Scarcity Of Organs For Transplantation Research Articles

Organ Donation Management using Blockchain

This research paper focuses mainly on the scarcity of organs for transplantation underscores the urgent need for innovative solutions to enhance the matching and allocation process.

Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM.

Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, et al. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022;26(S2):S43-S50.

Should Psychotic Experience Contraindicate Organ Transplant? A Narrative Review

The scarcity of organs for transplant and significant rates of organ transplantation failure mean it is important to identify factors relating to transplant success and failure. Experiencing psychosis or mania is often seen as a contraindication for transplant, and many transplant teams have been cautious at transplanting people with significant mental health difficulties. In this paper we explore whether there is any evidence to support this attitude towards psychiatric diagnosis and transplantation; consider modifiable risks to transplantation; and ask what is needed to provide equitable care for individuals with experience of psychosis. To place context to our discussion, we present the experience of a person who had a history of psychotic experience and who was assessed for double lung transplant.

Single Centre Experience of Altruistic Non-Directed Kidney Donation

Introduction The continuing scarcity of organs for transplantation coupled with advances in technology and changes in the legislative framework in the UK have encouraged more opportunity and choice in the options for living donor kidney transplantation. We reviewed the experience of altruistic non-directed kidney donors (ANDKD) at our centre to determine useful ways of optimizing the service while increasing the numbers of donors. Materials and Methods All enquiries by potential ANDKD at our centre from October 2007 to September 2017 were analysed. Donor assessment and preparation for donation were performed as per UK Guidelines and local protocol, including mental health and local independent assessment, prior to obtaining Human Tissue Authority approval. 185 enquiries resulted in 50 donations. Forty nine donors underwent hand-assisted laparoscopic donor nephrectomy while one had open nephrectomy. The ANDKD were sent questionnaires and the responses were analysed. The outcome of donation and reasons why the remaining did not proceed to donation were analysed. Results and Discussion During the period, 50 of the 185 enquiries (27%) resulted in kidney donation. There were 27 female donors and 23 males with an overall age range of 22 – 82 years (mean 58). Only 35 of 50 questionnaires (70%) were returned. Two donors had died of causes unrelated to kidney donation. Of the 35 responses, 23(66%) donors were retired, 5 (14%) self-employed and 7 (20%) were employed at the time of donation. Most donors heard about altruistic donation through media (43%) and internet services (31%). Five patients underwent both psychological and psychiatric assessments whereas 28 had psychological and two had psychiatric assessment alone. Twenty four donors (68.6%) thought psychological or psychiatric assessment was necessary while 11 (31.4%) thought it was not. Thirty three of 35(94%) found the information provided prior to donation adequate and 80% (28/35) rated their experience of the process as good/excellent. A significant proportion felt the process could have been more streamlined and quicker. Attitude towards ANDKD were changed negatively in 3 (8.6%) patients after donation but 88.6% (31/35) donors would recommend kidney donation to others. Thirty six of the donated kidneys were sent to recipients identified by the national Transplant office whereas 14 were fed into the paired/pooled kidney exchange program. Conclusions A significant proportion of enquiries for altruistic donation would result in donation. Psychiatric evaluation should be reserved for cases were clinically indicated. The process needs to be optimized to make the assessment process quicker. All transplant surgeons and nephrologists involved in the altruistic kidney donation program.

Unique Considerations When Managing Hypertension in the Transplant Patient.

For the select fortunate recipients of organ transplants, transplantation affords the rare opportunity for a new life. Given the scarcity of organs for transplantation, it is imperative that the health of transplant recipients be optimized in order to fully benefit from this gift of life. Unfortunately, hypertension is highly prevalent in the transplant population and it is considered a major cardiovascular risk factor contributing to mortality and morbidity in this population. In this chapter, we expound on the epidemiology, unique pathophysiology, evaluation, and management of hypertension as it pertains to the solid organ transplant recipient. In addition, a brief commentary is made on the subject of hypertension following living kidney donation, and practical aspects of management of hypertension in the solid organ recipient are summarized at the end of the chapter.

Organ shortage: the greatest challenge facing transplant medicine.

The success of organ transplantation as a treatment for end-stage organ disease has yielded a series of ethical quandaries originating from the issue of organ shortage. Scarcity of organs for transplantation necessitates formulation of just and fair allocation policies as well as ethically viable solutions to bridging the vast gap between organ supply and demand. The concept of "triage" provides a useful paradigm in which to contextualize the organ shortage issue. This entails subjugating the welfare of the individual patient for the benefit of the wider community as an ethically justified response to the challenge of scarcity.

Consumerist Responses to Scarcity of Organs for Transplant

Geographic disparities in availability of organs for transplant have spawned for-profit companies that help patients get on waitlists in more than one region and arrange travel for them if an organ becomes available.

Human liver stem cells improve liver injury in a model of fulminant liver failure

Liver transplantation is currently the only effective therapy for fulminant liver failure, but its use is limited by the scarcity of organs for transplantation, high costs, and lifelong immunosuppression. Here we investigated whether human liver stem cells (HLSCs) protect from death in a lethal model of fulminant liver failure induced by intraperitoneal injection of D-galactosamine and lipopolysaccharide in SCID mice. We show that injection of HLSCs and of HLSC-conditioned medium (CM) significantly attenuates mouse mortality in this model. Histopathological analysis of liver tissue showed reduction of liver apoptosis and enhancement of liver regeneration. By optical imaging we observed a preferential localization of labeled HLSCs within the liver. HLSCs were detected by immunohistochemistry in large liver vessels (at 24 hours) and in the liver parenchyma (after day 3). Fluorescence in situ hybridization analysis with the human pan-centromeric probe showed that positive cells were cytokeratin-negative at 24 hours. Coexpression of cytokeratin and human chromosome was observed at 7 and, to a lesser extent, at 21 days. HLSC-derived CM mimicked the effect of HLSCs in vivo. Composition analysis of the HLSC-CM revealed the presence of growth factors and cytokines with liver regenerative properties. In vitro experiments showed that HLSC-CM protected human hepatocytes from apoptosis and enhanced their proliferation. These data suggest that fulminant liver failure may potentially benefit from treatment with HLSCs or HLSC-CM.

The prevalence of colorectal neoplasia in patients with end-stage renal disease: a case–control study

The scarcity of organs for transplantation has led to aggressive pretransplant evaluations. Many younger kidney transplant patients with end-stage renal disease, who would be ordinarily at average risk for colorectal cancer, undergo screening colonoscopy as part of this evaluation. The purpose of this study was to determine the prevalence of colorectal neoplasia in patients with end-stage renal disease who are potential transplant candidates. We performed a retrospective chart review analysis on 57 kidney transplant candidates who underwent pretransplant screening colonoscopy between August 1999 and December 2004. The control group was comprised of 60 age- and gender-matched subjects without end-stage renal disease who underwent routine screening colonoscopy. The prevalence of polyps in end-stage renal disease patients was 37 vs 22% in the control group (p=0.07, not significant). None of the risk factors studied were found to predict the presence of polyps in the study group. These results suggest that screening guidelines for colorectal cancer for the general population should be adequate for potential kidney transplant recipients.

Cash for Kidneys: The Use of Financial Incentives for Organ Donation

Many campaigns and programs aimed at increasing donations have not been that successful, and the overall rate of organ donation after death has remained relatively constant over the past few years. The only solution to the widening gap between the number of organs available for transplant and the number of patients waiting is to substantially increase the number of suitable organ donors. This article addresses the historical perspectives of organ transplantation, examines the scarcity of transplantable organs, examines current state and federal legislation relating to organ donation, and explores the use of financial incentives that must be considered to alleviate these issues.

Why do transplant surgeons turn down organs?: A model of the accept/reject decision

Despite the scarcity of transplantable organs, 45% of livers are rejected by the first surgeon to whom they are offered. I present a model in which a surgeon decides to accept or reject an organ for a patient based on the patient’s current health level. Using data on transplanted patients, I show that surgeons’ behavior is consistent with the solution to an optimal stopping problem in which they reject low quality organs for relatively healthy patients in the hope that they will receive a better organ offer in the future. I discuss trends in organ procurement in light of this finding.

Alternatives to unmodified human islets for transplantation

Islet transplantation as a procedure to induce insulin independence is still a long way from benefitting the population of more than I million type I diabetic patients in the United States. In addition to the problems involved with immune suppression, the most significant obstacle is a scarcity of human organs for transplantation. In 1999, only 5882 donated pancreases were available, of which only 50% could be expected to produce islet yields suitable for clinical purposes. In this article, we review various sources with the potential to provide tissue for transplantation. These sources include islet and nonislet cells derived from both human and nonhuman sources, with an emphasis on human cells.

Nondirected kidney donation from living donors

Sir: Matas and colleagues [3] recently presented an interesting option for dealing with the scarcity of transplantable organs. The Minnesota transplantation program has implemented a policy of nondirected donation that allows altruistic strangers to donate a kidney. Acceptance would likely be high on the recipients’ side. In the extensive interviews which we have conducted as part of our follow-up study on recipients of kidneys from living donors, many deplore the fact that the German Transplantation Law of 1997 precludes anonymous or nondirected donation (the law requires an “obviously close personal relationship with the prospective recipient” (§ 8.1)). The well-known case of a German transplant surgeon who donated a kidney to an unknown patient in 1996 [l] is often mentioned in this context. Whereas the patients in our study categorically reject any form of organ trading, most of them don’t see why an altruistic donation should not be possible. The challenge will be to see if one can be had without the other. A possible advantage of nondirected living donation is that it excludes pressure on the donor resulting from the relationship to the prospective recipient or family members. In genetically or emotionally related living organ donation, decisions are always made within the context of a family system, even when no overt pressure is exerted. In our study we noted a significant gender imbalance, with mothers, wives, and sisters donating much more frequently than their male counterparts. The same tendency can be found in the national figures for living donation in Germany (63 % female vs 37 % male living kidney donors in 1998) and in the United States (UNOS reports 58 % female vs 42 % male living kidney donors in 1998). The decisions of these women may well be motivated by their role within the family as the caring, supporting ones. It shall be interesting to see whether the same gender pattern will appear in the Minnesota program or whether it will elicit a gender-neutral or even predominantly male response. As has been pointed out rightly [2], there are procedural aspects, like financial compensation or the selection process of potential donors, that need to be doublechecked for ethical pitfalls. Certainly protection from exploitation has to come first; pressuring people into living organ donation by whatever means or arguments is unacceptable. But given a satisfactory regulatory framework could be worked out, the national laws and professional guidelines prohibiting nondirected organ donation might have to be reconsidered.

Los injertos renales de donantes cadáver mayores de 60 años deben ser considerados subóptimos

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts fron aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of “ideal” ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0,032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival wich is 14% less at 12 months and 40% less at 36 months (p = 0,0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of inmunologic or surgical complications.

Trafficking in Human Organs: An Emerging Form of White-Collar Crime?

This article is based on a review and synthesis of media information and the professional literature relating to international human organ trafficking. The article inquires into the global scarcity of transplantable organs and explores the typical circumstances that surround the sale-for profit-of organs. Factors contributing to the establishment of legal, as well as clandestine, organ markets are discussed, as are the efforts of buyers and sellers of organs to avoid, or to violate, national laws that criminalize the sale and purchase of organs in most Western nations.

Strategies for Cadaveric Organ Procurement

THE SCARCITY OF ORGANS FOR TRANSPLANTATION The shortage of organs for transplantation is becoming more critical every year. Because of improvements in transplantation procedures, beginning with the advent of immunosuppressive therapies in the early 1980s, more patients now benefit from organ transplantation. As a result of transplantation's success, waiting lists for donor organs are increasingly crowded. Between December 1987 and June 1991, for example, the total number of patients on organ transplant waiting lists increased 75.3%, from 13153 to 23 056 patients.1 For editorial comment see p 814. Tragically, the supply of donated organs has not kept up with this demand. Between 1987 and 1990, the number of organ donors per year stayed nearly constant, increasing from 4000 to 4357.1Even though each cadaveric organ donor can often supply multiple organs for transplantation, many patients still die before a suitable organ becomes available. In September 1991, the United

Bioethical and legal considerations in increasing the supply of transplantable organs: From UAGA to ‘Baby Fae’

In the last 35 years, organ transplant technology has advanced greatly. The major problem associated with organ transplantation is organ availability, and not surgery-related mortality. This article examines current organ procurement procedures and technologies, legislative responses to the scarcity of transplantable organs, as well as the psychological barriers to organ donation. Issues of fairness in the allocation of scarce economic and social resources, the role of religion and ethics in organ donation and transplantation decision, and the impact of the media are also considered.