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ORGAN TRANSPLANTATION: TOWARDS ACHIEVING HUMAN HEALTH

ORGAN TRANSPLANTATION: TOWARDS ACHIEVING HUMAN HEALTH

Mandated Choice (MC) is a legally mandated decision. Under MC, all adults would be mandated by law to indicate their wishes regarding use of their organs after death. This could be done through the electoral roll, given that all adults are represented on the roll in contrast to driving licences, tax returns etc. and also be made mandatory by registering with a general practitioner or some other mechanism that a working group would need to explore. Under MC, family members will know that a genuine choice has been made by the deceased. This has the potential to relieve distress of the relatives. If relatives wish to refuse organ retrieval, then MC would relieve the uncomfortable action of refusal itself. Instead with MC, they are comforted in knowing that wishes of their deceased relatives have been honoured. xviii

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ANALYZING ORGAN TRANSPLANTATION LAWS IN INDIA- AN OVERVIEW

ANALYZING ORGAN TRANSPLANTATION LAWS IN INDIA- AN OVERVIEW

In an all India survey, conducted across 10 major Indian cities involving 600 participants, an attempt was made towards understanding this lack of willingness to donate. It was found that a major factor behind willingness/non-willingness to donate organs among some religions was because of their existing religious beliefs as cited by roughly one-third of the total participants. Thus, it was found that primarily religious beliefs were deterring individuals from donating their organs. About 39.8% of the total respondents were not prepared to have their body “be cut open/organs taken out from their body after their demise” owing to religious reasons and family refusal. Religious beliefs, were found to be akin to the logic relied upon in Saudi Arabia, which indicated that concerns about inadequate healthcare after donation, lack of family support, and lack of information about organ donation were the primary reasons for lack of willingness to donate. It was also observed that even amongst literate section of the masses, the confidence to donate was not enough. It was observed that with the exception of Delhi, where about 51 per cent of the surveyed individuals knew about Transplantation of Human Organs Act , the extent of awareness amongst masses was low. By educating potential donors and general masses about the act, could help in generating greater deterrence towards illicit organ trade. Lack of awareness was also responsible for nearly one-third of the participants who were previously not possessing donor cards, immediately signed up for procuring one. It was also found that while eye donation was more widely accepted among the participants other forms of transplantation were not as popular majorly owing to lack of information about them 26 .

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Biomarkers in solid organ transplantation: establishing personalized transplantation medicine

Biomarkers in solid organ transplantation: establishing personalized transplantation medicine

Non­invasive markers of CAD, including urinary and peripheral biomarkers, could not only be readily identified and validated at numerous time­points but would also allow regular monitoring over a long period of time at low cost and would be associated with low patient risk. In an attempt to correlate blood expression signa­ tures with biopsy­proven chronic allograft damage, gene expression panels were identified that predicted mild and moderate/severe chronic allograft damage, and Tribbles­1 (TRIB1) was identified to predict chronic antibody­ mediated rejection [13,77]. Well studied molecules in the pathogenesis of fibrosis, as seen in chronic allograft damage, are the transforming and connective tissue growth factors (transforming growth factor­β and connective tissue growth factor (CTGF)) [78,79]. CTGF was increased in transplant patient urine before histo­ pathological and functional chronic dysfunction, reveal­ ing it as a potential early non­invasive biomarker [80] and as a potential antifibrotic target [81]. Urinary expression of the chemokine CCL2 at 6 months post­transplantation predicted the development of chronic allograft dysfunc­ tion at 24 months post­transplantation in 111 patients [82]. Kidney injury molecule 1 (KIM1), previously dis­ covered as a proximal tubular biomarker of acute kidney injury [83,84], was associated with chronic allograft damage, including calcineurin inhibitor toxicity and inter­ stitial fibrosis/tubular atrophy [85,86]. However, KIM1 expression also correlated with transplant­indepen dent drug­induced nephrotoxicity [87] and renal cell carcinoma [84], revealing it as a marker of general renal injury [83].

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How is organ transplantation depicted in internal medicine and transplantation journals

How is organ transplantation depicted in internal medicine and transplantation journals

practice; the overidealization of its potential results; the triumphalist attitude of professionals who believe “death is our enemy”; nonchalant attitudes regarding the complex- ities of gift exchange; the massive financial investment in transplantation as opposed to other types of health care; and a general reluctance to consider the inherent uncer- tainties in this area of medicine [4]. The concept of uncer- tainty refers to difficulties in diagnosing, treating and accurately predicting the evolution and prognosis of indi- vidual patients. According to Renée Fox, this could stem from a physician’s personal ignorance, limits in actual medical knowledge, or a combination both, and is a source of anxiety for the patient, the physician and society. Med- ical and scientific advances do not rule out uncertainty, but modify its content and create new areas of uncertainty that were not previously known [5,6].

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Ethical considerations in uterus transplantation

Ethical considerations in uterus transplantation

The first transplantation of a human uterus was attempted on April 6, 2000, in Saudi Arabia. The transplant was performed on a 26-year-old female who had required a hysterectomy in 1994 after suffering from a postpartum hemorrhage at the time of a cesarean delivery. The donor uterus was from a 46-year- old woman. The transplant recipient experienced mild acute withdrawal on postoperative day 9 with low-grade fevers but was successfully treated. She was started on hormonal therapy and successfully experienced two withdrawal bleeds. On the 99th day postoperatively, she experienced foul-smelling vaginal discharge, and examination revealed uterine prolapse, with ultrasound confirming acute vascular thrombosis. She therefore underwent hysterectomy. Although fertility of the transplanted organ had not been tested, this study demonstrated the feasibility of uterus transplantation in a human as well as acceptable short- and mid-term outcomes with one acute rejection episode which quickly resolved. 24 The second attempt at uterus transplantation

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Pretransplantation Conditioning Influence on the Occurrence of Cyclosporine or FK 506 Neurotoxicity in Allogeneic Bone Marrow Transplantation

Pretransplantation Conditioning Influence on the Occurrence of Cyclosporine or FK 506 Neurotoxicity in Allogeneic Bone Marrow Transplantation

Vasospasm with brain hypoperfusion would lead to hypoxia with vulnerability in the watershed zones (oc- cipital poles, parietal region, frontal lobes, inferior temporal-occipital junction, and cerebellum), the typ- ical locations of the brain lesions in cyclosporine or FK-506 neurotoxicity (28, 31, 42). Regional hypoxia could induce vascular endothelial growth factor (pre- viously known as vascular endothelial permeability factor), leading to endothelial cell permeability alter- ation with capillary leakage of macromolecules and fluid (86–91). Vasospasm and watershed vulnerabil- ity, if sufficiently severe, could lead to more perma- nent ischemic changes and brain infarction. Hyper- tension frequently accompanying the toxicity process may be related to systemic vascular injury and vaso- spasm that could worsen the brain endothelial injury. The conditioning regimen, the immunosuppressive regimen used after transplantation, and the immune cells of the graft are all potentially toxic to the endo- thelium. High-dose chemotherapy and radiation ther- apy could lead to injury of actively turning over en- dothelial cells. Cyclosporine and FK-506 appear to have a direct endothelial toxic effect. Direct or by- stander immune reaction of the graft against the en- dothelial cell could lead to damage and death. The degree of HLA match has been shown to be a factor in the toxicity process (33). Hypertension, a reflection of the systemic vascular injury and vasospasm, could further aggravate the brain vessel endothelial surface, accelerating the injury process. Once established, a complex systemic response would likely occur, which may be the process of BMT-TM. Cyclosporine or FK-506 neurotoxicity is likely the brain manifestation of a systemic toxicity process. Early toxicity may be related to the acute phase of chemical and radiation toxicity and could be associated with initial immune response of the engrafted cells. Intermediate and late toxicity could be related to other causes such as late GVHD.

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The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

Shemie suggests that "BD is better understood as 'brain arrest' [BA], characterized by the complete and irreversible loss of clinical brain function [1]." For Shemie, and in this commentary, BD and BA can be used interchangeably. Shemie writes (all italics added): "Breathing replacement machines merely interrupt the way brain failure leads to cardiac arrest [1]." Shemie further writes that "Advances in organ support and replacement technologies teach us about the mechanics of death. Survival of...the human organism is related to adequacy of oxygenated blood flow...There are 3 basic mechanisms [leading to death]: a) primary cardiac arrest leading to arrest of the circulation b) primary respiratory arrest, which via loss of oxygen causes a secondary cardiac arrest, or c) primary BA, which via interruption of respiratory control causes a secondary respi- ratory then cardiac arrest. Regardless of initial disease state, all critical illnesses threaten life in this way [1]." He further states that life sustaining technologies are deployed to interrupt this sequence and therefore "to reverse the underlying life threatening state...the removal of those applied life sustaining technologies must occur for 'natural' death and cardiac arrest to ensue [1]." Thus, by these descriptions in defense of BD, we can conclude that 'BA' leads to death when it is allowed to result in irreversi- ble loss of circulation. If 'BA' threatens life, and leads to death, it follows that BA cannot be death itself. What BA must be is a mechanism leading to death. This is compatible with what Shemie writes in another paper: the "basic physiological mechanism of death [in BA occurs]...via interruption of airway control and respiratory drive cause a secondary respiratory arrest and then cardiac arrest... [BA] threatens life in this manner [2]." Shemie also implies this when he writes, when referring to cardiac arrest, that "the event may be cardiac arrest, but death only occurs if it leads to an accompanying [permanent] loss of circulation [1]."

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A cross sectional study of knowledge, attitude and practice of medical students about organ donation

A cross sectional study of knowledge, attitude and practice of medical students about organ donation

In our study majority of those who were against or undecided to donate organs believed family members may not agree to donation either living or dead. Other causes included fear of organ being misused, not wanting their body to be cut open and certain religious beliefs. The findings of our study correlate well with the study done among people seeking health care in tertiary care hospital in Mangalore in year 2013 (Prasanna Mithra et al., 2013). A survey conducted among general people in Karachi, Pakistan featured that religious beliefs were cited as the leading cause among those who felt organ donation should not be promoted (Taimur Saleem et al., 2009). A survey conducted among medical college students in Hongkong in 2008 showed concerns about premature termination of medical treatment, socio-cultural factors such as the traditional Chinese belief in preservation of an intact body after death, unease discussing death-related issues, and family objections to organ donation were significantly associated with a 'negative' attitude (Christina et al., 2008). study among 123 postgraduate medical students in Bangalore showed religious beliefs as barriers to organ donation in 12%. These included belief that the body should be cremated without disfigurement,

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Knowledge and ethical perception regarding organ donation among medical students

Knowledge and ethical perception regarding organ donation among medical students

General public opinion surveys have found that while most people have a positive attitude towards organ dona- tion and transplantation this seldom results in concrete action . The public’s lack of action towards organ donation is consistently sited as the major factor for the current shortage of organs for transplantation [8]. This attitude can be a result of multifarious reasons, religious being one of the main. Many religions, though favorable towards the ideology of organ donation are hesitant about the criteria involved in this procedure. In a survey done on Muslims about their attitude towards donation 68.5% agreed to the idea of donation but only 39.3% believed it was compatible with Islam [9]. Another study showed that even though 88.2% of religious authorities allowed donation only 1.4% of them were willing to donate their organs [10]. Other is- sues include ethical grounds, political reasons, moral and cultural inhibitions. Also cases of tissue mismatch, recipi- ent safety and organ conditions have created doubts in the minds of many about the actual significance of organ do- nation. In some systems, family members may give con- sent or refusal, or may even veto a potential donation even if the donor has consented. Asian countries such as China, Japan, Pakistan and India are amongst those where the knowledge and practice of organ donation is most lacking and where a diverse ethical perception is seen [11].

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A Primer on Organ Donation

A Primer on Organ Donation

Including in the will a desire to donate organs is an inadequate way for the client to make a commitment. Because organs must be harvested immediately upon death, medical personnel cannot wait until someone reads the will. Although a statement in the will that the testator wishes to donate does help to clarify the donor’s intent, the need for quick action requires the donor to carry an organ donor card or have “organ donor” stamped on his or her drivers license. In addition, the attorney should encourage the organ donor to inform family members of his or her wishes.

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Death, organ transplantation and medical practice

Death, organ transplantation and medical practice

We suggest that criteria for a concept are not necessarily truth conditions for assertions involving the concept. Hence, non-heart beating donors may be declared dead without meeting the criterion of strong irreversibility even though strong irreversibility is implied by the concept of death. Our perception that a concept applies in a given case is determined not by the concept itself but by our necessary skill and judgment when using it. In the case of deciding that a patient is dead, such judgment is learned by physicians as they learn the practice of medicine and may vary according to circumstances. Current practice of NHBD can therefore be defended without abandoning death as an empirical concept, as Shemie appears to do. We conclude that the dead donor rule continues to be viable and ought to be retained so as to guarantee what the public most cares about as regards organ donation: that physicians can be trusted to make determinations of eligibility for organ donation in the interests of patients and not for other purposes such as increasing the availability of organs.

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Invasive Aspergillus Infections in a Thai Tertiary Care Hospital during 2006 2011

Invasive Aspergillus Infections in a Thai Tertiary Care Hospital during 2006 2011

Aspergillus species are saprophytic filamentous fungi. This genus is characterized by the flask-shaped or cylin- drical phialides on the vesicle at the apex of a conidiophore. Asexual spores or conidia are globose and various in colors. Their spores can be found in the soil, composed piles, air, animals, and humans. They can be patho- gens in immunocompromised hosts such as patients with acquired immunodeficiency syndrome (AIDS), pa- tients who had allogenic hematopoietic stem cell transplantation or solid organ transplantation, patients who re- ceived immunosuppressive drugs, patients with prolonged neutropenia, and patients with others underlying dis- eases. The common pathogenic Aspergillus species include A. fumigatus, A. flavus, A. niger, and A. terreus. A. nidulans can also cause infections mostly in patients with chronic granulomatous disease (CGD). There are three forms of aspergillosis: invasive aspergillosis, chronic aspergillosis, and allergic forms of aspergillosis. Chronic aspergillosis is less frequently found than the acute disease. Affected patients usually have the common under- lying conditions including previous tuberculosis infection, atypical mycobacterial infection, Chronic Obstructive Pulmonary Disease (COPD), other chronic lung diseases, diabetes mellitus, and alcoholism. Allergic forms of aspergillosis include allergic sinusitis and allergic bronchopulmonary aspergillosis [1]. Invasive aspergillosis (IA) is the most concerning form for public health and also has high mortality rate [1]. IA also includes the in- fections of the lower respiratory system, sinuses, and skin as routes of entry. In addition, cardiovascular system, central nervous system, and other tissues could be infected from hematogenous dissemination or direct extension from adjacent infected tissues [1]. As a result of an increasing number of immunocompromised hosts, patients with IA were increasing at the same time [2]-[13] . In North America and Europe, there is an increase in IA among severely immunocompromised patients including patients with allogenic hematopoietic stem cell trans- plantation (HSCT) and solid organ transplantation [5] [6] [9] [12] [14]-[17]. It has been shown that after 1992 the incidence of IA increased in allograft recipients and continued high through 1990s [5]. Furthermore, the in- cidence of IA was mostly found in HLA (Human Leukocyte Antigen)-matched HSCT from an unrelated donor or HLA-mismatched HSCT and lung transplantation [14] [16] [18]-[20]. According to the systemic review from 50 studies [7], common underlying conditions were leukemia or lymphoma (42.6%), bone marrow transplant (25.8%), and solid-organ transplant patients (13.0%). The crude mortality rate in IA was high, more than 90% if untreated [7].

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Psychosocial challenges before and after organ transplantation

Psychosocial challenges before and after organ transplantation

In the preoperative period, the psychosocial evaluation of transplant patients is an important psychological task, par- ticularly in view of the prevailing organ shortage. Similar to the medical evaluation, the psychosocial evaluation should be evidence-based and avoid any moral judgment. The procedure should aim at identifying factors likely to have a negative impact on the postoperative prognosis. The goal should not be the exclusion of patients from transplantation but rather the recommendation of supportive or therapeutic measures which, upon successful completion, enable access to the wait- ing list (at a later date). Final exclusion is to be considered only if cooperation with the patient cannot be achieved in the long term, thus making graft loss highly probable.

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Clinical and ethical perspectives on brain death

Clinical and ethical perspectives on brain death

Elijah Smith was a 22-year-old man who was hit by a car while riding a bicycle on July 3, 2013. He suffered from a severe head injury and was declared dead by neurologi- cal criteria the following day, at Grant Medical Center in Ohio. Mr Smith had previously registered as an organ donor when he applied for his driver’s license. When he was determined to be dead by neurologic criteria, Grant Medical Center notified Lifeline of Ohio, the local organ procurement organization, which took steps to begin the process of organ procurement. However, his parents, Pamela and Rodney Smith, learned that organ removal takes place while the donor remains on mechanical ventilation during the surgery, and attempted to block Lifeline from removing Mr Smith’s organs. According to Mrs Smith, her son did not understand what he was agreeing to when he registered as an organ donor, and that, had he understood that organ removal takes place while on a ventilator and with a beating heart, he would not have registered as a donor. 99,100

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Kidney transplantation is often performed to treat patients with end stage renal disease, characterized by permanent loss of the kidneys' ability to fi lter wastes from the circulatory sys- tem. Th e most common causes of kidney failure are diabetic nephropathy, systemic arterial hypertension, glomerulone- phritis, chronic pyelonephritis and polycystic kidney disease []. One-year graft survival, graft half-life and patient survival after kidney transplantation has improved and the rate of graft loss has decreased over the last few decades []. However, ad- ditional treatment advances are warranted, as a number of complications can limit the success of kidney transplantation. The major contributing factors to acute kidney allograft rejection are immunosuppression (due to failure to op- timize the immunosuppressive regimen or failure of the patient to comply with the prescribed regimen) and infec- tion, which can trigger rejection. Graft-versus-host dis-

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Aging and the immune response to organ transplantation

Aging and the immune response to organ transplantation

Aging and B cell responses after transplantation. B cells exhibit intrinsic alterations such as impaired immunoglobulin class switch- ing with aging that impair antibody responses to vaccination (82). B cells produce alloreactive antibodies against the transplant, lead- ing to acute and chronic rejection (83–85). However, until recently it was unknown how aging impacts B cell responses during organ transplantation. The B cell pool plays disparate roles depending on host age. In a skin allograft model in which anti-CD45Rb and anti- CD154 enhance graft survival in young mice, B cell depletion led to a faster tempo to skin allograft rejection in young mice (86). In striking contrast, B cell depletion in aged mice (16–18 months of age) led to a 7-day delay in skin allograft survival (86). There was no alteration of regulatory B cell responses with aging; however, aged B cells exhibited enhanced priming of alloreactive B cells as com- pared with young B cells (86). A non–germinal zone, non–marginal zone B cell population, termed age-associated B cells (ABCs) (87), within the aged B cell pool were responsible for the enhanced T cell alloimmune priming and impaired the ability of anti-CD45Rb and anti-CD154 to prolong skin allograft survival after adoptive transfer into young mice (86). Thus, this study indicates that ABCs within the aged host may represent a barrier to immune modula- tion and could indicate that B cell depletion, currently used in the treatment of antibody-mediated rejection, may have disparate effects depending on host age. Other aspects of how aging impacts antibody-mediated rejection are not yet known.

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Globalized Medi Care and Organ Transplantation System

Globalized Medi Care and Organ Transplantation System

The Rijndael algorithm with a modification is implemented to increase the security of the website. Sometimes a problem which may occur with this site is that any hacker can enter to the site and can do some malfunctions like changing the availability of one organ to other. But the hospital may not be having that particular organ available. This may even cause to the loss of lives. In order to escape from the security issue the Rijndael algorithm is implemented. To be more secured a modification is also made in Rijndael algorithm. Actually in a Rijndael algorithm, the bits of the key are numbered from 1 through 64 where every eighth bit is ignored and is subjected to a permutation.

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ORGAN TRANSPLANTATION: A HOPE OF SURVIVAL

ORGAN TRANSPLANTATION: A HOPE OF SURVIVAL

Organ transplantation is only the hope of the survival for the patient suffering from life threatening diseases such as heart and liver diseases. Today Organ transplant is A major area of research for the physician. Organ Transplantation provides new life to the patient but some complication like graft reject reaction are very common from the organ transplant and that can be minimized by using a close donor and suitable immunosuppressant drugs. The Availability of the organ is another problem associated with organ transplant that can be minimized using artificial organ, Animal organ, stem cell and aborted fetus. The Major Organ transplanted are Kidney, Liver, Heart, Pancreas,Cornea,Lungs etc. Newer Immunosuppressant drugs cause a dramatic change in organ transplant because they minimize the Graft-Reject reaction and Improves the quality of life. The following article covers complete description about organ transplant, types of transplant, Graft-Reject reaction and its treatment etc.

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Pediatric Organ Donation and Transplantation

Pediatric Organ Donation and Transplantation

quires that all hospitals participating in Medi- care and Medicaid programs refer all potential organ donors to their local organ procurement orga- nization (OPO). It further mandates that all families of potential organ donors become aware of their option to donate. In addition, legislation further re- quires all hospitals to discuss organ donation with families of deceased patients. Even with these man- dates, organ availability remains limited. The num- ber of individuals who are on the national transplant waiting list remains far in excess of the number of organs procured. 2 Children from birth to 17 years of

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Pediatric Organ Donation and Transplantation

Pediatric Organ Donation and Transplantation

from deceased donors by this method before development of brain-death guidelines. For patients with severe brain injury for whom neurologic death is unlikely to occur, DCD enters the end-of-life continuum of care. Dis- cussions regarding DCD can occur only after the family and the medical team have made the decision to with- draw support or terminate care. Com- fort measures are provided for the pa- tient as would normally be instituted anytime withdrawal of support occurs. Once life support is withdrawn and the donor develops circulatory arrest, ap- nea, and unresponsiveness, the pa- tient is observed for a period of 2 to 5 minutes before certification of death. Organs can be recovered for trans- plantation if death occurs within a short period of time, usually 1 hour, after withdrawal of support. DCD is slowly gaining acceptance in the pedi- atric community, as evidenced by an increase in organs from pediatric non– heart-beating organ donors over the past few years. 3,4 DCD enables the

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