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Organ Transplantation

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Enoch Huang

on 16 June 2013

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Transcript of Organ Transplantation

An incision is made just under the ribs on both sides of the abdomen, extending straight up for a short distance over the breastbone.
The diseased liver is separated from surrounding structures, and arteries and veins are either clamped to stop blood flow, or bypass tubes are used to redirect blood flow.
Nephrectomy (deceased donor)
1906- 1st successful corneal transplant (no blood vessels)
1913- monkey kidney put into patient, died 3 days later
1923- lamb kidney put into patient, died 7 days later
1930- various human organs put into 6 humans, all died
1954- kidney from one twin into another was successfully transplanted
Organ Transplantation
By: Annie, Daniel, Enoch, Jessie
What is organ transplantation?
Organ transplantation is the process of moving an organ from one body (donor) to another body (recipient) in order to replace one that is damaged or missing.
Kidneys are the most commonly transplanted organ. Other types of transplants include pancreas, kidney and pancreas, liver, intestine, heart, lung, or heart and lung.
An incision is made in the chest, and anti-coagulation medicines are given.
A heart-lung machine ("the pump") is connected, which maintains blood circulation and oxygen content during surgery.
The aorta is clamped to stop blood flow.
In the original heart, the atria are left intact, plus the aorta past the coronary arteries, to provide large suture lines that help decrease surgical time.
The donor heart is dissected to match the native heart and aorta, and the two are joined by sutures.
"You Only Liver Once!"*
Nephrectomy (living donor)
Kidneys can be approached from the front, back or side. Each approach has its own advantages and disadvantages.
In a simple nephrectomy, once the kidney is exposed, the covering envelope called Gerota's fascia is opened. The fat around the organ is dissected, adjacent blood vessels are tied and cut, and the kidney is removed.
Dead Donation
Dead donation is when organs from a deceased corpse are harvested for transplantation
There are two main methods of determining death
The controversy lies in the question of how scientists and doctors can tell if someone is really dead
Donation by brain death
Donation by cardiac death
Supporters claim that the methods used are safe and reliable in determining death, and dead donors are essential to saving many lives
People opposed to using these criteria say that brain death is not true death
What is the brain-death criteria?
•In a 3 month period in 1968, the Harvard committee (Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death) came up with a simple set of criteria that allows doctors to declare a person dead in less time than it takes to get a decent eye exam
Unreceptivity and nonresponsivity. The committee’s standards reads, “Even the most intensely painful stimuli evoke no vocal or other response, not even a groan, withdrawal of a limb or quickening of respiration.”
No movements or spontaneous breathing, without being aided by a respirator. Doctors must watch patients for at least one hour to make sure they make no spontaneous muscular movements or spontaneous respiration. To test for spontaneous respiration, physicians are to turn off the respirator for three minutes to see if the patient attempts to breathe on his own, called the apnea test.
No reflexes. To look for reflexes, doctors are to shine a light in the eyes to make sure the pupils are dilated. Muscles are tested. Ice water is poured in the ears.
Flat EEG. Doctors should use electroencephalography, a test “of great confirmatory value” to make sure that the patient has flat brain waves.
•These tests have to be repeated for at least 24 hours with no change
However, the committee discovered that hypothermia and drug intoxication can mimic brain death. Since then, scientists have found more mimicking conditions of brain death.
Furthermore, Harvard’s criteria were based on zero patients and no experiments were actually conducted on humans or animals
But several states still adopted these standards for declaring people dead
•In 1981, the Uniform Determination of Death Act (UDDA) was sanctioned by the National Conference of Commissioners of Uniform State Laws
UDDA is based on Harvard Ad Hoc’s report. And it is a 4 page article defining death, which became codified by all 50 states within 13 years
death declared on the basis of cardiopulmonary criteria
irreversible cessation of circulatory and respiratory function
Cardiac Death
Obtaining organs from donors after cardiac death used to be valid when the heart stopped beating
generally followed in the 1960s and earlier
Today, donations typically involve patients who are on a ventilator as the result of devastating and irreversible brain injuries
such as those caused by trauma or intracranial bleeding
Potential donors might also have high spinal cord injuries or end-stage musculoskeletal disease
Organ Procurement and Transplantation Network (OPTN)
Under contract with the federal government
Developed rules for donation after cardiac death, which was finalized in March 2007
Process begins with the selection of suitable candidates and the consent of the legal next of kin to the withdrawal of care and retrieval of organs
Cardiac death donors usually already know that they will pass away soon, and donation after an unexpected fatal cardiac arrest is rare
When the potential donor meets the criteria for cardiac death, a doctor pronounces the patient dead
The time from the onset of asystole typically takes about 5 minutes, but it may be as short as 1.25 minutes
Onset = the absence of sufficient cardiac activity to generate a pulse or blood flow
Asystole = the point of the declaration of death
Then the organs, most commonly the kidneys and liver but also the pancreas, lungs, and, the heart are recovered
To avoid obvious conflicts of interest, neither the surgeon who recovers the organs nor any other personnel involved in transplantation can participate in end-of-life care or the declaration of death
The length of time varies as to which organs can be deprived of oxygen and still be transplanted successfully
It is best to retrieve the liver less than 30 minutes after the withdrawal of life-sustaining measures; the kidneys and pancreas may often be recovered up to 60 minutes after withdrawal
If a patient does not die quickly enough to permit the recovery of organs, end-of-life care continues and any planned donation is canceled
At present, this may happen in up to 20% of cases
Few medical procedures have proven to be as effective in saving lives as organ transplantation
Organ recipients often live for an extended decade or longer after receiving a transplant
Dead donors are important in organ transplantation because only dead donors can donate vital organs like hearts. Living donors can only donate paired organs, such as kidneys and livers so the donor can survive with just one.
Support from the Catholic Church
The Catholic Church, especially the late Pope John Paul II, have been enthusiastic supporters of organ transplantation
"organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity" - Catechism of the Catholic Church
In 2000, Pope John Paul II supported organ donation and the use of neurological criteria
Pope John Paul II called organ donation a “genuine act of love” and a “way of nurturing a genuine culture of life.”
"The criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology."
“A health worker professionally responsible for ascertaining death can use these criteria.”
Legal Status of Organ Trade
The sale, monetary exchange, or trade of organs is illegal in almost all countries.
Organ trade is condemned by several international organizations, such as American Medical Associates, UNESCO, the World Health Organization, and the U.S. Task Force on Organ Transplantation
Organ Laws In the United States
U.S. organ trade is prohibited by the Uniform Anatomical Gift Act (UAGA) and the National Organ Transplant Act of 1984 (NOTA)
At a federal level, a conviction of organ sale in the U.S. results in up to 5 years in jail and/or up to a $50,000 fine according to NOTA
A federal law (42 U.S.C. §274(E]) made it illegal for a person to “knowingly acquire, receive, or transfer any human organ for valuable consideration for use in human transplantation” (Hedges 175)
Organ trade is seen as immoral. When a physician named Barry Jacobs was convicted in 1983 for creating a kidney trade network between developing countries and the U.S. This resulted in strong public dissent against organ trade and the passing of NOTA
U.S. Organ Donation Guidelines
Why Is There A Donation Shortage?

Some organizations try to create incentives:
In Singapore: by law, a kidney recipient can pay for his donor's travel expenses, lodging, and time off work
In the U.S., the National Transplant Assistance Fund provides some monetary assistance for uninsured organ donors
Organ Trade "Black Market"
Exploitation of the Poor
What If Organ Trade Was Legalized?
The problem: There is a widespread shortage of legally donated organs in the world.

The Solution?: Acquire organs through monetary incentives for donors (currently illegal in most countries). But, this is usually done to get the poor to sell their organs.
2013 data

There are specific guidelines under the UAGA for how organs can be legally donated:
A donor may make an "anatomical gift" if the donor has signed a document of a gift signed in front of two witnesses
If donor wants to revoke or amend the donation, he has to clearly state the donation's intentions and sign it in front of two witnesses
If the donor is incapable of making the donation, consent may be given in the following order: spouse, adult child of decedent, either parent, adult brother or sister, grandparent, guardian
Hearts can be stored 4-6 hours, livers have 24 hours, and kidneys can be kept up to 48 hours.
The goal in storing organs is to cool them but not freeze them.
In harvesting from a dead donor, cold fluid is flushed into the organ and sterile ice is put in the body cavity.
The removed organs are packed in layers of containers and surrounded with a cold, slush like mixture.
Machines must continually pump cooling solution through kidneys, but other organs can simply be put in it.
kidney (nephrectomy) & liver (hepatectomy)
Organ matching process common elements:
Body size, blood type, proximity to hospital, severity of condition, mortality risk of future
People waiting for a heart receive a status code (urgency)
People waiting for a lung receive a score based on lab test results
These thoracic organs can only be outside body for 4-6 hours, so priority goes to people near or in the hospital where organs are taken from donor.
How are hearts and lungs allocated?
•Adult 1A: 18 years of age and meets one of the heart disease criteria
•Adult 1B: 18 years of age and has an assist device of some sort
•Adult 2: 18 years of age and does not qualify for 1A or 1B
Pediatric Status Codes (Heart):
•Pediatric 1A: less than 18 and meets one of the criteria, ex. Mechanical ventilation, extreme youth.
•Pediatric 1B: less than 18 and meets one of the criteria, ex. Deviations in standard height or weight growth
•Pediatric 2: less than 18 and does not qualify for 1A or 1B
If candidate is unsuitable for transplant, called "inactive"
Allocation of hearts from donors aged 18+
Lower on list: in utero, or farther away (Zone E), incompatible blood
Adult Status Codes (Heart):
Where Are A Lot of Donors In The World?
Allocation of hearts from donors aged under 18
Most donors are from developing countries, since people in those countries are usually desperate for money
Organs are expensive when sold, so only the wealthy are able to obtain them
For lung allocation: Lung Review Board (LRB) can accept or deny a request to be higher up on the classification list, voted on within 7 days
How are livers allocated?
Patients receive a MELD or PELD score (Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease) to indicate urgency
MELD: 10 ((0.957 loge(creatinine mg/dL) + 0.378 loge(bilirubin mg/dL) + (1.120 loge(INR) + 0.643))

PELD: 10 ((0.436 (if age is less than 1 year) + (0.480 loge(bilirubin mg/dL) + (1.857 loge(INR) + (0.667 (if candidate has growth failure) - (0.687 loge(albumin g/dL))

You will get specific MELD or PELD scores if you have certain conditions, for example patients with Cholangiocarcinoma or Cystic Fibrosis automatically get a MELD=22 or PELD=28
Patients with Hepatic Artery Thrombosis (HAT) automatically get a score of 40
Adult Statuses (Liver): Adult 1A: the candidate registered on the waiting list before turning 18 years of age, has a life expectancy without a liver transplant of less than 7 days, is in the intensive care unit (ICU), and has condition from list
Risks of Illegal Organ Transplant
Pediatric Statuses (Liver): Pediatric 1A: the candidate registered on the waiting list before turning 18 years of age, has a life expectancy without a liver transplant less than 7 days, and has condition from list.
Pediatric 1B: 1. Registers on the waiting list before turning 18 years of age, Has a MELD/PELD greater than 25 and condition from list.
Liver Points:
Donors can be defrauded by the sellers (the middlemen):
Sellers may not give as much money as they originally offered for the organ
Donors may not receive proper medical care for the surgery as well as during recovery
Recipients fear organs will have diseases (fungus, hepatitis, or HIV) or be a poor match
Recipients also fear whether or not the surgery is performed under sanitary conditions
10 if status 1A or 1B and has a blood type identical to the donor
5 if Status 1A or 1B, has a blood type O, and will accept a liver from a donor with a non-A1blood type
5 if Status 1A or 1B and has a blood type compatible with the donor
0 if blood type is incompatible
For general Status 1A or 1B patients: points = 10 x ((rank of candidate’s waiting time within the classification, from smallest to largest) / (number of candidates within a classification))
Within each classification:
Status 1A heart candidates are sorted by waiting time at Status 1A.Status 1B heart candidates are sorted by waiting time at Statuses 1A and 1B.Status 2 heart candidates are sorted by waiting time at Statuses 1A, 1B, and 2.
Allocation of livers from donors aged 0-10
Allocation of livers from donors aged 11-17
Allocation of livers from donors aged 18+
Within each allocation classification...

Status 1A patients are sorted by:
1. Total points (highest to lowest)
2. Total waiting time at Status 1A (highest to lowest)
3. Previous waiting time at Status 1 (highest to lowest)
4. Total waiting time (highest to lowest).
Status 1B patients are sorted by:
1. Total points (highest to lowest)
2. Total waiting time at Status 1B (highest to lowest)
3. Total waiting time (highest to lowest).
Candidates with MELD/PELD score ≤ 6 are sorted by:
1. Identical blood types, compatible blood types, then incompatible blood types
2. Total waiting time (highest to lowest)
3. Then those waiting list positions assigned to candidates with a PELD score less than or equal to six are redistributed between those candidates according to their PELD score (highest to lowest).
Everyone else is sorted by:
1. MELD/PELD score (highest to lowest)
2. Identical blood types, compatible blood types, then incompatible blood types
3. Waiting time at the current or higher MELD/PELD score (highest to lowest)
4. Total waiting time (highest to lowest).
"Kidney Zones"
Kidney Zones: Locations where illegal organ trade flourishes

“Kidney zones” emerge from interactions between surgical entrepreneurs, improvised people, and medical brokers

Globalization has brought organ transplant to countries all over the world, and with it has created kidney zones in places where foreigners have easy access to
As of right now, there are 118,413 total people on the national waiting list to receive organs.
Kidneys: 96,525
Pancreas: 1,177
Kidney/Pancreas: 2,086
Liver: 15,726
Intestine: 264
Heart: 3,502
Lung: 1,646
Heart/Lung: 46
Concerns and Regulations from the Supporters
The Catholic Church does not view organ donation as intrinsically wrong, but it suggests how research may be conducted respectfully.
John Paul II says, "Any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an 'object' is to violate the dignity of the human person."
Organ donation should also require the informed consent of the patient or the patient’s family.
Organ Gangs / Body Mafias
Criminals who have links to hospital surgeons and police force to illegally transplant organs. Set up agreements with surgeons throughout the world to perform donor and recipient surgeries
Organ gangs are the main driving force behind illegal organ trades
Wealthy recipients use organs obtained by body mafias to bump up on the waiting list
Organ gangs turn the exploitative nature of the organ trade into a commercial business
China' Organ Trade
China is the only country in the world to transplant organs from executed prisoners.
China has become a haven for foreign recipients. They spend up to $30,000 per organ transplant
Hospitals are heavily involved in the organ trade in China
Hospitals in China are increasingly market-driven. Hospitals are under pressure to generate income
Hospitals ask few ethical questions as to the source of the organ being transplanted
Paul A. Byrne is a neonatologist at St. Charles Mercy Hospital in Oregon, Ohio
“Patients who have been declared brain dead for the purposes of organ transplants are not truly dead because there has not been complete cessation of all of the functions of the brain, including the brain stem. In reality, when organs are harvested from a brain dead patient, they are being taken from a living body. Organs from a body that is completely dead are not useful for transplantation. Therefore, a patient's right to live is violated by the declaration of brain death and doctors who harvest organs from a brain dead person are committing homicide”
In a radial nephrectomy, the adrenal gland and surrounding lymph nodes are also removed.
These may also be hand-assisted, where the surgeon actually removes the kidney by hand. This allows the surgeon to feel the kidney and surrounding structures.

A vertical incision is made from below the breastbone to the navel.
Muscles are moved aside, and another cut is made through the outer membranous lining of the body cavity to reveal the inner organs.
Post-operation: Immunosuppressant drugs and rejection
There are 3 types of rejection:
chronic rejection develops over months or years.
acute rejection develops within days.
hyperacute rejection can occur within minutes, but is not common in human-to-human transplants.
Immunosuppressants are drugs used to prevent rejection by suppressing the immune system. However, this also makes the user more vulnerable to disease/infection.
There are 4 groups of immunosuppressants.
Most patients begin with a group 1 and a group 2, which they stay on forever.
They will also take a group 3 drug for about a year and then stop if the transplant is working well.
GROUP 1: cyclosporine and tacrolimus
Tacrolimus works directly on skin cells.
It binds to a receptor inside to inhibit a protein that reduces T cell activity.
This also prevents cytokine production.
GROUP 3: prednisolone
The problem: Millions of people in the world are in poverty and desperate to get money in any way possible

The solution: Poor people sell their organs. They make money, the vendors make money, and recipients get an organ. It's a win-win situation, right?
Wrong. At least not for the poor.
A curved incision is made on one side of the abdomen, just above or around the top of the pelvis.
The renal arteries and veins of the donor kidneys are sutured to the recipient's iliac artery and vein, and the donor ureter is connected to the recipient's bladder.
In reality, organ vendors profit fifteen to twenty times the amount that donors make for their organs.
It's possible that a kidney can be bought for $1,000 from a donor and sold for $40,000.
The new organ is placed above the pelvis, below the site of the original kidney.
A small plastic pipe is usually inserted into the ureter to prevent it from becoming blocked, and then removed after a few months.
In about a third of transplant patients, the new kidney will not produce urine for a few days - this does not necessarily indicate failure.
How are kidneys allocated?
Brain Death is not True Death
Brain-dead patients continue to exhibit:
Cellular wastes continue to be eliminated, detoxified, and recycled
Body temperature is maintained, though at a lower-than-normal temperature and with the help of blankets
Wounds heal
Infections are fought by the body
Infections produce fever
Organs and tissues continue to function
Brain-dead pregnant women can gestate the fetus.
Brain-dead children mature sexually and grow proportionately
Zack Dunlap
"Brain death" never was, and never will be true death.
Vendors are deceptive
Vendors including organ gangs use deception, violence, extortion, and coercion to force people to sell their organs so that vendors are able to make a profit.
Example: A Moldovan shepherd was offered $10,000 from an organ gang to sell his kidney.
The shepherd was forced out of desperation to accept the offer
But they only gave him $7,500 for all his problems. And $2,000 was paid in counterfeit bills
•Zack Dunlap from Oklahoma was declared dead, and a transplant team was ready to take his organs until the young man moved
Zack was not truly dead but would have been truly dead had they excised his heart for transplantation
Zack claimed that he could hear the doctors discuss his brain death but he could not move at that time to tell them that he was alive
Point system:
1 point per year waiting
1 x ((rank of candidate’s waiting time within the geographical distribution unit, from smallest to largest) / (number of candidates within the geographical distribution unit))
4 points if aged 0-10 and zero antigen mismatch with donor
3 points if aged 11-17 and zero antigen mismatch with donor
1 point if aged 0-10 and donor is under 35
4 points if you were a prior living donor
1 point if you share a match with the donor at one HLA-DR loci
2 points if you share a match with the donor at two HLA-DR loci
No matter how generous one might want to be by donating his own self, or vital organs from someone else to save others, suicide or homicide to save another is not morally acceptable
Another method is donation by cardiac death (DCD)
Organs are obtained for transplantation by first getting a DNR (Do Not Resuscitate) order, then taking the patient off life support and waiting until the patient is without a pulse.
The waiting period decreased from 10 minutes to 5, then 4, then 2, and now the waiting period is a mere 1.25 minutes.
This waiting period is too short and humans could still be alive
The Israeli Organ Gang
An Israeli organ trafficking group led by Levy Rosenbaum, the only person convicted of organ trafficking in the U.S. since 1984, tried to recruit poor people to donate their organs:

An Israeli unemployed man, Avichai Osuna, from Beer Sheva, a working class town, was recruited to sell his kidney as well as get paid $410 per month to network for the gang with foreign hospitals to arrange illegal organ transplants.
Osuna refused to sell his organ out of fear. The organ gang threatened him with violence. In addition, they told him if he did not sell his kidney, he would be in debt to the mafia.
Osuna was flown to New York City for health and blood checks and a donor surgery. Osuna remained in New York for six months in a room under a couple of minders' watch until the recipient eventually backed down.
The hospital where Osuna was getting health checks in claims it sets many obstacles against organ traffickers using the hospital
Osuna was then flown to Manila where he was paid $26,000 for his kidney from a wealthy Israeli citizen.
Osuna claims the psychological damage behind all of this was not worth the money he was given.
Only one country has a legal organ trade: Iran (kidneys only)

Iran's system provides evidence for how a legal system might work.
Iran's Kidney "Vendor" System
Pros of Iran's Legalization
•In the UK, a potential deceased organ donor is assumed to have not provided his or her consent to provide organs for transplant, even if that person carries a Donor Card or has previously indicated their wish to donate
•The process of seeking permission or refusal of the donor’s relatives and kin result in delays, failed operations, and continuing misery for potential organ recipients
•The kidney transplant waiting list was at least 7,000 long in 2002
System should assume that consent for donation is assumed if the donor has previously expressed interest in donating organs
Unless a relative has expressed a wish to “opt out” of the system
Also, donors should inform families and friends about their wish to donate so that they do not “opt out” against the donor’s wishes
•In European countries that assume consent:
Issues of compensation, illicit live organ trading or lack of organs available for transplant do not exist
No waiting lists for kidney transplant operations in these countries
Lower risk of illegal organ trade
Family members may make the decision to give consent for organ or tissue donation after their loved one has passed on
These donors or their family members have the opportunity to indicate whether any organs or tissues ineligible for transplants may be donated to benefit research studies like GTEx (The Genotupe-Tissue Expression Project)
Donating to GTEx would not interfere with the use of the organ or tissues for transplantation, which takes priority
Rules for consent:
How Do Vendors Get Compensated?
Vendors are initially paid $1,200 by the Iranian government plus limited health insurance until one year after the surgery and only for concerns deemed related to the surgery.
Vendors receive remuneration from the recipient. If the recipient is impoverished a charitable organization will provide remuneration of between $2,300 and $4,500 (as arranged by DAPTA)
So vendors receive money under a regulated market.
Calculated Panel Reactive Antibody:
CPRA is based upon the candidate’s unacceptable antigens.
4 points if CPRA ≥ 80%
By 1999, there was no waiting list for kidney transplants in Iran
DATPA is a not-for-profit "middleman" compared with the for-profit organ gangs
DATPA act as an intermediary in events of moral conflicts.
There is a huge reduction in the amount of people being exploited for their organs.
Kidneys from deceased donors are classified as either being from a standard criteria donor (SCD) or an expanded criteria donor (ECD).
Within each classification...
Potential recipients of SCD kidneys are sorted by total points (highest to lowest).
Potential recipients of ECD kidneys are sorted by waiting time (longest to shortest).
Although entire livers can only be harvested from deceased donors, living donors can choose to donate a part of their liver.
Cons of Iran's Legalization
A candidate will be classified as a prior living donor and receive priority for each kidney if the candidate donated at least one of the following in the U.S.
Liver segment
Lung segment
Partial pancreas
Small bowel segment.
Organ Storage
Iran's system does not guarantee safety.
Recipients of kidneys from the vendor system have a ten-year survival rate of 44% compared with a ten-year survival rate of 53% for recipients of living organ donors.
Because of socioeconomic reasons, Iranian organ vendors tend to be likely to have developed a form of kidney disease.
What This Means?
If heavily regulated, a legal organ trade market could work.
The problem with Iran is that it is difficult to regulate a market in a developing nation.
But, in the U.S., it may be possible for a heavily regulated legal organ trade to exist to cut on shortages.
The problem is the risk to implement this seems to be both ethical and socioeconomic.
Laparoscopic nephrectomies use flexible videoscopes maneuvered through incisions to view the kidney and surrounding tissues.
This method takes longer than a standard, open nephrectomy, but promotes shorter recovery and less pain afterwards.
If removed from a cadaveric donor, the abdominal aorta and inferior vena cava above and below the kidneys are isolated.
A thin tube is inserted to irrigate the kidneys with preservation fluid, and both kidneys, ureters, and related blood vessels are all removed.
kidney, liver & heart
Livers must always be removed since they are so large, weighing an average of 5 lbs in full grown adults.
Arteries and veins are then connected to those of the donor liver.
The donor liver is connected to the recipient's intestines, and the arteries and veins are either unclamped or the bypass tubes are removed.
Then the cardiac chambers are deaired as the organs fill with blood, which is diverted from the pump.
Cyclosporine works by penetrating helper T cells and binding to a protein inside, blocking the action of other proteins so that the cell cannot produce cytokines.
This means it can't activate the rest of the immune system, and very few mature B and T cells are formed.
This drug mimics the effects of hormones naturally produced by the adrenal glands.
When the dose of prednisolone exceed the body's natural levels, inflammation is suppressed.
“There are countless instances in which America allows the poor to do dangerous things with their bodies for money. Working-class people shoulder the burden of war; they risk their lungs and limbs in mine shafts, factories, slaughterhouses, and fishing boats. And it remains perfectly legal for a surrogate mother to sell her womb—also no small physical burden. What makes a kidney so special?” -Cord Jefferson
The Organ Trade Should Be Legalized
The Organ Trade Should Be Kept Illegal
People typically don't want to donate to strangers
The procedure takes a long time, requires a lot of time in the hospital, is very painful for months after surgery, and recovery takes a long time.
Only legally donated organs may be legally transplanted.
The UAGA also set strategies for locating organ donors
Opposing Viewpoints
Legalization could lead to regulation of the organ trade and could eliminate all the health and economic abuses experienced by either the donor or the recipient by organ gangs or vendors
The risk of death for illegal organ transplantation is not as high as some dangerous yet legal occupations. Therefore, it would not be fair to say that the organ trade should be outlawed because some people can die from it (a lot of people could actually be saved from death with a legal organ trade).

Organ donors could obtain complete consent on whether or not they wish to donate, rather than being forced to donate by crime gangs.
Most bioethicists believe that organs should not be made a "marketable commodity" in the open market.
Legalization would make would-be donors think they could easily get out of poverty by selling a part of themselves
The sale of organs is exploitative towards the poor
Criminality of the "Black Market"
Money and Organs Typically Flow From The "Third World" to The "First World"
In Iran's system, potential kidney recipients, once they have already expressed their interest, are consulted by kidney transplant teams and told that a donation from a closely related relative is in their best interest.

Potential recipients wait for a match to be found. If no deceased match can be found within 6 months, recipients are referred to the Dialysis and Transplant Patients Association (DATPA) which identifies compatible kidney donors. DAPTA is staffed by people with End Stage Renal Disease who are not financially compensated for their work.
Vendors express their own interest in participating by contacting DATPA. Vendors are then medically evaluated through the same standards as living donors who are not financially compensated.
So What About You?
1. When should a human being really be considered "dead"?
2. Should consent be assumed when the donor is dead? How much power should the relatives have over what happens to the donor's body?

3. Who do you think should be prioritized for receiving organs?

4. Would you feel comfortable donating an organ? (Living or dead?)

5. Do you think it is possible for a legalized organ trade system to function without any corruption, widespread health problems, or exploitation? Do you think legalization would be effective?
*Unless You Transplant
Classification:•1. In donor hospital’s local unit and Zero antigen mismatch and a blood type identical with the donor•High on list: younger than 18, high CPRA points•Low on list: CPRA between 20 and 80 %, compatible blood type•Children under 11 who need kidneys are automatically assigned additional points
How are pancreata allocated?
1. Donor hospital’s local unit, CPRA 80+, zero antigen mismatch
2. Donor hospital's local unit, CPRA 80+

Lower on list, farther away
Low short term risk apart from surgery risk.

Long term risks are undocumented—small risk of end stage renal disease, hypertension, no association with low glomerular filtration rate

Living donors only allowed to donate paired organs or organs that can regenerate
Surgical risks to donors after living kidney donation:
From January through March, 6,891 organ transplants have been performed. 5,456 were organs from deceased donors, and 1,435 were from living donors.
Source: traffickingproject.org
Bypass tubes are inserted into the hepatic veins and connected to veins in the arms to direct blood flow away from the liver.
Then the hepatic veins are cut and the liver and gall bladder are removed.
Depending on circumstances, the original/diseased kidney may not have to be removed.
On average, with no complications, a kidney transplant takes 2-4 hours.
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