Teaching ethics in organ transplantation and tissue donation (original) (raw)
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Organ transplantation in the modern era
BMC Anesthesiology
Background Organ transplantation (OT) is one of most successful advances in modern medicine. For patients with end stage disease, transplantation most often provides their only chance for survival. Even before the first transplant was performed, it was clear that OT could only be successful with a multidisciplinary approach. The history of OT has involved a series of breakthroughs in medicine that has influenced all aspects of health care. As you will see, for nearly a century, the contributions of specialists in anesthesiology and critical were largely underrepresented in the worlds literature. Short history of organ transplantation The earliest descriptions of OT can be found in ancient Greek, Rome, Chinese, and Indian mythology involving bone, skin, teeth, extremity, and heart transplantation [1, 2]. In the sixteenth century, Italian surgeon Gasparo Tagliacozzi used skin transplant for plastic reconstruction. He was the first to describe what we now know is an immunologic reaction when the graft is obtained from a different person. It was only at the end of nineteenth century that OT research began to be both more systematical and better documented. The first animal models (usually dogs) were developed at this time. Early in the twentieth century, French surgeon Alexis Carrel (who later move to the US) developed a new method for vascular anastomoses. Dr. Carrel performed several successful kidney transplants in dogs, developed an approach for vessel reconstruction, and began the practice of cold graft preservation. In 1912 Dr. Alexis Carrel was awarded the Nobel Prize in Physiology or Medicine for his pioneering work [3]. The first human to human transplant was performed in 1933 in the Soviet Union by the Ukrainian surgeon U.U. Voronoy. The blood group mismatched graft was obtained six hours after the donor's death and although the patient survived two days, the graft never produced urine [3, 4]. Despite significant
Need, process and importance of organ transplantation
Asian Journal of Pharmacy and Pharmacology, 2020
Organ transplantation is a medical procedure in which an organ is removed from one body and replaced in the body of a patient who has damaged or missing organs. The person who donates organ is called donor whereas a patient who receives it, is called the recipient. The donor and recipient may be available in the same location, or organs may be transferred from a donor site to the recipient site by a suitable method. Successful transplanted organs to date include the lungs, intestine, uterus, heart, pancreas, liver and thymus and kidneys. Tissues that are transplanted include tendons, skin, bones, valves, cornea, nerves and veins. Worldwide, the most commonly transplanted organs are kidneys, then liver and then the heart. Organ donors are living, or brain dead. Cadaver transplantation is the most challenging, complex and risky areas in the field of medical and surgical science. Overall transplantation requires patience, financial planning, ethical consideration, dedication and expertise of the medical team. It involves major risk of patient's life. But it is considered the most miraculous treatment of the century in the field of medical science. The present review is therefore planned to focus on its importance, types, history, need, process, medications and risks of organ transplantation.
Organ & tissue transplantation: A second chance of life
INTERNATIONAL JOURNAL OF SCIENTIFIC DEVELOPMENT AND RESEARCH, 2023
Transplanting a healthy organ into a person who lacks that organ can save their life and boost their quality of living. While organ transplants have improved greatly over the past two decades, with generally excellent outcomes for children and young adults, the increased proportion of older transplant patients with comorbidities poses new challenges. Transplants are essential for the treatment of patients with irreversible diseases of the liver, heart, or lungs, and renal transplantation improves patient survival compared to dialysis. There has been a consistent increase in the number of solid organ transplant programmes, but this growth falls well short of meeting worldwide needs. Giving someone a second chance at life is possible only via organ and tissue donation. Giving to charity has far-reaching benefits for society as a whole, not just for the individual or family receiving the donation. In 2021, there were 1,44,302 organ transplants worldwide; India accounted for 8% of that total with its 42,259 transplants. Therefore, decreasing the number of patients in need (the waiting list) of an organ can be accomplished by increasing public awareness of the significance of volunteer enrolling for organ donation. Index Terms-organ donation, tissue donation, body donation, transplantation, organs and tissues of transplantation. I.
Organ transplantation—how much of the promise has been realized?
Nature Medicine, 2005
Since the introduction of organ transplantation into medical practice, progress and optimism have been abundant. Improvements in immunosuppressive drugs and ancillary care have led to outstanding short-term (1-3-year) patient and graft survival rates. This success is mitigated by several problems, including poor long-term (> >5-year) graft survival rates, the need for continual immunosuppressive medication and the discrepancy between the demand for organs and the supply. Developing methods to induce transplant tolerance, as a means to improve graft outcomes and eliminate the requirement for immunosuppression, and expanding the pool of organs for transplantation are the major challenges of the field. Historical overview Burns suffered by victims of aerial bombardment in World War II inspired Sir Peter Medawar's now famous studies in transplantation immunology. Seeking to understand skin graft rejection, he observed that rabbits rejected foreign skin grafts more quickly if the animals were re-transplanted with a graft from the same donor 1. At the same time, however, Ray Owen noted that nonidentical Freemartin cattle that share a common placenta fail to reject skin grafts from littermates but not from other cattle 2. Collectively, these findings showed that the immune system could respond to transplantation antigens by the induction of memory or, alternatively, by the induction of tolerance. In 1953, Billingham, Brent and Medawar, in what is probably the most famous single paper in transplantation immunology, described the creation of acquired immunological tolerance to alloantigens in mice 3. The following year, Joseph Murray's team at the Brigham and Women's Hospital, building on roughly fifty years of progress in vascular surgical techniques, performed a successful renal transplant between identical twins 4. Current status of organ transplantation Since the birth of the field, progress in transplantation medicine has been rapid. Chemical immunosuppression with corticosteroids and 6-mercaptopurine was first used to enable transplantation between nonidentical individuals in the early 1960s. The introduction of newer immunosuppressive agents and improvements in surgical techniques and ancillary
Current scenario and future prospectus of organ transplantation
IP Innovative Publication Pvt. Ltd., 2017
“Organ transplant” is not just a term or a medical procedure, but an idea, a startling yet extraordinary discovery of medical science in the 20th century that has undoubtedly saved millions of lives across the world. ‘An organ is a mass of specialized cells and tissues that work together to perform a function in the body’. So what exactly is organ transplantation? “An organ transplantation is a surgical procedure wherein failed or damaged organ in the human body is removed and replaced with a new one.” The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Tissues transplanted between members of same species are called allografts, which can either be from a living or cadaveric source
Organ Donation and Transplantation: “Life after Death”
Organ Donation and Transplantation - Current Status and Future Challenges, 2018
Organ donation is defined as giving an organ or part of an organ to be transplanted into another person. Organ transplantation is the only option to save lives in patients affected by terminal organ failures and improve their quality of life. However, there is a disparity exists between the supply and demand of donated organs, leads to a loss of many lives. The number of organ transplantation have gradually increased in the last two decades and provide excellent results in children and young adults, and are challenging by the growing proportion of elderly transplant patients with co morbidity. The results of organ transplantation continue to improve, as a consequence of the innovations and the improvements in peri-operative management. This chapter describes organ donation and transplantation and its trends and challenges.
Case Studies in Organ Transplantation
2004
Case Studies in Organ Transplantation by Christopher Baldwin (Iowa State University), David Bristol (North Carolina State University), Emily Deaver (Chowan College), Bruce Hammerberg (North Carolina State University), Carole A. Heath (Iowa State University), Surya Mallapragada * (Iowa State University), Gavin J. Naylor (Iowa State University), Elaine Richardson (Clemson University), Jim Wilson (North Carolina State University) * corresponding author
Organ donation and treatment of the multi-organ donor
Current problems in surgery, 2003
O rgan transplantation is currently the standard therapy for end organ failure in those patients who are suitable medically for transplantation. At present, there are more than 80,000 patients who are listed for transplantation in the United States (Table 1). 1 The United States organ transplant waiting list grows an average of 16% to 20% per year. In the past 10 years, the number of registrants has increased from 23,901 registrants to more than 80,000 registrants. In contrast, the number of cadaveric organ donors that are available increased from 4526 donors in 1991 to 5985 donors in 2001 (Fig 1). 2 The number of transplantations that were performed in the United States has also increased from 12,626 transplantations in 1988 to more than 22,000 transplantations in 2000, with the significant increase being related to broader use of living donors and expanded acceptable criteria for cadaveric donors (Fig 2). 2 Of those registrants who are listed for life-saving organs (such as heart, lung, and liver), the 1-year mortality rate while awaiting a transplant ranges from 10% to 25%. The overall mortality rate for all patients on the waiting list is 7.5% and continues to grow yearly. 1 Patients who have irreversible loss of all brain function, but who are maintained on ventilators (ie, brain dead) are the single largest source of transplantable organs. It has been estimated that between 6900 and 10,700 potential donors are available annually in the United States (28.5 to 43.7 donors per million population). Unfortunately, organ procurement efforts are between 37% and 59% efficient in terms of the actual recovery of organs. Efficiency varies greatly by state and organ procurement organization. 3 The most realistic estimates of donor supply place the number of potential donors between 43 and 55 per million population. The range of potential donors is therefore somewhere between 7088 and 25,865. Realistically, estimates must be adjusted on the basis of public attitudes toward donation. Between 53% and 68% of the public is willing to donate the organs of relatives under appropriate circumstances. Subsequently, between 5700 and 9300 donors may be
ORGAN TRANSPLANTATION AND ITS PHYSIOLOGICAL IMPLICATIONS – A Review
Organ transplantation is the mechanism of transferring an organ (heart, lung, etc.) from one body to another or from one donor site on the patient's own body for the purpose of replacing the recipient's damaged or absent organ. The different types of transplantation considering the relationship between the donor and the recipient species are autotransplantation, xenotransplantation, iso-transplantation and allotransplantation. Allotransplantation is further divided into split and damino-transplant. Donors for organ transplantation are classified into living and deceased donors. Living donors remain alive and donate renewable or regenerative organs. Deceased or cadaveric donors are those that are cardiac dead or brain dead. Some of the organs that can be transplanted include intestine, eyes, thymus, heart, kidney, liver, and lung, out of which the last four are done worldwide. The transplantation of organs, mainly of allotransplantation and xenotransplantation types is accompanied by graft rejection. Other implications of organ transplantation include: immune system inefficiency, transplant rejection, chimerism and xenozoonosis. Graft rejection can be solved using immunosuppressive mechanism aided by immunosuppressant drugs. Immusuppression is also limited by some side effects and immune system inefficiency. Some of the strategies for overcoming rejection include the interruption of the complement cascade, use of transgeneic organs and induction of non-responsive haematopoietic-chimerism.
Renal transplantation is well established as the treatment of choice for selected patients with end-stage renal failure. A renal transplant recipient can enjoy an improved quality of life whilst benefiting from a reduction in the mortality compared with long-term dialysis. However, the success of transplantation is limited by the disparity between an ever growing demand and an insufficient supply of organs. Expansion of the organ donor pool has been achieved through increased utilization of living donor kidneys, transplantation across HLA and ABO boundaries as well as a greater acceptance and consideration of more marginal kidneys from deceased donors. Whilst one-year graft survival rates are significantly higher than a decade ago, the rate of chronic graft loss after the first year remains substantial. Although the surgical procedure has changed little over many years recipients have certainly become more complex with increasing age, obesity, co-morbidity and repeat transplants.