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ORGAN DONATION AND ALLOTRANSPLANTATION

ORGAN DONATION AND ALLOTRANSPLANTATION. HEALTH LAW AND BIOETICS Helena Pereira de Melo 23 April , 2014 Szilvia Szabó - 003903. ORGAN DONATION AND ALLOTRANSPLANTATION Introduction. Organs and tissues for donation heart , kidneys , liver , lungs , pancreas , intestine , thymus

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ORGAN DONATION AND ALLOTRANSPLANTATION

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  1. ORGAN DONATION AND ALLOTRANSPLANTATION HEALTH LAW AND BIOETICS HelenaPereira de Melo 23 April, 2014 Szilvia Szabó - 003903

  2. ORGAN DONATION AND ALLOTRANSPLANTATIONIntroduction • Organs and tissuesfordonation • heart, kidneys, liver, lungs, • pancreas, intestine, thymus • Bones, cornea, skin, heartvalves • Nervesand veins… Most of kidneys>liver>heart • Cultureinrelationtotransplant • Human rightsinrelation • Justicerights • Beneficerights

  3. ORGAN DONATION AND ALLOTRANSPLANTATIONIntroduction – Human rights • Mr. George Olds is a 76-year-old nonsmokingretired business executivewithend-stageheartfailure. He has goodpulmonary and renalfunctionand is notdiabetic;thus he is medically a goodcandidateforahearttransplant. His life expectancywithout a transplant is 1 mouth. He has a lovingfamily, withtheresourcestopaythe $100,000 cost of procedure. • Mr. Matt Younger is a 46-year-old divorced man who is unemployed, havinglosthisjobas an autoworker 3 yearsago. He has a history of smoking and alcoholuse. He suffers a heartattack, developsintractableheartfailure, and will die within 1 mouthwithout a hearttransplant. He has goodpulmonary and renalfunctionand is notdiabetic, makinghim a goodcandidatefortheprocedure. Whoshouldreceiveit? 1984 National OrganTransplaltationActdesignedthe United Network forOrganSharing (UNOS)

  4. ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – before modern society

  5. ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 19 century • 1818 first human – to – humanbloodtransfusion • 1831 Mary Shelley publishes Frankenstein • 1878 firstsuccessful human – to – humanbonetransplant • 1881 firstreporteduse of skingraft • 1896 firstattemptsatbonemarrowtransplant

  6. ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 20 century • 1900-1902 bloodgroupsdiscovered • 1902-1908 CarrelDevelopsTechniqueforconnectingblood • 1905 firstsuccessfulcorneatransplant • 1908 firsttransplant of a knee • 1909 firstrecordedkidneytransplant, animalto human • 1913 researchescreatethefirstartificialkidney

  7. ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 21 century 2000-2002 • Population of kidneyfailurepatiensgrows • Tissue and bloodbanksrespondto terror attack • Number of livingdonorspassescadavericdonors • Patientslivingwithorgan and tissuetransplantsnumbersintheMillions 2003 • Eighteenpeople die eachdayonthewaitinglist 2004 • 50th anniversary of thefirstkidneytransplant 2004 and beyond • The future of transplantation

  8. Deathbymedicalsience • Clinicaldeath: The circulation, breathingand brainfunctiontemporarilysuspended. Reversible! 2. Biologicaldeath: The body’sviability is irreversiblyterminated. 3. Braindeath: The brain– includingthebrainstem – complete and irreversiblecessation. The sameasthetraditionalsense of invidual’sdeath

  9. LegalDeath – A statutorydefinition of death? The Criminal Law RevisionCommittee (1980): acknowledgetheexistence of thebraindeath. Totakeplacein a statuewould be toorestrictive. Intheothersidewouldpromotedistrust. Main questions: What is human death? Howcanwedeterminethat is has occured? • The currentmainstreamview– thewhole-brainapproach (irreversiblececassion of brain and brainstream) • The progressivealternative – thehigher-brainapproach(irreversiblececassion of consciousness) 2.1. essence of human persons 2.2. personalidentity 2.3. thedefinition of death is a moralissue

  10. Braindeath

  11. Deathoralive?The case of anencephalicnewborns 95 % of which die withinthefirstpostnatalweek ‚Organsobtainedfromtheseanencephalicnewbornscouldmake a substantialcontributiontothesupply of infantorgans’ ‚Theywouldprovide a significantproportion of transplantableorgans’ US Uniform Determination of DeathAct (1980) alsorequiresthatanencephalicslikeallorgandonorsmeetestabilishedcriteriaforbraindeath, icludingcessation of brainstemactivity, beforetheyareusedasdonors.

  12. Transplantation’sinterspecies • Allotransplantation is thetransplantation of cells, tissues, ororgansto a recipientfromageneticallynon-identical donor onthesame species. • Autotransplantation is thetransplantation of organs, tissuesorproteinsfromone part of the body to an otherinthesameinvidual. • Xenotransplantation is thetransplantation of livingcells, tissuesororgansfromone species toanother(pigs – human) • Isograft is a graft of tissuebetweentwoinvidualswhoaregeneticallyidentical. (i.e. Monozygotictwinswherethetransplantrejectionneveroccur)

  13. Transplantation • Live donor transplants • Cadavertransplantation • FoetalTissueTransplantation 2.1 Opting/Contractingincountries: USA, UK, Canada, Germany, The Netherlands, Switzerland, New Zeland, Australia, Japan, South Korea, Thailand, Ireland, South-America, and in most Arab countries 2.2 Opting/Contractingoutcountries: Austria, CzehRepublic, Poland, Denmark, Portugal, Finland. Somecountriescanchoosetogiveopportunitytoaskthefamily (France, Italy, Spain)

  14. TransplantationfromLiveDonors • Wholeorgans (kidneys) • Organmaterials (liverorbonemarrow) 2 cases • Parentsconceived a childinthehopethatthebaby’sbonemarrowcellswouldsavethe life of a teenagedaughterdying of leukemia. • 3 years old one of twin’sbonemarrowrequestdbythefather of theirhalf-brotherinthefaceoftheirmother’sobjection ‚thelawalonecannotprovideall of theanswerstomattersof human relation’ (Curran 1991)

  15. FoetalTissueTransplantation • Fromabortedfoetus (may be infectedordefective) • ‚secondpatient’ • ?Independent fromthewoman? Usefulness: • Itseemstohavethegreatesttherapeuticpotentialsuchas - Parkinsonism, • Treatment of diabetes and • immunodeficiencydisorders, • Anaemiapatients, • Immunesystemresearch. Inthe US researchsouldcontinue, onpoliticalgroundstoo (=wintheanti-abortionmovement). Modification:allowresearchonspontaneouslyabortedfoetuses and embryos, andwillprobably be overturnedintime.

  16. FoetalTissueTransplantation The Council of Europe (1986) ‚evenwhendeadtheembryo of foetusretainsits human character and … respectfor human dignityrequiresthat anycommercialorindustrial use must be prohibited’ BeneficeRightsinFoetalTransactions (US National OrganTransplantAct 1983; United StatesniformAnatomicalGiftAct 1983)

  17. FoetalTissueTransplantation • Howtoprovideequitableacesstothesescaretissues? • Howtoprotectthe right of couplesorwomentoproducefoetaltissuetohelplovedones? • Howtoavoidthepossibleexploitation of poorwoman?

  18. https://www.youtube.com/watch?v=uXulTMrNI4M Organtheftin Kosovo

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