 some of them are incredibly rare. So if a patient 0:09:21.400 --> 0:09:25.480 is unfortunate enough to have an incredibly rare tissue type, 0:09:25.920 --> 0:09:28.680 it's going to be much more difficult to get that 0:09:28.920 --> 0:09:30.199 patient donor. 0:09:30.520 --> 0:09:34.280 Another main factor in histo compatibility is antibodies, and we've 0:09:34.280 --> 0:09:37.920 talked a lot about antibodies before in various different contexts. 0:09:38.120 --> 0:09:40.439 Most recently we talked about it in Lab forty seven 0:09:40.520 --> 0:09:43.640 when we explore the immune system, and in that context 0:09:43.679 --> 0:09:48.120 we talked about antibodies really being these protectors to shield 0:09:48.160 --> 0:09:52.120 our bodies from invaders and foreign particles. That's generally a 0:09:52.160 --> 0:09:56.120 good thing, but in the context of transplantation and histo compatibility, 0:09:56.400 --> 0:09:58.840 antibodies can be a huge problem. 0:09:59.080 --> 0:10:02.360 Oh no, everything I thought I knew out the window. 0:10:05.640 --> 0:10:08.360 They're part of your immune system and they can trigger symptoms. 0:10:08.400 --> 0:10:11.440 We would generally categorize a sickness that's just your immune 0:10:11.480 --> 0:10:15.360 system responding, right, So if you have a lot of antibodies, 0:10:15.360 --> 0:10:17.560 they can recognize a lot of different things. That means 0:10:17.600 --> 0:10:21.520 they might recognize your donor tissue and give you a 0:10:21.520 --> 0:10:22.480 pretty bad reaction. 0:10:22.920 --> 0:10:26.400 So they're like, I, I this was not here before. Yes, 0:10:26.520 --> 0:10:28.800 that is not us attack. 0:10:30.440 --> 0:10:33.199 Yeah, you know what this reminds me of what in 0:10:33.280 --> 0:10:35.760 the matrix were like the mister Smith agents, like they're 0:10:35.880 --> 0:10:37.440 checking constantly for your signature. 0:10:37.520 --> 0:10:39.480 Yes, yes, this is so good. 0:10:39.520 --> 0:10:41.440 And so if you come back in like the same doors, 0:10:41.440 --> 0:10:44.160 like they're constantly looking for you, Like they were constantly 0:10:44.200 --> 0:10:47.000 looking for NEO in the matrix, that specific part of 0:10:47.040 --> 0:10:52.520 the matrix scared meat. That was terrifying, mister Smith, always 0:10:52.520 --> 0:10:54.480 in the same spots, just constantly looking for you. 0:10:55.120 --> 0:10:56.199 It was like a horror film. 0:10:56.240 --> 0:11:00.240 But that sounds exactly like what's happening in our immune system. 0:11:00.280 --> 0:11:01.480 Like those antibodies are. 0:11:01.360 --> 0:11:05.480 Just like right, But really it's great for your body 0:11:05.520 --> 0:11:07.920 if you have a FORID invader, a low level of virus, 0:11:08.000 --> 0:11:09.960 or a low level of bacteria, mister Smith, and mune 0:11:10.000 --> 0:11:12.480 system is constantly looking, constantly finding them, reading those green 0:11:12.520 --> 0:11:15.760 little characters scrolling down through your blood system. Okay, it's 0:11:15.840 --> 0:11:17.840 great to have antibodies looking for things on the surface 0:11:17.880 --> 0:11:20.120 of a bacterial cell or things on the surface of 0:11:20.160 --> 0:11:24.120 a virus. Not so great if those things appear on 0:11:24.120 --> 0:11:26.880 the surface of a donor tissue right right, they don't 0:11:26.880 --> 0:11:28.959 know those antigens, so they're like, yo, we got to 0:11:28.960 --> 0:11:30.000 get them out of here. 0:11:29.920 --> 0:11:32.200 And your antigens are defenseless essentially. 0:11:32.320 --> 0:11:34.400 Yeah, they're just things that they don't recognize. They say, hey, 0:11:34.400 --> 0:11:35.440 this is not part of the code. 0:11:35.520 --> 0:11:37.880 So the antigens, they can't even do the matrix thing 0:11:37.960 --> 0:11:38.440 that neo. 0:11:38.559 --> 0:11:39.680 Yeah, they can't do the Sierra. 0:11:39.800 --> 0:11:41.600 You know, Sierra was able to go back like that 0:11:41.840 --> 0:11:44.439 to do the neo and yeah, she's the only one. 0:11:44.480 --> 0:11:46.800 Those antigens are not doing that. Bruh. I remember trying 0:11:46.800 --> 0:11:49.920 to do that in high school. I was close. Really, 0:11:50.000 --> 0:11:50.240 I was. 0:11:50.240 --> 0:11:54.880 A different human being back then, not so different, just 0:11:54.920 --> 0:12:00.120 a different mobility. 0:12:01.440 --> 0:12:04.440 That's one thing that we find is on our transplant 0:12:04.440 --> 0:12:08.240 waiting lists, the more antibodies you have, the harder it 0:12:08.360 --> 0:12:11.200 is for you to get a transplant, and usually that 0:12:11.320 --> 0:12:12.680 means you will wait longer. 0:12:12.920 --> 0:12:17.080 So why would somebody have more antibodies than someone else. 0:12:17.280 --> 0:12:20.640 How do we even get the antibodies? We ask doctor 0:12:20.720 --> 0:12:23.960 Low how people who are on the waiting list for 0:12:24.000 --> 0:12:27.360 a transplant got so many antibodies that made them have 0:12:27.440 --> 0:12:29.720 to be on the waiting list for so long. Doctor 0:12:29.760 --> 0:12:32.320 Low says that there are three main ways. 0:12:32.320 --> 0:12:35.160 And the first is if you have a previous transplant, 0:12:35.360 --> 0:12:39.839 and quite often our patients when they have these previous transplants, 0:12:40.120 --> 0:12:44.000 they will form antibodies against some of those la and 0:12:44.040 --> 0:12:47.880 then the antibodies persist basically almost for the rest of 0:12:47.880 --> 0:12:50.959 that patient's life. So if you're then faced with a 0:12:51.040 --> 0:12:54.320 patient who has antibodies to HALA, all it does is 0:12:54.360 --> 0:12:59.199 it further reduces the number of potential donors for that patient. 0:12:59.440 --> 0:13:02.680 So if you have a previous transplant, remember that's cells 0:13:02.720 --> 0:13:05.840 that make up multiple different structures and that forms a tissue. 0:13:05.880 --> 0:13:10.440 That previous transplant will have antigens from the donor, and 0:13:10.480 --> 0:13:13.959 so your body, naturally, your immune system will make antibodies 0:13:14.400 --> 0:13:17.320 to that transplant. So now you have the antibodies that 0:13:17.360 --> 0:13:19.440 you already had that were part of your immune system, 0:13:19.440 --> 0:13:23.040 plus a new subset that have developed in response to 0:13:23.080 --> 0:13:26.679 your first transplant. So when it's time to get another transplant, 0:13:26.960 --> 0:13:30.360 you have an expanded set of antibodies, which could increase 0:13:30.360 --> 0:13:32.280 the likelihood that you would have a reaction. 0:13:33.200 --> 0:13:36.680 So is there a critical mass of antibodies where once 0:13:36.720 --> 0:13:40.199 it gets to that amount that your body automatically starts 0:13:40.200 --> 0:13:40.720 to react. 0:13:40.960 --> 0:13:43.120 I think that's a very good question. TT It is, 0:13:43.440 --> 0:13:47.000 I think two things. So it is volume of antibody 0:13:47.040 --> 0:13:53.079 and type of antibody. So you could have a variety 0:13:53.120 --> 0:13:55.440 of different types of antibodies, but if some of them 0:13:56.000 --> 0:13:59.480 are lower in number, it's less likely that you will 0:13:59.520 --> 0:14:03.439 have a strong immune reaction. Okay, does that make sense. 0:14:03.280 --> 0:14:05.800 Yeah, that makes sense. The next problem that some patients 0:14:05.800 --> 0:14:09.000 may run into that will cause them to have more antibodies, 0:14:09.000 --> 0:14:11.679 which makes it difficult for them to receive a transplant, 0:14:11.960 --> 0:14:13.720 is if they've had a blood transfusion. 0:14:14.000 --> 0:14:17.839 A lot of transplant patients get transfused quite a lot, 0:14:17.960 --> 0:14:23.160 and if there are cells in the transfused units that 0:14:23.280 --> 0:14:27.520 express HLA that is different, then there's a possibility in 0:14:27.560 --> 0:14:30.000 that way they can form antibodies as well. 0:14:30.080 --> 0:14:32.440 So a transfusion is having blood from a donor and 0:14:32.480 --> 0:14:34.880 putting it into a recipient. You know, and when we 0:14:34.920 --> 0:14:37.360 think about blood, you may just think, oh, red liquid, 0:14:37.440 --> 0:14:40.080 but it's not. It has cells in it, and those 0:14:40.080 --> 0:14:43.840 cells have antigens on their surface. So if I am 0:14:43.840 --> 0:14:47.680 a recipient and I initially didn't have antibodies that would 0:14:47.760 --> 0:14:50.280 react to those antigens that are on the surface of 0:14:50.320 --> 0:14:53.440 those cells. In my transfusion, there are components of my 0:14:53.480 --> 0:14:56.560 immune system that will recognize those antigens and begin to 0:14:56.600 --> 0:15:01.440 make antibodies. So now my antibody profile is expanded because 0:15:01.440 --> 0:15:04.280 my immune system has detected these other antigens, and now 0:15:04.320 --> 0:15:08.640 I have antibodies against those antigens plus whatever antibodies I 0:15:08.680 --> 0:15:09.320 initially had. 0:15:13.680 --> 0:15:17.040 Another way that folks can acquire antibodies that might keep 0:15:17.080 --> 0:15:20.480 them from being able to receive an organ transplant is 0:15:20.480 --> 0:15:23.880 a really tricky reason, and that is because your antibody 0:15:23.920 --> 0:15:27.000 profile can expand through giving birth. 0:15:27.400 --> 0:15:31.560 That sounds really wild, right, yes, but basically you have 0:15:31.600 --> 0:15:34.320 to think of when a baby is. 0:15:34.280 --> 0:15:36.360 Born magical times. 0:15:36.560 --> 0:15:40.160 Yeah, if a baby is born, the baby is not 0:15:40.200 --> 0:15:44.600 your clone, so it's gonna have half the genetic information 0:15:44.680 --> 0:15:48.800 from the other parent. And if that genetic signature causes 0:15:48.840 --> 0:15:52.160 the baby to express antigens that the birthing parent doesn't 0:15:52.200 --> 0:15:54.760 already have. As soon as that parents given birth, their skin, 0:15:55.280 --> 0:15:59.320 their womb, all of that is in contact with new antigens. 0:15:59.600 --> 0:16:02.960 We talk about that, right, And so then that immune 0:16:03.000 --> 0:16:05.920 system is like, hey, here's some foreign particles I've never seen. 0:16:05.960 --> 0:16:06.760 This wasn't with me. 0:16:06.760 --> 0:16:11.240 Before, and so at that moment, the birthing parents immune 0:16:11.240 --> 0:16:15.920 system makes antibodies to those antigens that are on the 0:16:15.960 --> 0:16:18.360 baby that came from the father that don't match with 0:16:18.600 --> 0:16:21.000 the birth and parents antigens that they already had. Now 0:16:21.040 --> 0:16:23.800 let's go back to early genetics. We know that when 0:16:24.120 --> 0:16:27.520 a parent birth's a child, it is not a clone. 0:16:28.040 --> 0:16:31.160 The other thing we know is that siblings are not clones. 0:16:31.440 --> 0:16:33.360 So every time there's a new birth, there's a new 0:16:33.400 --> 0:16:37.720 possibility of the birthing parent generating antibodies in response. 0:16:37.360 --> 0:16:37.920 To the baby. 0:16:38.200 --> 0:16:42.880 So let's say you are a parent of three, you've 0:16:42.880 --> 0:16:45.960 birthed three children. You are going up for a kidney 0:16:46.000 --> 0:16:48.040 transplant and they may say, have you ever had a 0:16:48.080 --> 0:16:51.400 blood transfusion? No, have you ever had a previous transplant? No, 0:16:52.040 --> 0:16:53.760 have you ever had kids? And it's like, whoa, And 0:16:53.840 --> 0:16:56.480 you know your antibody profile could be off the charts 0:16:56.520 --> 0:16:58.080 because I've been exposed. 0:16:58.200 --> 0:17:01.360 That's so tough. Wow, it was really tricky, you know. 0:17:01.640 --> 0:17:03.480 So if you think about that, that feels like that 0:17:03.480 --> 0:17:06.480 can really increase your antibody profile. Now here's the good news. 0:17:07.119 --> 0:17:10.359 This only happens about thirty percent of the time. So 0:17:10.440 --> 0:17:12.359 only thirty percent of the time do we see this 0:17:12.440 --> 0:17:14.520 type of antibody response after birth. 0:17:15.800 --> 0:17:17.760 But it's good to know. Yeah, it's good to know 0:17:17.800 --> 0:17:19.440 about that. Is this something that. 0:17:19.359 --> 0:17:22.040 We should be testing ourselves for or getting tested. 0:17:21.720 --> 0:17:23.639 For or is that like not until it's time to 0:17:23.640 --> 0:17:24.480 have a transplant. 0:17:24.600 --> 0:17:28.040 Okay, So we've talked about three main ways someone can 0:17:28.040 --> 0:17:30.680 get antibodies that makes it harder for them to match 0:17:30.720 --> 0:17:35.800 with a donor, like previous transplants, blood transfusion, and giving birth. 0:17:35.960 --> 0:17:40.840 But doctor Low told us about an even more unusual case. 0:17:41.160 --> 0:17:45.520 A patient many years ago who came for transplant and 0:17:45.960 --> 0:17:48.800 it was a male. He was a really big guy actually, 0:17:49.080 --> 0:17:52.960 and he'd never had a previous transplant, and he'd never 0:17:53.280 --> 0:17:58.800 had a transfusion either, so we were really confused because 0:17:58.840 --> 0:18:03.040 he had a ton of anti so we were trying 0:18:03.040 --> 0:18:04.960 to work out where he could have got these from. 0:18:04.960 --> 0:18:07.320 And it was only just one day that he told 0:18:07.400 --> 0:18:09.959 us that he used to be a bare knuckle cage fighter, 0:18:10.480 --> 0:18:15.720 so he'd been fighting for years and exchanging blood, which 0:18:16.440 --> 0:18:20.640 sounds horrible that he'd been exchanging bloods and other fluids 0:18:20.680 --> 0:18:23.960 I guess with his opponents, and he'd had a lot 0:18:24.040 --> 0:18:27.400 of antibodies. So don't do cage fighting if you ever 0:18:27.440 --> 0:18:28.920 want to get a kidney. 0:18:29.960 --> 0:18:31.440 I think these are things they don't tell you on 0:18:31.520 --> 0:18:32.040 Fight Club. 0:18:32.240 --> 0:18:36.359 Tyler Durton didn't say this so after the tissue type 0:18:36.440 --> 0:18:40.840 has been identified correctly in the antibodies confirm, the last 0:18:40.840 --> 0:18:44.359 step in checking a patient for histo compatibility is a 0:18:44.359 --> 0:18:45.040 cross match. 0:18:45.320 --> 0:18:48.400 You would get material from the donor, so you would 0:18:48.400 --> 0:18:52.480 get cells and tissue, and you would test for reactivity 0:18:53.280 --> 0:18:56.919 from your patient and if it's positive, then that usually 0:18:56.920 --> 0:18:59.760 means you don't go ahead. So I would often be 0:19:00.080 --> 0:19:03.480 performing these cross matches, and it usually turned out to 0:19:03.520 --> 0:19:08.080 be at three am, because often transplantation happens when you 0:19:08.160 --> 0:19:10.480 can when you have the donor. The cross match is 0:19:10.520 --> 0:19:11.560 absolutely crucial. 0:19:11.840 --> 0:19:14.239 Okay, So it seems like initially we're just looking at 0:19:14.240 --> 0:19:16.240 small things like the antibodies. Now we're pulling clumps of 0:19:16.280 --> 0:19:18.560 sales so tissues and saying, all right, are y'all gonna 0:19:18.560 --> 0:19:20.960 play well together? On paper, you look good together, but 0:19:21.040 --> 0:19:23.680 are y'all gonna play well together? And that cross match 0:19:23.720 --> 0:19:25.879 is where things can really start to look up. 0:19:25.960 --> 0:19:26.200 Right. 0:19:26.400 --> 0:19:28.359 The question is, you know, are you two gonna play 0:19:28.400 --> 0:19:31.480 well together? And so I think a cross match physically 0:19:31.480 --> 0:19:34.719 putting those tissues together is so important because if somebody 0:19:34.720 --> 0:19:37.560 made a mistake at the early stages of the antibody panel, 0:19:37.600 --> 0:19:39.920 or if there's something that wasn't detected. If you were 0:19:39.960 --> 0:19:43.560 to move forward with that transplant and they are not 0:19:43.760 --> 0:19:47.040 a good match, instantly the body will reject it, like 0:19:47.119 --> 0:19:51.200 within minutes seconds, even the organ begins to turn black. Wow, 0:19:51.320 --> 0:19:54.840 that's just how strong the immune response is in the body. 0:19:56.400 --> 0:19:58.920 Okay, let's take a quick break and when we get back, 0:19:58.920 --> 0:20:02.320 we'll get into another important part of organ transplants with 0:20:02.400 --> 0:20:18.119 doctor Low, and that's immunosuppression. We're back and we've been 0:20:18.160 --> 0:20:21.560 talking with doctor Dave Low all about organ transplants and 0:20:21.640 --> 0:20:24.880 how important the PROSS match is to make sure tissues 0:20:24.920 --> 0:20:27.159 will be compatible in an organ transplant. 0:20:27.480 --> 0:20:29.400 And I think that really gets us to the importance 0:20:29.440 --> 0:20:33.119 of another component of transplants, and that's immunosuppression. When a 0:20:33.119 --> 0:20:36.440 transplanted organ is rejected by the body, it's because of. 0:20:36.400 --> 0:20:40.639 A really strong immune response. And this is the worst 0:20:40.680 --> 0:20:41.400