Ch 8: Conclusion and Final Thoughts

 Ch 8: Conclusion and Final Thoughts

 The field of medicine is showing so much progress in every field of theirs and now maximum of the patients are able to be cured. Organ Transplantation is also one of such fields in which continuous research have made it a possible for the doctors and specialist to perform any transplant.  As any field, organ transplants had  its share of ethical issues such as  the black market of organs and the concepts of savior sibling. Nevertheless, this field progressed over time through new scientific interventions to include new technologies such as the Organ Care System. This technology is designated to keep the organ functioning and alive outside the body. In addition, interventions also manifested to include artificial organs, the one alternative for organ transplants. Artificial organs are  made to replace a defective or malfunctioning organ in a human patient. This way, the normal function of  the transplanted tissue or organ can be restored. Finally, organ printing, the future of artificial organ development, in which the next generation of synthetic organs will be visualized thanks to a 3D printing technique.

The field of organ transplant was and still has its unique print on the world of science and medicine. Hopefully,  new policies and solutions will be available soon to resolve the continuous need for organ donation and thus leading patients to the organ black market as an alternative .  

Ch 7: A Critique of an Article from South China Morning Post

Ch 7:  A Critique of an Article from South China Morning Post 

This is a critique of an article from South China Morning Post which talks about change in ethical considerations of the Chinese Government regarding the use of organs from executed prisoners. Previously organs were removed from dead bodies of prisoners sentenced to execution without their consent which basically lead to a massive criticism from international ethical committees. Given the circumstances China aims at changing the practice and introduces ethical usage of transplant organs including donor consent. The change from systematic organ removal to ethical practices is driven by the international image of China which had become tarnished due to the above mentioned facts. The Chinese government plans to implement accepted ethical international standards which ensure that organs are not used without consent.

The overall setting of the article is adequate. However, there are some annoying adds and some irrelevant news suggestions towards the left. The article post is an important issue but it could have been addressed in a better way.

Secondly, it just looks like a publicity stunt by the media, the issue is there and it is not handled well by the government but the article says that the act is worthy, especially after it mentions the growing organ black market. So there is a conflict of interest in the article  itself.

The article lacks flow as it mentions random statements and facts. Furthermore, the style in which the article is addressed is not appealing enough to make the reader finish the whole article.

Implementation of ethical standards is an important issue and therefore it is addressed at the right time. The article talks about the implementation of ethical standards in China where previously 64% of the organs came from dead inmates without their or their family’s consent. However, if organ transplantation ceases without consent from inmates, it can lead to severe shortage of organs for those under the waiting list. Currently after the law implementation, 300,000 patients are wait-listed every year and about one in 30 are lucky enough to receive an organ. Although the implementation complies with ethical standards, it also opens up trading in the black market. Therefore the steps that have been taken seem to be specifically designed to eliminate statistical reports on the Government’s behalf and transfer it to the unknown statistics of the black market. This is like ignoring the fact that a black market for organs exists and also indirectly fuels the illegal trade of organs. Also, a process that was systemic is now abolished and people are forced to come to terms with the illegal trading of organs in the black market.

Some suggestions for these steps would be that information is enough for a death row inmate and for his/her family. Because withholding the legal processing of organ transplantation can lead to complications rather than correcting the issue at hand. Besides, inmates’ bodies are routinely used for dissections by medical students so why can’t they be used for something much more practical such as organ transplantation.

The article  highlighted an important issue. However, the issue could be handled in a better way by the author and it could have been made very interesting. It just gives basic information and leaves the decision to the readers which is sort of open ended and inconclusive.

References:

http://www.scmp.com/news/china/article/1296889/china-phase-out-use-prisoners-organs-transplants-november

Chapter 6: FAQ Of Organ Transplants

1.      What organs can be transplanted?

Organs that can be transplanted include heart, lung, liver, kidneys, pancreas, intestine, and thymus. Tissues that can be transplanted include bones, tendons, cornea,nerves, veins, skin, and.heart valves,  and veins.

2.      What are the most commonly transplanted organs, worldwide?

 Kidneys are the most commonly carried out transplant organ, then the liver comes after and then the heart [1].

3.      Are transplants successful?

Yes, transplants have very high success rates with an average rate of 80-90 %, the success depends upon the type of organ and the type of donor.  97% of kidneys in living donor transplants are still functioning well (Based on adult transplant recipients, 1 January 2009 to 31 December 2012) [2].

4.      Are there age limits for organ donors?

No. as long the physical condition of the donor is fine, then there is no problem since newborns and seniors can be donors. [5]. 

5.      Why does the rejection of organ occur?

The rejection of the organ occurs because of the immune response against transplanted organs leading to organ failure [4].  

6.      What can occur to the patient in the case organ rejection?

The transplanted organ must be removed immediately if the body rejects the transplanted organ. Otherwise the body will destroy the transplanted organ. Followed by fever, flu, pain & uneasiness [8].

7.      What are the new technologies used in organ transplant?

After the introduction of xenotransplantation, artificial organ transplantation has become more popular. Artificial Organs are now being made by organ printing, which is a 3D technique.

8.      What is stem cell therapy?

Stem cell therapy is a therapy used to replace damaged /diseased cells by healthy functioning ones. This technique is relatively new but they have wide applications in medical [3].

9.      What are stem cells?

Stem cells are undifferentiated cells that are present in everyone throughout their life. They have the ability to become any of the specialized cell types in our body. Stem cell exists in blood, all organs and tissue, and in bone marrow.

10.      What are the Challenges of Stem Cell Therapy?

There are many challenges in using this therapy but a major difficulty with stem cell therapy is to identify stem cells within an actual tissue culture. Because cultures contain many different types of cells and it is a challenge to identify specific cell types.

 11.      Are there organizations who can help patients afford the cost of transplantation?

Yes there are many national & international organizations that can help patients in affording the cost of transplantation [7]. Few have been listed down:

·         Private Health Insurance

·         COBRA Extended Employer Group Coverage

·         Health Insurance Marketplace

·         Medicare

·         Medicare Prescription Drug Plans

·         MediGap Plans

·         State Health Insurance Assistance Programs

12.      What is the political standing in regard to organ transplant?

There are also controversial issues regarding how organs are allocated to recipients. However, Donation rates can be increased if there is adequate funding available, strong political will to see transplant outcomes improve, and the development of specialized training & care facilities helps in increasing the donation rates [7].

13.      What is the religious stand for some religions?

Organ donation is not prohibited in major religions such as Roman Catholicism,most branches of Judaism, Islam,  and most Protestant faiths. 

References

1.      WHO Guiding Principles on human cell, tissue and organ transplantation, Annexed to World Health Organization, 2008

2.      http://www.organdonation.nhs.uk/about_transplants/success_rates/

3.      http://www.explorestemcells.co.uk/overviewstemcelltherapy.html

4.      Frohn C, Fricke L, Puchta JC, Kirchner H (February 2001). "The effect of HLA-C matching on acute renal transplant rejection". Nephrol. Dial. Transplant. 16 (2): 355–60.doi:10.1093/ndt/16.2.355. PMID 1115841

5.      http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/organ-donation/art-20047529

6.      http://www.transplantliving.org/community/patient-resources

7.      Bird, Shiela M.; Harris, John (2010). "Time to move to presumed consent for organ donation". Analysis. BMJ 340: c2188. doi:10.1136/bmj.c2188. PMID 20442244

8.      http://www.nlm.nih.gov/medlineplus/ency/article/000815.htm

Ch 5: Artificial Organs

 

http://www.manoramaonline.com/advt/EnglishNews/Yearender-2013/science-tech/scence-tech-news/story14.html

 An artificial organ is a synthetic device that is made to replace a defective or malfunctioning organ in a human patient. This way, the normal function of  the transplanted tissue or organ can be restored. Artificial organs are designed in such a way that they do not have to depend on a continuous power supply or chemical filters, in a way they are self sustaining. An artificial organ can serve many purposes such as:

Short term life support: short term life support for organ awaiting patients.

Self care: Artificial limbs can be implanted in individuals to enhance self care.

Improvement of social interaction: one example is the restoration of hearing ability such as cochlear implants.

Cosmetic restoration:  facial reconstruction after accident or cancer surgery.

Initially biomedical engineering was employed in artificial organ development which aimed at developing mechanical structures based on functioning organs. Examples of early artificial organs are pace-maker in the heart and mechanical prosthetic limbs. However, recent advances in stem cell technology have given a major boost to the development of artificial organs that are  similar to the natural organs.

Organ development through tissue engineering is a very promising solution for artificial organ development. A few examples of organs that are being developed for transplant are:

Bioartificial windpipe: it was the first artificially produced organ that was successfully transplanted in human patients.

Artificial Bladder: polyglycolic acid scaffolds have been suggested as a substrate for urinary bladder construction.

Artificial pancreas: previously xenografts of islets cells were used to develop a pancreas which was successfully transplanted in test animals without the use of immunosuppression. Seeding islet stem cells on the surface of biocompatible scaffolds in order to regulate the production of insulin in diabetic patients is currently being tested for transplantation into human subjects.

Organ printing: the Future of Artificial Organ Development

The next generation of synthetic organs will be visualized thanks to a 3D printing technique. Three dimensional organ printing makes use of computer aided additive  biofabrication of tissue constructs and technology known as rapid prototyping  (RP). RP can be used to print three dimensional structure using cells, biomaterials and cell laden biomaterials.

References

Atala, A., Freeman, M. R., Vacanti, J. P., Shepard, J., & Retik, A. B. (1993). Implantation in vivo and retrieval of artificial structures consisting of rabbit and human urothelium and human bladder muscle. The Journal of Urology, 150(2 Pt 2), 608–12. Retrieved from http://europepmc.org/abstract/MED/8326605

Baiguera, S., Birchall, M. A., & Macchiarini, P. (2010). Tissue-engineered tracheal transplantation. Transplantation, 89(5), 485–91. doi:10.1097/TP.0b013e3181cd4ad3

Maki, T., Otsu, I., O’Neil, J. J., Dunleavy, K., Mullon, C. J., Solomon, B. A., & Monaco, A. P. (1996). Treatment of diabetes by xenogeneic islets without immunosuppression. Use of a vascularized bioartificial pancreas. Diabetes, 45(3), 342–7.    http://www.ncbi.nlm.nih.gov/pubmed/8593940

Ozbolat, I. T., & Yu, Y. (2013). Bioprinting toward organ fabrication: challenges and future trends. IEEE Transactions on Bio-Medical Engineering, 60(3), 691–9. doi:10.1109/TBME.2013.2243912

Chapter 4: Discussion of Mathurin et al's . (2011) "Early Liver Transplantation for Severe Alcoholic Hepatitis "

Discussion of  Mathurin et al's . (2011)

Early Liver Transplantation for Severe Alcoholic Hepatitis ""

Fig 1: Stages of alcohol-induced liver damage

Note : Cirrhosis caused by several caused included excessive alcohol intake and hepitits B and C 

Objective :    

          Mathurin et al. (2011) conducted a research titled "Early Liver Transplantation for Severe Alcoholic Hepatitis"  in response to the controversial issue regarding early transplantation of liver to patients who suffer from  sever alcoholic hepatitis.

Controversial issue  :

       Most centers wait for a period of six months after abstinence  from alcohol  before allowing the liver transplantation  for two  reasons. The first reason is that  high consumption of alcohol  is the reason behind the  alcoholic hepatitis so the patients are responsible for their illness. The other reason is that the centers need to assess the patient's ability to stop consumption of alcohol and their appropriateness for  transplantation .The major problem of  this is that the survival rate of patients whose alcoholic hepatitis that is resistant  to medical treatment is approximately 30%.

Research questions :

        Mathurin et al. (2011) article aimed to evaluate the effect of early liver transplantation , without waiting 6 month after abstinence  from alcohol, on the survival rate  and  the percentage of alcohol relapse  of alcoholic hepatitis- patients  who didn't response to  the treatment ( by Glucocorticoids ).In addition ,the research  assessed  the  effect  early liver transplantation on  the whole level of transplantation activity of the participated centers.

Method:

        Patients with severe alcoholic hepatitis( Maddrey's discriminant function  is larger than 32)  that is resistant to medical treatments and at high risk of death in the absence of transplantation (Lille model score≥0.45 after constant rise in the Model for End-Stage Liver Disease (MELD) score or after  7 days of treatment).Written informative consent were given to the selected groups .

Participants were divided in to two groups : matched group who didn't undergo early liver transplantation (20)  and experimental group that involve  patients who undergo transplantation ( 26 patients ) .

Survival rate were compared between two groups to assess the effect of early liver transplantation   .

Result:  

          Mathurin et al.  (2011) showed  that  early liver transplantation is beneficial for patients with severe acute alcoholic hepatitis  that is not responsive to medical treatment. The survival rate of patients who undergo the early liver transplant were much higher than that of matched group . 18 out of 20 patients in the control group  died after two months after recognition of resistant to treatment. On the other hand ,6 out of 26 patients died within two weeks after transplantation. Five out of six deaths were related to infection . Though most centers use 6-month abstinence rule as predictor of the alcohol relapse after the transplantation , the research findings challenge the 6-month abstinence rule .Participants who had early liver transplant didn't experience alcohol relapse during  the first 6 months after the transplantation.

Response to the article

           The research conducted by Mathurin et al. (2011) raised the awareness of benefit of early liver transplantation for patients with severe alcoholic hepatitis that is resistant to medical  treatment.The study showed  that 6 out 26 participants of the experimental group died after two weeks of transplantation. This represents 23% of the number of participants . this research indicated  that the death of  5 out of these six cases were related to infection . As a result , preventive measures should be taken in to account  in the future studies .

          The selection process of participants of control group depended on two process of matching which decreased the investigator bias , the coherent effect , and limit period  .Although this would increase the validity of the research and the selection process of participant of  experimental group ,patients who undergo transplantation were different in term of the family support  and availability of  counseling in case of relapses , and the patients plans to stop alcohol-consumption .As suggested by Mathurin et al. (2011) , similar social characteristics should be matched between the experimental and control  groups in future studies  .   

References

 Mathurin et al." Early Liver Transplantation for Severe Alcoholic Hepatitis."The New England Journal of Medicine 365(2011):1790-1800. DOI: 10.1056/NEJMoa1105703.

<http://www.nejm.org/doi/full/10.1056/NEJMoa1105703#t=article>

           

  

  

Chapter#3: A Critique of Jacque Wilson’s (New transplant technology keeps organs alive' outside body)

 A Critique of Jacque Wilson’s

(New transplant technology keeps organs alive' outside body)

 

The TransMedics Organ Care System is a portable device that allows doctors to keep organs "alive" during transport.

            Organ transplant is an operation of transferring  an organ from a donor into recipient or from a place into another in the body of the patient to substitute the injured or missing organ. Throughout the years, doctors used a cooler filled with ice to transfer organs that are used for transplantation. Transmedics generated new technology called the Organ Care System. This technology is designated to keep the organ functioning and alive outside the body (Transmedics ) .                                           

        Jacque Wilson is a health writer in CNN. In her article “New transplant technology keeps organs 'alive' outside body”, she concentrated on the advantages of the Organ Care System .In attempt to raise the readers’ attention of its advantages , she began with presenting the disadvantages associated with the traditional organ transplant methods which is the organ damage caused by the delay in the transplant . Wilson presented three main potential benefits of the Organ Care System. First, it reduces the amount of organ damage resulted from the delay of transplant by keeping the organ worm and functioning. In addition , it increases the time the organ can be sustained outside the body that in turn enable the organ to be moved into more distant geographic area . Moreover, it could be used to fight chronic diseases such as cancer by improving the function of the organ after its removal from the donor.

         Wilson used general words that could reduce the level of article’s precision. For example, she used the words “surgeons in Europe” and “U.S. breathing lung transplant studies” without specifying the name of the surgeons and title of the studies or providing sources of the provided information. In addition, she provided numerical information about the maximum time the organ can sustained intact in the cooler outside the body (8 hours) and the number of organ transplants that have been completed in Europe (200 organ transplants). Sources of these data should be provided to enhance the article accuracy. On the other hand, Wilson provided details that support her arguments by presenting information given by professionals such as Ardehali, UCLA's heart and lung transplant program director, and Beswick who is the “vice president of global marketing for TransMedics”.

      The language and the tone that Wilson used while describing the scenario of transporting the organ through the cooler were emotionally –loaded. She also mentioned that this cooler is the same as the container that is used to maintain the temperature of the soda. Using this description underestimated this method and could affect the reader judgment regarding how the Organ Care System is more effective than the cooler which as a result also reflects the author's preference and bias toward the Organ Care System. While Wilson mentioned that the Organ Care System is expensive, she did not provide the cost of using the cooler. A balanced argument would provide the cost of the old and new methods.

Throughout the article “New transplant technology keeps organs alive' outside body”, Willson provided the benefits of using the new method of organ transplant which is Organ Care System.  While Wilson provided a rational argument, specific information that enhances the accuracy of the article should be provided. In addition, comparison of  cost of both  old method, the cooler , and the new technology , Organ Care System, should be acknowledged . 

  

References

Wilson , Jacque . “New transplant technology keeps organs alive' outside body”.CNN , 25April 2013.Web.29October 2014 <http://edition.cnn.com/2013/04/25/health/live-organ-transplants/>