Extracorporeal Artificial Organs

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Paul S. Malchesky

Historically, the term "extracorporeal artificial organs" has been reserved for life support techniques requiring the on-line processing of blood outside the patient's body. The substitution, support, or replacement of organ functions is performed when the need is only temporary or intermittent support may be sufficient. The category of extracorporeal artificial organs does not include various other techniques which may justifiably be considered as such, such as infusion pumps or dermal patches for drug delivery, artificial hearts used extracorporeally, eyeglasses and contact lens for vision, and orthotic devices and manipulators operated by neural signals to control motion.

This chapter focuses on artificial organ technologies which perform mass transfer operations to support failing or impaired organ systems. The discussion begins with the oldest and most widely employed kidney substitute, hemodialysis, and outlines other renal assist systems such as hemofiltration for the treatment of chronic renal failure and fluid overload and peritoneal dialysis. The blood treatment process of hemoperfusion, and apheresis technologies which include plasma exchange, plasma treatment, and cytapheresis—used to treat metabolic and immunologic diseases—are also discussed. In addition, blood—gas exchangers, as required for heart-lung bypass procedures, and bioartificial devices that employ living tissue in an extracorporeal circuit are addressed. Significant concerns and associated technological considerations regarding these technologies, including blood access, anticoagulation, the effects of the extracorporeal circulation, including blood cell and humoral changes, and the biomodulation effects of the procedure and materials of blood contacts are also briefly discussed.

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