Organ Donation & Transplant Matters Resources
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Organ Donation & Transplant Matters Resources
Combining reports, research findings and topic reviews
Curated by Deborah Verran
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'Head Transplant' Research in China Raises Serious Concerns

'Head Transplant' Research in China Raises Serious Concerns | Organ Donation & Transplant Matters Resources | Scoop.it

The announcement of the first head transplant performed in China has met with scepticism and raised some major concerns.


But two pressing questions are being overlooked, according to international experts: Where are the bodies for this type of research coming from? And why is this type of research happening only in China, where there have been problems in the past with how organs have been obtained for the purpose of transplantation.


In addition there are now concerns being expressed within China as to whether these type of research procedures should now continue -


http://www.ecns.cn/2017/11-25/282230.shtml


A summary of the media conference held in China in Nov 2017 can be viewed via this link-


http://www.dailymail.co.uk/news/article-5103213/World-s-head-transplant-corpse-not-completed.html


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Swedish review board finds misconduct by Macchiarini, calls for six retractions - Retraction Watch

Swedish review board finds misconduct by Macchiarini, calls for six retractions - Retraction Watch | Organ Donation & Transplant Matters Resources | Scoop.it

An ethical review board in Sweden is now asking a number of scientific journals to retract six papers that were co-authored by former star surgeon Paolo Macchiarini, after concluding that he and his co-authors committed misconduct.


One of the papers is the seminal 2011 article in The Lancet, which described the first case of a transplant using an artificial trachea seeded with cells.


This follows on from further investigations into the outcomes of the trachea transplant cases where the outcomes were not as good as initially reported.

Deborah Verran's insight:
The post script of what has turned out to be a sorry saga of over optimism and hence inaccurate scientific reporting of the initial results of a new form of tissue transplantation.
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3D bioprint me: a socioethical view of bioprinting human organs and tissues

3D bioprint me: a socioethical view of bioprinting human organs and tissues | Organ Donation & Transplant Matters Resources | Scoop.it

In this article, the authors review the extant social science and ethical literature on three-dimensional (3D) bioprinting, also now known as biofabrication. 


3D bioprinting has the potential to be a ‘game-changer’, because the printing human organs on demand, may no longer necessitate the need for living or deceased human donation or perhaps even xenotransplantation. Although the technology is not yet at the level required to bioprint an entire organ, 3D bioprinting may have a variety of other mid-term and short-term benefits that also have positive ethical consequences, for example, creating alternatives to animal testing in the laboratory setting, filling a therapeutic need for minors and avoiding species boundary crossing. 


Despite a lack of current socioethical engagement with the consequences of the technology, the authors outline what theyThis see as some of the preliminary practical, ethical and regulatory issues that need tackling. These relate to managing public expectations and the continuing reliance on technoscientific solutions to diseases that affect high-income countries. 


Avoiding prescribing a course of action for the way forward in terms of research agendas, we do briefly outline one possible ethical framework ‘Responsible Research Innovation’ as an oversight model should 3D bioprinting promises are ever realised. 3D bioprinting has a lot to offer in the course of time should it move beyond being a conceptual therapy, but is an area that requires ethical oversight and regulation and debate, in the here and now. The purpose of this article is to begin that discussion.

Deborah Verran's insight:
This is a must read for anyone interested in the governance issues related to 3D bioprinting and/or the biofabrication of human tissues and/or organs. 
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Sergio Canavero says the first head transplant patient will be a Chinese national, who will have surgery this year

Sergio Canavero says the first head transplant patient will be a Chinese national, who will have surgery this year | Organ Donation & Transplant Matters Resources | Scoop.it

Head transplantation continues to attract attention particularly via social media. This story has now been given more impetus with Dr Sergio Canavero the Italian neurosurgeon (pictured right), stating that the operation will take place in China within the next 10 months. This has also been aided by the reports of head transplantation being performed on rats-


http://www.independent.co.uk/news/science/scientists-china-full-head-transplant-rats-human-sergio-canavero-cns-neuroscience-therapeutics-a7711871.html


However Dr Canavero is now also claiming that there are plans to transplant cryogenically frozen brain tissue into patients as well. There is no evidence that this will work as some are pointing out in response to this claim-

https://joinfo.com/world/1029268_cryogenically-frozen-brains-will-be-woken-up-and-transplanted-in-donor-bodies-within-three-years-neurosurgeon-claims.html


Deborah Verran's insight:
This story keeps doing the rounds on social media and looks likely to keep going until the experimental head transplant procedure is performed in humans
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A Dying Man's Wish To Donate His Organs Gets Complicated

A Dying Man's Wish To Donate His Organs Gets Complicated | Organ Donation & Transplant Matters Resources | Scoop.it
Dying in America doesn't always go the way we plan. One terminally ill man's hope to be disconnected from his respirator and donate his organs was almost thwarted, despite his best laid plans.

Despite the wishes of David Adox to donate his organs and the agreement of physicians in a nearby hospital, the lawyers for this particular  hospital blocked the proposed organ donation. Fortunately professionals in an organ procurement organization heard about David's plight and were able to make arrangements for his wishes to be carried out in another hospital in New York.

As outlined in the article, donation after circulatory death is an established practice in many parts of the United States. Patients with progressive neurological conditions can opt to cease their treatment and then donate their organs if they go on to decease within a certain time period. There are guidelines as well as protocols in place both within organ procurement organizations as well as hospitals.

This article highlights the confusion as well as the conflict that can arise within an institution when not everyone is on the same page about modern established practices in organ donation.
Deborah Verran's insight:
Important story and a reminder that hospitals must have established protocols for DCD organ donation in the countries around the world where the practice is now established
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Does China still harvest organs of executed? Doctors divided (not really!)

Does China still harvest organs of executed? Doctors divided (not really!) | Organ Donation & Transplant Matters Resources | Scoop.it

A Canadian patient's receipt of a kidney transplant recently after waiting just three days during a recent visit to China raised an immediate red flag among surgeons at the Montreal-based Transplantation Society. A turnaround that quick indicates the organ likely came from the body of an executed prisoner. 


The case adds to doubts among many doctors internationally about whether China has met its pledge to stop harvesting the organs of executed inmates. The practice is widely condemned by the World Health Organization and others because of concerns over coercive practices and fears it could encourage executions. China officially claims it ended the harvesting of executed inmates' organs in January 2015. 


China sought to use the Transplantation Society's decision to hold its annual meeting in Hong Kong this last month as validation of its organ donation system. 


But Dr. Philip O'Connell, the society's president, rejected that interpretation, even if it appeared some reforms had been successful. In a country that routinely suppresses discussions of human-rights issues and cracks down on lawyers and independent groups, government officials and state media have been relatively open about China's problems with organ donation. 


Dr. Huang Jiefu, head of the system that supervises transplants in Chinese hospitals, has been the public face of the country's attempts to change its transplant practices. Huang publicly admitted in 2005 that doctors used executed prisoners' organs. In 2011, Huang and other officials estimated that 65 percent of transplanted organs from the deceased came from executed prisoners. In an interview Friday with The Associated Press, Huang said he was confident hospitals under his purview were moving to donated organs, but that black-market surgeries still persist. "We still have a long way to go," Huang said. According to the government, Chinese doctors performed 10,057 organ transplants in 2015.  


To read the full story click on the banner headline

Deborah Verran's insight:
Nb the word harvest in the title of this story needs to be replaced by either organ recovery or organ retrieval in 2016. Nevertheless this latest online post provides some additional detail on the current issues with organ donation in China along with confirmation from a senior official that there are still unresolved problems,
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Increasing Transplant Organ Supply Through Uncontrolled Donation After Circulatory Death

Increasing Transplant Organ Supply Through Uncontrolled Donation After Circulatory Death | Organ Donation & Transplant Matters Resources | Scoop.it

The whole issue of increasing transplant organ supply via the implementation of uncontrolled Donation After Circulatory Death pathways raises legal, ethical and moral issues.

 

This creates a number of challenges at the intersection of health, health care, and policy which are context specific, i.e. are dependent on the specific legislation as well as standards for practice which already exist within a number of countries around the world.

 

This particular article is written for a professional audience within the United States and was posted online via Health Affairs. The one minor deficit of the article is the use of the outdated term cardiac death. 

Deborah Verran's insight:

This article will be of interest in particular to health care professionals who have an interest in policy and regulatory frameworks pertaining to organ donation from deceased donor.

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The Ethics Of Solving The Transplant Organ Shortage

The Ethics Of Solving The Transplant Organ Shortage | Organ Donation & Transplant Matters Resources | Scoop.it

At the 2014 AAAS meeting in Chicago, medical ethicist Mark Siegler laid out a framework for a potentially provocative solution to the shortage of kidneys available for transplantation.

 

His recommendations all pertain to enhancing live kidney donation as a means of increasing the number of kidney transplants that can be performed, particularly within the United States.

Deborah Verran's insight:

In order to optimise the number of live donor kidney transplants that are able to be undertaken within any country it is important to examine where barriers may exist

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The Dead-Donor Rule and the Future of Organ Donation — NEJM

The Dead-Donor Rule and the Future of Organ Donation — NEJM | Organ Donation & Transplant Matters Resources | Scoop.it

Two articles which fall into the category of Perspective from The New England Journal of Medicine have now been published in full text online.

 

The first— The Dead-Donor Rule and the Future of Organ Donation- 

http://t.co/WvLMW6ZQ5i explores the issues surrounding the circumstances where potential organ donors do not become actual organ donors when certain criteria are not able to be met. This includes scenarios where the potential donor after the declaration of circulatory death (DCD) does not decease within the accepted timeframe and hence organ donation is unable to proceed.

 

 

 The second explores why the Dead Donor Rule is in place within the United States and what are the implications of either continuing to adhere to this rule or moving to change it. This can be viewed via-

http://www.nejm.org/doi/full/10.1056/NEJMp1308078

 

 

Deborah Verran's insight:

Essential reading for ethicists, policy makers and everyone who has a professional interest in organ donation systems.

 

The background context to these articles appearing at this point in time are the case scenarios that are outlined in the first artcle.

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ATS publishes statement on organ donation after circulatory determination of death - EurekAlert (press release)

ATS publishes statement on organ donation after circulatory determination of death - EurekAlert (press release) | Organ Donation & Transplant Matters Resources | Scoop.it

ATS publishes statement on organ donation after circulatory determination of death EurekAlert (press release) The American Thoracic Society has released an official statement on the ethical and health policy considerations surrounding adult and paediatric controlled Donation After Circulatory Death.

Deborah Verran's insight:

The latest guideline document pertaining to DCD organ donation

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The Ethics of Organ Transplantation: A Brief History, US Perspective

Throughout the history of the development of organ transplantation, the transplant community in a number of countries has taken pauses, to make sure that transplantation was truly a boon to patients and to ensure that there was genuine ethical engagement.

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New book highlights shortage of organ donors - beds.ac.uk

New book highlights shortage of organ donors - beds.ac.uk | Organ Donation & Transplant Matters Resources | Scoop.it

Have an interest in policy underpinning organ donation and transplantation? Looking for a written resource containing interesting information?

 

Organ Donation and Transplantation - Public Policy and Clinical Perspectives, is packed with expert chapters and has just been released as an e-Book in the United Kingdom. It provides specialist information via chapters on public policy as well as clinical developments in organ transplantation.

 

The link to the eBook is- http://www.intechweb.org/books/show/title/organ-donation-and-transplantation-public-policy-and-clinical-perspectives

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World’s first human head transplant successfully performed on a corpse, scientists say

World’s first human head transplant successfully performed on a corpse, scientists say | Organ Donation & Transplant Matters Resources | Scoop.it

It has just been reported that a head from a deceased individual has been attached to the body of another deceased individual via an 18 hour surgical procedure led by Professor Xiaoping Ren (picture left above), of Harbin University in China.


This story has generated a number of misleading headlines partly due to the fact that it is not actually a proper transplantation surgical procedure where either a viable organ or tissue is transplanted from a donor into an alive recipient. Instead the procedure that has been performed appears to be an experimental technical exercise.


Apparently a full head swap between brain dead organ donors is now being planned as the next step according to Dr Sergio Canavero (pictured right), who is frequently interviewed on this ongoing research. Dr Canavero claims that 'We stand on the brink of a revolution, not only in medicine but in human life'


Not everyone agrees with this sentiment, particularly as the ongoing breakthroughs that are now being seen in pharmacology, gene editing, bioengineering and the use of stem cells may in fact lead to head transplantation never being a viable procedure to treat serious conditions of the spinal cord etc for which it is being proposed.


However the background information on how this procedure was undertaken has now been published online in Surgical Neurology International. This involves operating on the bodies of deceased individuals whose relatives agreed could be used for research purposes  -


http://surgicalneurologyint.com/surgicalint-articles/first-cephalosomatic-anastomosis-in-a-human-model/


Deborah Verran's insight:
The latest on the head transplant saga which no doubt will continue to generate headlines until there is some kind of outcome with this ongoing research
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Lancet Commission: Stem cells and regenerative medicine

Lancet Commission: Stem cells and regenerative medicine | Organ Donation & Transplant Matters Resources | Scoop.it
A consensus document has just been published in The Lancet outlining exactly what is the status the current research endeavours into regenerative medicine.

This includes the use of stem cells for the purposes of either bioprinting and/or biofabricating tissues and organs.

This article dissects out the reality from the hype. In addition it summarises what are the current barriers to achieving more in the way of outcomes which may be of direct relevance to patient's. In addition there are challenges which will need to be faced at the level's of both organizations and regulatory agencies as this type of research progresses.
Deborah Verran's insight:
This is a must read for anyone interested in this type of research and what are the possible implications
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One doctor's war against global organ trafficking

One doctor's war against global organ trafficking | Organ Donation & Transplant Matters Resources | Scoop.it

Dr. Francis Delmonico, a Harvard Medical School professor, has spent more than a decade leading the fight to establish global ethics principles that govern how human organs are obtained and transplanted.


Read about his involvement in some of the international efforts to try and put a stop to various illicit organ donation and transplantation practices around the world including but not limited to China.


Deborah Verran's insight:
This article will be of particular interest to policy makers as well as healthcare professional involved in either organ donation or transplantation
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Meeting an organ trafficker who preys on Syrian refugees - BBC News

Meeting an organ trafficker who preys on Syrian refugees - BBC News | Organ Donation & Transplant Matters Resources | Scoop.it

An interview is held with a young man in a small shop in a back alley way of a city in Lebanon. The information that he goes on to provide is chilling.


Abu Jaafar's job is to find people desperate enough to give up a part of their body for money i.e being willing to sell one of their kidneys or even an eye.


This includes desperate Syrian refugees who need money in order to try and survive.


The descriptions of how the transactions occur and how individuals are managed after the surgery to remove a kidney are chilling.

Deborah Verran's insight:
Extremely concerning that vulnerable refugees in Lebanon are being sought to provide organs and tissues for transplantation
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Head transplant team’s new animal tests fail to convince critics

Head transplant team’s new animal tests fail to convince critics | Organ Donation & Transplant Matters Resources | Scoop.it

The latest report of research performed on animals in preparation for the first possible so called head transplant has not convinced critics of the procedure. A dog has reportedly recovered the ability to walk after an injection into its damaged spinal cord, but some have criticized the standard of the study as outlined in this online report.


Although there are plans for the first head transplant to be performed in China in 2017, concerns continue to be expressed around both the safety and efficacy of the procedure. Of note the patient will actually undergo a body transplant, that is their body will be replaced.


There are significant barriers to this procedure being successful in practice, of which 5 are identified in this online article posted via Business Insider-

http://www.businessinsider.com.au/italian-surgeon-head-transplant-dog-experiment-2016-9?r=UK&IR=T




Deborah Verran's insight:
The latest news on the so called head transplant which may be performed in China in 2017
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The Chinese Claim That The World Accepts Its Organ Transplant System Are Rebutted

The Chinese Claim That The World Accepts Its Organ Transplant System Are Rebutted | Organ Donation & Transplant Matters Resources | Scoop.it

After it was revealed in the media that delegates from China were speaking at the Transplantation Society meeting in HongKong, concern was raised as to the veracity of their claims that the use of organs from executed prisoners within China has largely subsided. This followed publication of an article in the American Journal of Transplantation where further concerns were raised about organ donation in China. The previous article from the New York Times can be viewed via this link-

http://www.nytimes.com/2016/08/18/world/asia/debate-flares-on-chinas-use-of-prisoners-organs-as-experts-meet-in-hong-kong.html


The head of the Transplantation Society Professor Philip O'Connell (pictured), stated that the decades-long practice of using the organs of executed prisoners, which China claims it has stopped, had horrified the rest of the world.


There now seems to be ongoing uncertainty over whether the claims being made by Chinese officials can actually be supported by accurate data. Whatever the outcome it is clear that the majority of transplant professionals around the world are not supportive of unscrupulous organ donation practices. 

Deborah Verran's insight:
Important issue which will not go away until the appropriate management and governance practices are both adopted and promulgated within China
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Desperately needed organs from anonymous living donors are saving lives but raise ethical concerns

Desperately needed organs from anonymous living donors are saving lives but raise ethical concerns | Organ Donation & Transplant Matters Resources | Scoop.it

The National Post in Canada was recently invited to document one woman's altruistic living kidney donation — an act that still generates controversy and is even banned in some U.S. hospitals. In the process an exploration was undertaken to also explore some of the ethical issues around altruistic live organ donation which contribute to the reluctance of some transplant hospitals to offer this service.

 

Concerns over the safety and the long term well being of a live organ donor who is not related in any way to the transplant recipient have helped contribute to the high degree of caution around this process.

 

The live donor featured in this article is interviewed along with members of her surgical team as well as other health professionals with expertise in the assessment of live organ donors. The full text of this interesting article can be viewed by clicking on the banner headline.

Deborah Verran's insight:

A well written article that will be of interest to anyone with an interest in live organ donation

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Ethical dilemmas surround those willing to sell, buy kidneys on black market - CBS News

Ethical dilemmas surround those willing to sell, buy kidneys on black market - CBS News | Organ Donation & Transplant Matters Resources | Scoop.it

This article outlines the ethical dilemmas that surround those willing to sell, and buy kidneys on the black market and is posted online via
CBS News in the United States.

 
There's no denying that there is a shortage of organ donations in the United States and that this leads to some individuals looking to 'buy a kidney'. However what is less well known are some of the risks with this approach as well as the downsides.

 

The article is in advance of a programme on this topic which will air via HBO in the United States in November. However for those who are interested there is a short video of an interview held with ethicist Arthur Kaplan on the topic of paying live kidney donors.

Deborah Verran's insight:

This will be of interest to healthcare professionals associated with both live and deceased donor organ donation programmes

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How Social Media Is Changing Organ Donation

How Social Media Is Changing Organ Donation | Organ Donation & Transplant Matters Resources | Scoop.it

In the age of social media, doctors, patients, and ethicists face new dilemmas over organ transplants.

 

With patients being able to make direct requests for a donor organ via social media platforms, this creates new challenges with respect to fairness and equity which are outlined and explored in the article.

Deborah Verran's insight:

More about the pro's and con's of the current use of social media in the field of organ donation, with a number of perspectives also outlined

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Organizing an Organ Donation System in China is Complicated Operation - Caixin Media

Organizing an Organ Donation System in China is Complicated Operation - Caixin Media | Organ Donation & Transplant Matters Resources | Scoop.it

In recent years there have been a number of concerning reports featuring news about organ donation practices within China. This report outlines attempts by the ministry of health in China to ensure that a properly structured and managed system for organ donation is established across the country. Many challenges are still faced.

 

Hence the title of the report: Organizing an Organ Donation System in China is a Complicated Operation. Huang Jiefu, the vice minister for health, said the creation of an ethical and sustainable organ donation system was imminent.

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Organ Donation After Circulatory Death: Vital Partnerships : AJN The American Journal of Nursing

From the American Journal of Nursing a Case study of organ donation. The authors present the case of a woman in her mid-50s who sustained extensive brain injury and proceeded down the donation after circulatory death pathway.

 

There is a full discussion of the ethics of the case as well as the need for there to be collaborative work practices established for all who are involved in the organ donation process.

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