Have you ever wondered how doctors determine whether a donated organ is the right fit for a patient in need of a transplant? Gary received a new liver in 2005 to overcome a rare autoimmune disease called Primary Sclerosing Cholangitis, but his surgeon couldn’t just put any old liver into his body — it had to meet a number of criteria.
There are three factors that play into matching an organ to a recipient: blood type, human leukocyte antigens (HLA), and antibodies. The donor’s and recipient’s blood type need to be compatible, though HLA and antibodies get tricky — you don’t need to have the exact same HLA, though the better the match the less likely you are to have harmful antibodies against your type.
How do antibodies work?
Most blood donors know their ABO blood type and understand how it works with blood transfusion: O can only receive type O blood; AB can receive blood from any other types; A can receive blood from an A or O donor; and B can receive blood from an O or B donor. If you receive the wrong blood type, a transfusion reaction can occur.
O red blood cells have no antigens, but that blood type has antibodies in the serum (the fluid in your blood) against antigens found on A and B red blood cells. AB red blood cells have both A and B antigens, but no antibodies in the serum (because these would attack the person’s own red blood cells). This is why O is the universal whole blood donor, while AB is the universal blood recipient.
HLA works in the same way, on a much larger scale — it’s the most polymorphic (variable) genetic system in humans. For example, there are only four or five alleles (genetic markers) that code for hair or eye color, but there are thousands of HLA alleles. Each person only expresses a few alleles (inherited from their parents) so the chances of someone not related to you being an exact HLA match is essentially one in a million.
The immune system: HLA and antibodies
HLA and antibodies are part of our immune system: our body’s defense against invaders like bacteria, parasites, and viruses. According to Dr. Paul Warner in our HLA Lab,
The main function of the immune system is to tell what is ‘you’ from what is not ‘you’. Anything that’s not ‘you’ in a part of your body that should be sterile, like your blood, you need to get rid of, because it wants to use your body as a food source. That’s basically what an infection is. Because your specific HLA molecules are present on the surface of virtually every cell in your body, it’s a good way for your immune system to tell ‘friend’ from ‘foe’.
Unfortunately, this is a mixed blessing when we are trying to match a donor organ to a recipient. The immune system, designed to protect the body, will attack and reject an organ that it views as being foreign. So,
The main thing that we do is not so much [HLA] matching – we do mismatched transplants all the time. The main thing that we do is make sure that the person receiving that transplant does not have antibodies against the mismatched HLA of the donor, because those antibodies can cause graft rejection.
Detection and identification of antibodies against HLA in a transplant recipient is more important than HLA matching of the donor and recipient, by far. You can be a zero HLA match, as long as you don’t have antibodies against the mismatched HLA of the donor. However, the better the match, the better the long-term outcome – because you don’t make antibodies against your own HLA, so if someone has the same HLA you do, you won’t make antibodies against them, either.
So, what does the testing look like? Click through to see the steps.
Because of these tests, Gary and thousands of other transplant recipients in the Pacific Northwest are able to enjoy many more years of doing what they love. In Gary’s case, it’s spending time with his family.