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Transplantation ethics

V Moalic-Allain
Hematopoietic stem cell transplantation is a common procedure potentially beneficial to many individuals with cancer, hematological, or inherited disorders, and has highlighted the need of related or unrelated donors to perform allograft. Donation of hematopoietic stem cells, either through bone marrow harvest or peripheral blood stem cell collection, is well-established and widespread. Over the past two decades, the peripheral blood stem cell collection by aphaeresis has become the main source of hematopoietic stem cells for transplantation, due to faster engraftment and practicability and lower risk of relapse for high-risk patients...
March 16, 2018: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Nidal Abukhaizaran, Mohammed Hashem, Osama Hroub, Souad Belkebir, Khaled Demyati
BACKGROUND: Organ transplantation is the treatment of choice for organ failure, but organs are scarce and their availability is affected by relational ties, religious beliefs, cultural influences, body integrity, medical mistrust, and other factors. This aim of this study was to assess the knowledge, attitudes, and practices of Palestinian population with respect to organ donation. METHODS: In this cross-sectional study, we used a validated questionnaire delivered by land telephone to collect data on the knowledge, attitudes, and practices relating to organ donation in the general population of the West Bank...
February 21, 2018: Lancet
Liana Al-Labadi, Yazan Gammoh, Reham Shehada, Reem Shahin, Walaa Jbarah, Madleen Amro, Hanan Athamny
BACKGROUND: Access to corneal transplantation is limited worldwide because of poor knowledge. Ethical, religious, and cultural barriers contribute to low rates of corneal donation. In the occupied Palestinian territory, limited information is available on factors affecting corneal donation. The aim of this study was to assess the knowledge and willingness towards corneal donation in Palestinian students. METHODS: This cross-sectional study included university students selected through convenience sampling in Nablus in the summer of 2016...
February 21, 2018: Lancet
K Ganapathy
Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. With the availability of ventilators, even determining when death has occurred is becoming difficult, as cessation of life functions is often not simultaneous across organ systems. With increasing accessibility to intensive care units (ICUs) even in Tier II and Tier III cities, and the government making it mandatory to notify brain death to facilitate cadaveric organ transplants, it behooves the neurosurgeon and neurologist to totally understand the minutiae of brain death...
March 2018: Neurology India
Ke-Wei Tian, Yuan-Yuan Zhang, Hong Jiang, Shu Han
The placenta has emerged as an attractive source of mesenchymal stem cells (MSCs) because of the absence of ethical issues, non-invasive access, and abundant yield. However, inflammatory cell invasion into grafts negatively impacts the survival and efficacy of transplanted cells. Previous studies have shown that synthetic C16 peptide can competitively block the transmigration of leukocytes into the central nerve system, while angiopoietin-1 (Ang-1) can inhibit inflammation-induced blood vessel leakage and inflammatory cell infiltration in rats with experimental allergic encephalomyelitis (EAE)...
March 15, 2018: Scientific Reports
Corinne Berzon
In 2008, responding to a widening gap between need and availability of transplant organs, Israel's Ministry of Health adopted a program of incentivized cadaveric organ donation. The Organ Transplant Law rewards individuals with prioritized access to organs on the condition that they participate in procurement efforts. Priority is awarded in the form of additional points allocated to the individual's organ recipient profile. Although Israel has experienced moderate gains in the years since the law's implementation, these have not been sufficient to satisfy the demand...
March 16, 2018: Israel Journal of Health Policy Research
James M West
Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Nur Altınörs, Mehmet Haberal
To determine the cost effectiveness of transplantation, we analyzed the financial economics of the organ and tissue transplant process. We compared the cost of this process with traditional modalities for treating endstage liver and kidney disease. Medical, surgical, legal, social, ethical, and religious issues are important in organ transplant procedures. Government, health insurance companies, and uninsured individuals are affected by the financial economics of organ transplantation. The distribution of financial burden differs among countries and is dependent on the unique circumstances of each country...
March 2018: Experimental and Clinical Transplantation
Carol Keen, Julie Skilbeck, Helen Ross, Lauren Smith, Karen Collins, Joanne Dixey, Stephen Walters, Diana M Greenfield, John A Snowden, Susan Mawson
INTRODUCTION: While myeloma is an incurable malignancy, developments in disease management have led to increased life expectancy in recent years. Treatment typically involves stem-cell transplantation. Increased survival rates equate to more patients living with the burden of both the disease and its treatment for increasing number of years, rendering myeloma a long-term condition.Evidence exists to demonstrate the benefits of exercise for patients recovering from stem-cell transplantation, and prehabilitation-exercise before treatment-has been shown to be effective in other disease areas...
March 9, 2018: BMJ Open
Eduardo Hariton, Pietro Bortoletto, Randi H Goldman, Leslie V Farland, Elizabeth S Ginsburg, Antonio R Gargiulo
OBJECTIVE: Our objective was to evaluate opinions and attitudes of the general public regarding uterine transplantation (UTx) in the United States (U.S.). DESIGN: Cross-sectional study (Canadian Task Force Classification II-2) SETTING: Web-based survey. PATIENTS(S): Nationally representative sample of adult U.S. residents by age and gender. INTERVENTION(S): Web-based questionnaire administered in November 2016. MAIN OUTCOME MEASURE(S): Respondents who supported UTx were compared with those who were opposed using log binomial regression to calculate relative risk ratios and 95% confidence intervals RESULT(S): Of the 1,444 respondents recruited, 1,337 (93%) completed the survey...
March 7, 2018: Journal of Minimally Invasive Gynecology
Julie B Eisengart, Kyle D Rudser, Yong Xue, Paul Orchard, Weston Miller, Troy Lund, Ans Van der Ploeg, Jean Mercer, Simon Jones, Karl Eugen Mengel, Seyfullah Gökce, Nathalie Guffon, Roberto Giugliani, Carolina F M de Souza, Elsa G Shapiro, Chester B Whitley
PurposeEarly treatment is critical for mucopolysaccharidosis type I (MPS I), justifying its incorporation into newborn screening. Enzyme replacement therapy (ERT) treats MPS I, yet presumptions that ERT cannot penetrate the blood-brain barrier (BBB) support recommendations that hematopoietic cell transplantation (HCT) treat the severe, neurodegenerative form (Hurler syndrome). Ethics precludes randomized comparison of ERT with HCT, but insight into this comparison is presented with an international cohort of patients with Hurler syndrome who received long-term ERT from a young age...
March 8, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Yijin Wu, Robert Elliott, Linzi Li, Tongwei Yang, Yusen Bai, Wen Ma
In this paper, we will discuss several ethical issues concerning cadaveric organ donation from the perspective of sociocultural factors that are unique to China under the condition that China has ended the use of executed prisoner's organs for transplants. It is found that though great developments have been made in organ transplantation, the ethical issues relating to organ transplantation still face dilemmas in China. It is argued that organ donation and transplantation in China could make further progress if the ethical issues proposed in this paper can be carefully considered...
March 2018: Medicine (Baltimore)
Mehrzad Kiani, Mahmoud Abbasi, Mehdi Ahmadi, Bahare Salehi
Organ transplantation is a new issue in medical science. It is an important achievement and a sign of the progression and ability of medical centers around the world. Governments, populations, the medical community and people involved in culture, art, and media all have a decisive role in the culture of organ donation, which is the only way to guarantee that the healthy organs of a brain-dead person can continue to work and save the lives of people in need of organ transplantation. The brain death phenomenon and its possible application in organ transplantation, while offering new hope for the salvation of a number of patients, has led to many ethical, cultural, and legal issues...
March 5, 2018: Journal of Clinical Medicine
Pietro Bortoletto, Eduardo Hariton, Leslie V Farland, Randi H Goldman, Antonio R Gargiulo
OBJECTIVE: To determine whether reproductive endocrinologists and minimally invasive surgeons support uterine transplantation as a treatment option for absolute uterine factor infertility (AUFI). DESIGN: Cross-sectional study (Canadian Task Force Classification II-2) SETTING: Web-based survey. PATIENTS(S): Physician members of the American Society of Reproductive Medicine (ASRM) and the American Association of Gynecologic Laparoscopists (AAGL)...
March 1, 2018: Journal of Minimally Invasive Gynecology
Tao Zhang, Pan Wang, Yanxia Liu, Jiankang Zhou, Zhenqing Shi, Kang Cheng, Tuanjie Huang, Xinxin Wang, Greta Luyuan Yang, Bo Yang, Shanshan Ma, Fangxia Guan
Mesenchymal stem cells (MSCs) are unique precursor cells characterized by active self-renewal and differentiation potential. These cells offer the advantages of ease of isolation and limited ethical issues as a resource and represent a promising cell therapy for neurodegenerative diseases. However, replicative senescence during cell culture as well as low efficiency of cell migration and differentiation after transplantation are major obstacles. In our previous study, we found that FOXQ1 binds directly to the SIRT1 promoter to regulate cellular senescence and also promotes cell proliferation and migration in many tumor cell lines...
March 3, 2018: Cell and Tissue Research
Kiran K Khush
The growing disparity between the supply of donor hearts for transplantation and the demand for such organs has led to liberalization of the criteria for donor heart acceptance over the past few decades. The upper age limit and size restrictions for donor heart acceptance continue to be revised and hearts are being routinely used from donors with left ventricular dysfunction, left ventricular hypertrophy (LVH), cocaine use, multiple medical co-morbidities and after cardiopulmonary resuscitation. This article reviews recent data for use of such "expanded criteria" donor hearts and suggests ways to further increase the donor pool, including use of hearts from donors with hepatitis C and after circulatory determination of death...
January 2018: Annals of Cardiothoracic Surgery
Andrea Lavazza, Marcello Massimini
Organoids are three-dimensional biological structures grown in vitro from different kinds of stem cells that self-organise mimicking real organs with organ-specific cell types. Recently, researchers have managed to produce human organoids which have structural and functional properties very similar to those of different organs, such as the retina, the intestines, the kidneys, the pancreas, the liver and the inner ear. Organoids are considered a great resource for biomedical research, as they allow for a detailed study of the development and pathologies of human cells; they also make it possible to test new molecules on human tissue...
February 28, 2018: Journal of Medical Ethics
Laurel Willig, Erin Paquette, D Micah Hester, Bradley A Warady, John D Lantos
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function...
February 28, 2018: Pediatrics
Atsushi Asai, Sakiko Masaki, Taketoshi Okita, Aya Enzo, Yasuhiro Kadooka
BACKGROUND: Destination therapy (DT) is the permanent implantation of a left ventricular assist device (LVAD) in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications...
February 27, 2018: BMC Medical Ethics
Joseph Lee
Face transplantation (FT) is a landmark in reconstructive surgery involving vascularised composite allotransplantation. A recent issue of FT for patients who are blind has arisen. Some bioethicists recommend not excluding a patient who is blind, as this may amount to discrimination. From an ethical standpoint, FT for those with blindness is appropriate in selected candidates. This article seeks to add to the clinical evidence supporting FT for those with blindness by detailing a complementary psychosocial perspective...
February 24, 2018: Journal of Medical Ethics
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