Transplants III

There's a lot of great intellectual meat in transplant medicine. Even from a basic science standpoint, the immunology of the body's recognition of self and not-self is fascinating. How do you coerce the body to accept an organ from someone else yet still recognize cancer and infections to fight them off? How are host defenses modulated, and what happens to this process over time? After transplant, we have to maintain a delicate balance between preventing rejection of the organ and safeguarding the rest of the body against malignancy and microbes. But our tests for this are poor; much of the time, we have to biopsy the new organ to determine whether there is rejection. There's so much room for transplant research. Why can't we create targeted drugs to prevent self-harm while preserving immunologic defense? Why can't we identify markers to better characterize rejection without invasive procedures? Do we actually know what's going on when we stick someone else's liver, kidney, heart, or lung into a patient's body?

Even from a macroscopic medicine point of view, transplant medicine has lots of nuances. A post-transplant patient suddenly has a host of new medications all with significant side effects. The whole process ages a patient; suddenly cancer and opportunistic infections become more likely, patients develop diabetes and coronary disease, chronic medical problems are exacerbated. On the one hand transplant medicine is extraordinarily specialized, but on the other hand, it is simply general medicine for a specific population.