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Transplantation ethics

Minoo Heidari Kani, Eng-Cheng Chan, Roger C Young, Trent Butler, Roger Smith, Jonathan W Paul
Research insights into uterine function and the mechanisms of labour have been hindered by the lack of suitable animal and cellular models. The use of traditional culturing methods limits the exploration of complex uterine functions, such as cell interactions, connectivity and contractile behaviour, as it fails to mimic the three-dimensional (3D) nature of uterine cell interactions in vivo. Animal models are an option, however, use of these models is constrained by ethical considerations as well as translational limitations to humans...
October 21, 2016: Annals of Biomedical Engineering
David Shaw, Denie Georgieva, Bernadette Haase, Dale Gardiner, Penney Lewis, Nichon Jansen, Tineke Wind, Undine Samuel, Maryon McDonald, Rutger Ploeg
Millions of people want to donate their organs after they die for transplantation, and many of them have registered their wish to do so or told their family and friends about their decision. For most of them, however, this wish is unlikely to be fulfilled, as only a small number of deaths (1% in the United Kingdom) occur in circumstances where the opportunity to donate organs is possible. Even for those who do die in the 'right' way and have recorded their wishes or live in a jurisdiction with a 'presumed consent' system, donation often does not go ahead because of another issue: their families refuse to allow donation to proceed...
October 19, 2016: Transplantation
J Wu, A Platero Luengo, M A Gil, K Suzuki, C Cuello, M Morales Valencia, I Parrilla, C A Martinez, A Nohalez, J Roca, E A Martinez, J C Izpisua Belmonte
More than eighteen years have passed since the first derivation of human embryonic stem cells (ESCs), but their clinical use is still met with several challenges, such as ethical concerns regarding the need of human embryos, tissue rejection after transplantation and tumour formation. The generation of human induced pluripotent stem cells (iPSCs) enables the access to patient-derived pluripotent stem cells (PSCs) and opens the door for personalized medicine as tissues/organs can potentially be generated from the same genetic background as the patient recipients, thus avoiding immune rejections or complication of immunosuppression strategies...
October 2016: Reproduction in Domestic Animals, Zuchthygiene
G Testa, E C Koon, L Johannesson
The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This paper analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility...
October 18, 2016: American Journal of Transplantation
Antonella Putignano, Thierry Gustot
Acute-on-Chronic Liver Failure (ACLF) is a recently defined syndrome that occurs frequently in patients with cirrhosis and is associated with a poor short-term prognosis. Currently, management of patients with ACLF is mainly supportive. Despite medical progress, this syndrome frequently leads to multi-organ failure, sepsis, and, ultimately, death. The results of attempts to use liver transplantation (LT) to manage this critical condition have been poorly reported but are promising. Currently, selection criteria of ACLF patients for LT, instructions for prioritization on the waiting list, and objective indicators for removal of ACLF patients from the waiting list in cases of clinical deterioration are poorly defined...
October 17, 2016: Liver Transplantation
M Raj, S W Choi, J Platt
Informed consent (IC) struggles to meet the ethical principles it strives to embody in the context of hematopoietic cell transplantation (HCT). Patients often participate in multiple clinical trials making it difficult to effectively inform the participants and fulfill complex regulations. The recent Notice of Proposed Rule Making would make major changes to federal requirements, providing a timely opportunity to evaluate existing practice. Twenty health care professionals within a Midwest Academic Medical Center involved in obtaining IC in the HCT clinic or involved in patient care during or after the IC process were interviewed to understand: (1) how they approached the IC process; (2) how they described a 'successful' IC process; and (3) opportunities for innovation...
October 17, 2016: Bone Marrow Transplantation
Nayan Lamba, Daniel Holsgrove, Marike L Broekman
BACKGROUND: Since the turn of the last century, the prospect of head transplantation has captured the imagination of scientists and the general public. Recently, head transplant has regained attention in popular media, as neurosurgeons have proposed performing this procedure in 2017. Given the potential impact of such a procedure, we were interested in learning the history of the technical hurdles that need to be overcome, and determine if it is even technically possible to perform such a procedure on humans today...
October 14, 2016: Acta Neurochirurgica
David Shaw
This brief report describes the contribution of the UK Donation Ethics Committee to organ donation and transplantation in the UK, and explains why the committee has met an early demise.
October 12, 2016: Journal of Medical Ethics
Oliver Mauthner, Veerle Claes, Jeremy Walston, Sandra Engberg, Isabelle Binet, Michael Dickenmann, Déla Golshayan, Karine Hadaya, Uyen Huynh-Do, Stefano Calciolari, Sabina De Geest
AIM: To present the rationale, design and methodology of the GERAS project, which examines whether assessment of frailty and mild cognitive impairment could enhance risk prediction for biomedical, psychosocial outcomes and foster efficient resource allocation in kidney transplantation. BACKGROUND: For the burgeoning cohort of older patients considered for kidney transplantation, evidence gaps regarding frailty and mild cognitive impairment limit clinical decision-making and medical management...
October 12, 2016: Journal of Advanced Nursing
Sarah Fogleman, Casey Santana, Casey Bishop, Alyssa Miller, David G Capco
Thousands of mothers are at risk of transmitting mitochondrial diseases to their offspring each year, with the most severe form of these diseases being fatal [1]. With no cure, transmission prevention is the only current hope for decreasing the disease incidence. Current methods of prevention rely on low mutant maternal mitochondrial DNA levels, while those with levels close to or above threshold (>60%) are still at a very high risk of transmission [2]. Two novel approaches may offer hope for preventing and treating mitochondrial disease: mitochondrial replacement therapy, and CRISPR/Cas9...
2016: American Journal of Stem Cells
Michael Lauerer, Katharina Kaiser, Eckhard Nagel
BACKGROUND: Transplantation medicine is associated with several ethical issues related to the lack of organs. Major questions concern the regulations for giving permission for organ removal, informing the public about organ donation, setting of organ allocation priorities, waiting list access, and strategies to counteract scarcity. METHODS: This contribution is based on analyses of legal regulations, guidelines of self-regulatory bodies, administrative data, and literature from medical, normative, and empiric disciplines...
August 2016: Visc Med
M-O Timsit, F Kleinclauss, M F Mamzer Bruneel, R Thuret
OBJECTIVES: To review ethical, legal and technical aspects of living kidney donor surgery. MATERIAL AND METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database ( and Embase ( using different associations of the following keywords: Donor nephrectomy; Kidney paired donation; Kidney transplantation; Laparoscopic nephrectomy; Living donor; Organs trafficking; Robotic assisted nephrectomy; Vaginal extraction...
October 6, 2016: Progrès en Urologie
Jacques Balayla
The uterine transplant is an innovative surgical procedure whereby a healthy uterus is transplanted into a woman with uterine factor infertility (UFI) for the purpose of procreation. Twelve uterine transplants have been attempted in the world in the last two decades, and five have led to viable births. While uterine transplantation is still in its experimental stages, it remains unclear whether Canadian centres plan to attempt the procedure in the near future. Herein, I raise several observations that are specific to the Canadian setting and apply the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation to determine whether there is fertile ground for a uterine transplantation program to be adopted in Canada...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Vitaliy M Pashkov, Iryna A Golovanova, Petro P Noha
INTRODUCTION: the issue of commercialization of transplantation analyses in the article. Attention is paid to the importance of transplantation as a method of treatment and saving human lives. AIM: the clarify the feasibility of the introduction of donation commercialization as an avenue to solve the shortage of donor organs and means of combating with black organ market and finding alternative avenues solving these problems, which are more morally acceptable for society is the aim of this article...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Yanfei Chen, Bryan W Tillman, Sung Kwon Cho, Tara D Richards, Amit D Tevar, Xinzhu Gu, William R Wagner, Youngjae Chun
Donation after cardiac death has been adopted to address the critical shortage of donor organs for transplant. Recovery of these organs is hindered by low blood flow that leads to permanent organ injury. We propose a novel approach to isolate the perfusion of the abdominal organs from the systemic malperfusion of the dying donor. We reasoned that this design could improve blood flow to organs without open surgery, while respecting the ethical principle that cardiac stress not be increased during organ recovery...
October 7, 2016: Journal of Medical Engineering & Technology
Evelyn Hsu, George V Mazariegos
Current literature and policy in pediatric liver allocation and organ procurement are reviewed here in narrative fashion, highlighting historical context, ethical framework, technical/procurement considerations and support for a logical way forward to an equitable pediatric liver allocation system that will improve pediatric wait-list and post-transplant outcomes without adversely affecting adults. Where available, varying examples of successful international pediatric liver allocation and split liver policy will be compared to current US policy to highlight potential strategies that can be considered globally...
October 5, 2016: Liver Transplantation
Mohammed Rafique Moosa, Jonathan David Maree, Maxwell T Chirehwa, Solomon R Benatar
Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the 'Accountability for Reasonableness' (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion...
2016: PloS One
R Roat, M M Hossain, J Christopherson, C Free, S Jain, C Guay, R Regazzi, Z Guo
Currently there is no effective approach for monitoring early β cell loss during islet graft rejection following human islet transplantation (HIT). Due to ethical and technical constraints, it is difficult to directly study biomarkers of islet destruction in humans. Here, we established a humanized mouse model with induced human β cell death using adoptive lymphocyte transfer (ALT). Human islet grafts of ALT-treated mice had peri-graft lymphocyte infiltration, fewer insulin(+) β cells, and increased β cell apoptosis...
October 3, 2016: American Journal of Transplantation
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults...
September 7, 2016: World Journal of Gastroenterology: WJG
M-O Timsit, J Branchereau, R Thuret, F Kleinclauss
OBJECTIVES: To report major findings that may build the future of kidney transplantation. MATERIAL AND METHODS: Relevant publications were identified through Medline ( and Embase ( database from 1960 to 2016 using the following keywords, in association, "bio-engineering; heterotransplantation; immunomodulation; kidney; regenerative medicine; xenotransplantation". Articles were selected according to methods, language of publication and relevance...
September 21, 2016: Progrès en Urologie
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