UNIT III ORGAN TRANSPLANTATION AND REPLACEMENT Organ Transplantation

An organ transplant replaces a failing organ with a healthy organ. A doctor will remove an organ from another person and place it in your body. This may be done when your organ has stopped working or stopped working well because of disease or injury. You may need an organ transplant if one of your own organs has failed. This can happen because of illness or injury. When you have an organ transplant, doctors remove an organ from another person and place it in your body. The organs that can be transplanted include Heart Intestine Kidney Liver Lung Pancreas People who need an organ transplant often have to wait a long time for one. Doctors must match donors to recipients to reduce the risk of transplant rejection. This is when the recipient's body turns against the new organ, causing it to fail. People who have transplants must take drugs the rest of their lives to help keep their bodies from rejecting the new organ. How Organ Transplants Work Sixty years ago, scientists were on the cusp of a revolutionary scientific breakthrough. In the preceding decades, researchers had had some success transplanting organs in animals, and there had even been a few failed attempts at human organ transplants. Numerous studies showed that human organ transplantation was feasible, and that it would be enormously beneficial to thousands of patients, but nobody had been able to make it work. Success finally came in the early 1950s, when several kidney transplants within a few years gave new life to ailing patients. In the following decades, doctors learned how to transplant other organs successfully, and they dramatically improved recovery rates. Today, most organ transplants are relatively safe, routine procedures, and transplantation is considered to be the best treatment option for thousands of patients every year. Unfortunately, doctors and patients now face a new obstacle: The demand for transplants has far surpassed the supply of donated organs. Simply put, there aren't enough organ donors, so patients must wait months, even years, for their chance at recovery. In this article, we'll look the three major processes involved in organ transplantation: the organ distribution system, the surgery itself and the post-surgery recovery. We'll also explore how scientists and politicians are working to remedy the organ-shortage problem. The Screen, the List and the Match Organ transplants are one option when a particular organ is failing. Kidney failure, heart disease, lung disease and cirrhosis of the liver are all conditions that might be effectively treated by a transplant. For problems with the heart, the lungs and other highly sensitive organs, a transplant is

typically the course of last resort. But if all other avenues have been explored and the patient is willing and able, transplantation is a good, viable option. Kidneys and livers may be transplanted from a living donor, since people are born with an extra kidney and the liver is regenerative. Even a lung can be transplanted from a living donor, but this is still very rare. For these procedures, a patient will generally find a willing donor in a friend or family member. If the donor is a match, they can proceed directly to the surgery stage. A smaller number of living transplants come from charitable people donating for the general good. If a patient needs a heart transplant, a double lung transplant, a pancreas transplant or a cornea transplant, they will need to get it from a cadaverous (deceased) donor. Generally, acceptable donors are people who are brain dead but on artificial life support. Even though they are technically dead, their body is still functioning, which means the organs remain healthy. Organs will deteriorate very quickly after the body itself expires, making them unusable for transplant. In the United States, a patient who wants an organ transplant from a cadaverous donor must become part of an elaborate nationwide organ distribution system. This system, known collectively as the Organ Procurement and Transplantation Network (OPTN), is operated by the United Network for Organ Sharing (UNOS), an independent nonprofit organization working under contract with the U.S. Department of Health and Human Services. UNOS maintains a database of eligible transplant patients awaiting organs as well as detailed information on all the organ transplant centers around the country. Additionally, the UNOS board of directors, primarily made up of transplant doctors, transplant patients and organ donors, establishes the policies that decide who will get which organs. Getting on the List To be included on the national waiting list, a patient must first find a transplant team that will treat him or her. The transplant team, a group of surgeons, nurses and other health professionals at a hospital, evaluates the patient to decide whether he or she is a good candidate for transplantation. In addition to assessing the patient's physical condition, the team will consider the patient's attitude, psychological state and history of drug abuse, among other factors. Donated organs are a rare and precious commodity, so doctors don't want to proceed unless they are confident that a patient is physically and mentally prepared for the procedure, as well as life after the procedure. For the most part, patients who are unwilling to give up unhealthy drugs, including cigarettes and alcohol in many situations, will be automatically disqualified. If the transplant team feels that a patient is a good candidate for transplant, they will contact the UNOS Organ Center in Richmond, VA, in order to put the patient on the national waiting list. The Organ Center operators record all relevant information about the patient, including his or her physical condition, blood type, tissue type and age. This information is entered into the national database.

When an organ becomes available (when an organ donor is pronounced brain dead at a hospital, typically), the local organ procurement organization (OPO) will gather all relevant information about the donor and enter this data into a program maintained by the UNOS Organ Center. Based on the criteria established by the UNOS board of directors, the program generates a ranked list of potential recipients. The criteria involve several factors, including the physical compatibility between the donor and the recipient, the health of the recipient and how long the recipient has been waiting for an organ. The purpose of the criteria is to choose a recipient who is a good match and stands a good chance of recovery, while also taking into account who has been "in line" longer.

The OPO will

immediately contact the transplant team of the first person on the list. The transplant team will note all of the donor's information and make a decision whether or not to accept the organ. It may choose to decline the organ if it feels that the donor and potential recipient is not a close enough match or that the organ is unsatisfactory. For example, the donor may be much larger or older than the potential recipient, making the organ a bad fit, or the donor may have had health problems that could have damaged the organ. The transplant team might also

decline the organ if the potential recipient is ill or otherwise unprepared for surgery. If the organ is declined, the OPO will move to the next name on the list. In most cases, the OPO will first look for potential recipients in the local area. If there are no matches in the local area, the OPO will extend the search to anyone in the UNOS region (there are 11 regions across the country). If there are still no matches, the OPO will offer the organ to the person who is ranked first on the national list. The intention is to minimize organ transportation time and to encourage donation by offering donors a chance to help out their local community. When a recipient's transplant team accepts the organ, things start moving pretty fast. The team tells the recipient to hurry to the hospital for surgery preparation, and another team is dispatched to remove the organs from the donor. In the next section, we'll see what is involved in both surgical procedures. The Surgery When a donor's family authorizes the removal of organs, several surgical teams immediately begin work recovering the organ. (While the term harvesting is still in use, many organizations now prefer the term recovery because it is more sensitive to the donor family.) To understand what is involved in this procedure, let's focus on a particularly harrowing operation: the heart transplant. Organs from Overseas The shortage of donated organs in the United States is so severe that many patients are seeking out transplants in other countries. In some countries, notably China, foreigners can buy the organs they need instead of waiting at home. These organs typically come from executed prisoners who have not volunteered to donate organs. This situation is extremely controversial in the organ transplant community. Paying for organs is considered unethical in most Western nations, as is the recovery of organs if the donor has not agreed to donate them. Furthermore, there is strong indication that execution schedules are being modified to meet patient demand. The first step for all the harvesting teams is to cut open the donor's chest. Next, a surgeon saws through the breast bone and pulls the ribs outward to reveal the heart. While other teams are working on other parts of the body, the heart team clamps the different blood vessels leading into the heart and pumps in a cold, protective chemical solution. This solution stops the heart from beating and helps preserve it during transportation. The surgeons then sever the vessels and remove the heart from the body, placing it in a bag filled with a preservative chemical. This bag is then packed in an ordinary cooler filled with ice, which is rushed to the recipient's hospital, often via plane or helicopter. Meanwhile, the recipient is fully anesthetized and his or her chest is shaved. He or she is wheeled into the surgery room and covered in sterile cloths, leaving only the chest exposed. Typically, the surgery won't actually begin until the heart arrives, just in case there is some problem in transport. When the donated heart has arrived, the transplant team begins the procedure. First, they hook up an IV and inject an anticoagulant into the patient's bloodstream. This keeps the blood from clotting during the transplant procedure. As with the recovery surgery, the team begins the surgery by making an incision in the patient's chest, sawing through the breastbone and pulling back the ribs. The doctors then hook up a heart-lung machine to the patient's body. The heart-lung machine's job, as you might expect, is to act as the patient's heart and

lungs temporarily. The machine's plastic tubes are connected to blood vessels leading to and from the heart. Instead of being pumped to the lungs to get rid of carbon dioxide and pick up oxygen, blood returning to the heart is diverted to the machine. The machine drives the blood through a series of chambers to release carbon dioxide and pick up oxygen and then returns it into the body to be recirculated. This enables the surgical team to remove the heart without disrupting respiration and circulation. Additionally, the heart-lung machine can be adjusted to warm or cool the blood. During the operation, it is set to cool all the blood that passes through it. This cools the rest the body, which helps protect the other organs during the operation. Typically, the machine will have an attachment to suck up blood from the surgery area and send it directly back into the bloodstream. When the blood has been effectively diverted around the heart and lungs, the surgeons remove the diseased heart by cutting it loose from the attached blood vessels. The back walls of the atria, the upper chambers of the heart, are actually left in place. The surgeons remove the back walls of the donor heart's atria and suture the donor heart to the remaining tissue of the old heart. Then they suture the blood vessels formerly leading to the diseased heart to the vessels leading out of the donor heart. After the new heart is in place, the team gradually warms up the blood flowing through the patient's body. As the body warms a little, the heart may start beating on its own. If it does not, the team applies an electrical shock to get it going. The team lets the new heart and the heart-lung machine share the job of circulating blood for some time, giving the heart time to build strength. If everything is working correctly, the team wires the halves of the breast bone back together and stitches up the patient's chest using dissolving stitches. The patient is hooked up to a ventilator and brought to the recovery room. In a few hours, most patients regain consciousness. They may be ready to leave the hospital within a week. Typically, the entire procedure only takes about five hours. But patients have to work the rest of their lives to make sure the donated organ continues to function. In the next section, we'll find out what is involved in this post-transplant treatment. Living with a New Organ As with most other surgeries, recovery from a transplant operation involves additional medication and hospital visits to make sure the incisions heal correctly. But while other surgery patients typically can move on from the experience, most transplant recipients must continue medical treatment for the rest of their lives. This is because of the immune system's reaction to the new organ. Your immune system comprises all the elements in your body that keep bacteria, microbes, viruses, toxins and parasites from destroying your organs and tissues. In other words, the immune system works to destroy any harmful foreign matter that ends up in your body. When the system is working correctly, it can distinguish most foreign cells from cells produced by the body. A transplanted organ is made entirely of foreign cells, of course, which means the body will attack it if left to its own devices. To minimize the immune response, transplant teams make sure donors and recipients have matching blood and tissue types. But even with a good match, the body will see the new cells as foreign

matter and reject the organ (destroy it cell by cell). Only tissue from an identical twin will be fully accepted. There are three types of rejection that might occur following a transplant: Hyperacute rejection occurs as soon as the donated organ is in the body. This only happens if there are already antibodies in the recipient's bloodstream that react to the new organ, which would occur if the blood types of the donor and recipient were incompatible for some reason. This almost never happens, since transplant teams always test for any incompatibility ahead of time. If it were to happen, the recipient would most likely die on the operating table. Acute rejection occurs at least a few days after the transplant, after the body has had time to recognize the foreign material. This is the normal immune response to foreign matter. Chronic rejection is a very gradual rejection, lasting months or years. It can be so subtle that the patient doesn't notice any ill effects for some time. Acute Rejection The chief obstacle to living with a transplant is acute rejection. This sort of rejection would happen to nearly all recipients if it weren't for immunosuppressive drugs. As you might expect, immunosuppressive drugs generally suppress elements of the immune system so they do not attack the donor organ. The problem with this is that the drugs also suppress some of the beneficial things the immune system does. A person taking immunosuppressive drugs is much more susceptible to infection and disease. A new approach may eventually change this course. In a few experimental cases, kidney transplant patients have also received bone marrow transplants from their donors. Bone marrow produces the white blood cells that play a crucial role in guarding the body against foreign matter. The theory behind this new approach is that the white cells from the donor marrow will merge with the recipients natural cells, allowing the immune system to recognize the new organ as part of the body. The initial experimental results are encouraging. The first test subjects are doing very well without taking any immunosuppressive drugs. Drugs are still the main course of action, however, and they do yield good results. Typically, a transplant team prescribes specific combinations of drugs to patients in order to achieve the right balance of suppression. The goal is to suppress the system just enough to prevent rejection, while minimizing side effects and the risk of infection. The transplant team usually adjusts the drug prescription over time, fine-tuning it to the patient's needs. In some cases, the patient may eventually be weaned off all drugs as the body adapts to the new organ, but this is extremely rare. Transplant patients must be vigilant about taking their medication, and they must visit the hospital regularly for follow up tests. But it is worth it in most cases -patients who have been sick for many years due to a diseased organ may feel completely rejuvenated following a transplant. Unfortunately, thousands of people never get this chance at a new life. In the next section, we'll find out why this is and look at a few possible solutions. Improving the System Forty years ago, countless people died because doctors could not successfully perform a transplant and prevent rejection. The knowledge of

immunosuppressive drugs was minimal, and the surgery involved was extremely difficult. Today, science has advanced to the point that most transplant operations are considered relatively low risk. The success rate is phenomenal for kidney transplants, liver transplants, cornea transplants, pancreas transplants -- even heart and lung transplants. But more than 5,000 potential transplant recipients die in the United States every year, not because of scientific obstacles, but because of social ones. A Fair Trade The United Network for Organ Sharing is trying out a promising new organ exchange program as an incentive to encourage kidney donation. In this program, someone who wants to donate a kidney to a friend or family member but is not a match can donate to another transplant patient in order to move his or her loved one up on the waiting list. Donors can either arrange an exchange with a matching family in the same situation or they can donate the organ into the general pool in exchange for a cadaver kidney. Obviously, this arrangement directly benefits the specific recipients, but it also benefits the transplant community as a whole since more kidneys are donated into the system. In the United States, the vast majority of the population is in favor of organ donation, but only a small percentage of people actually end up donating their organs when they die. There aren't anywhere near enough organs to meet the demand, which means an average of 16 potential recipients die every day from a curable condition. This is partly due to human psychology and partly due to donation consent laws. Under current U.S. law, the final decision to donate a deceased person's organs is left to whoever has power of attorney or to the person's family. Organ donor cards or organ donor indications on a driver's license are important legal documents, but the consent of family members takes precedence. Naturally, most people don't want to dwell on the thought of their own death, so few take the time to discuss their feelings about organ donation with their families. When it comes time to make the decision, the family members aren't sure what to do. They may be so troubled by the thought of surgeons cutting their loved one's body that they decline to donate the organs. The main problem, then, is that donating organs requires at least two people to take decisive action that may be uncomfortable. The donor must take the initiative to talk to his or her family and the family must take the initiative to adhere to the donor's wishes. If these things don't happen, and in the majority of cases they don't, nobody gets to use those organs. This has created a national medical crisis in the United States, and hundreds of surgeons, scientists and politicians are clamoring for a solution. One interesting possibility is xenotransplantation, the transplantation of organs between different species. The study of xenotransplantation is still in the early stages, but there have been some promising results. It is not a totally viable alternative at this time for a number of reasons. Chiefly, many scientists are worried that transplants between animals and humans could introduce new diseases into the human population.

Xenotransplantation is also problematic ethically, as it would involve killing animals for their organs. Another interesting avenue is the development of artificial organs. But while there have been tremendous advances in this field over the past decade, artificial organs don't work nearly as well as natural organs for most patients. It is still a very young science. At this time, many doctors and politicians suggest legal and social changes as the best option. In some European and Asian nations, it is automatically assumed that you are an organ donor unless you notify the government that you do not want to be. Few people take this necessary action, and this has greatly increased the supply of available organs. Many feel that the United States should follow this model, but the idea has met with a lot of resistance. It would mean exerting greater control over people's bodies. Most experts agree that the ideal solution to the problem would be a shift in national consciousness. To this end, the United Network for Organ Sharing, the American Medical Association, the National Institute of Health and many other organizations have stepped up efforts to educate the public about the benefits of donation. These groups hope that if more people understand the need for organs and the tremendous benefit of donation, they will begin to see donation as their social responsibility. They will understand that organ transplantation is truly one of the most remarkable achievements of modern science, and that organ donation is among the greatest opportunities to serve humanity. Not all organs can be transplanted. Organs most often transplanted include: The kidney , because of diabetes, polycystic kidney disease, lupus, or other problems. The heart , because of coronary artery disease, cardiomyopathy, heart failure, and other heart problems. The lung , because of cystic fibrosis, COPD, and other problems. The pancreas , because of diabetes. The liver , because of cirrhosis, which has many causes. Bone Marrow Transplant Cornea Transplant Cord Blood Cell Transplant More than one organ can be transplanted at one time. For example, a heart and lung transplant is possible. Not everyone is a good candidate for an organ transplant. Your doctor or a transplant center will do tests to see if you are. You probably are not a good candidate if you have an infection, heart disease that is not under control, a drug or alcohol problem, or another serious health problem. If your tests show you are a good candidate, you are put on a waiting list. It may be days, months, or years before a transplant takes place. How successful is an organ transplant? The procedure is always improving, and transplants are more successful today than ever before. Organ transplant success depends on : Which organ is transplanted. How many organs are transplanted. For example, you could have a heart transplant or a heart and lung transplant. The disease that has caused your organ to fail. How do you prepare for an organ transplant?

First, you'll need to have blood and tissue tests done that will be used to match you with a donor. This is because your immune system may see the new organ as foreign and reject it. The more matches you have with the donor, the more likely your body will accept the donor organ. You'll need to take care of your health. Continue to take your medicines as prescribed and get regular blood tests. Follow your doctor's directions for eating and exercising. You also may want to talk with a psychiatrist, psychologist, or licensed mental health counselor about your transplant. Heart Failure and Heart Transplants Once a patient is diagnosed with severe heart disease that will lead to Heart Failure, a patient may be considered for a Heart Transplant. While waiting for a transplant, a patient may have need surgery to place an LVAD, a balloon pump or another Device to Temporarily Improve Heart Function. Kidney Failure, Dialysis and Kidney Transplants Kidney patients are one of the few types of transplant recipients who can receive treatment that replaces the function of the organ that is damaged. Causes of Kidney Failure vary, but Dialysis allows patients in kidney failure to tolerate the wait for an organ. Kidney transplants are by far the most commonly needed and transplanted organ, with over 70,000 people currently waiting for a new kidney. Diabetes and Pancreas Transplants The most common reason for a pancreas transplant is Type 1 Diabetes that is difficult to manage and control. In some patients, insulin, diet and exercise does not control blood glucose levels, regardless of how diligent the patient is in following the doctor's instructions. For these patients, a Pancreas Transplant may be the only solution. In fact, uncontrolled diabetes can lead to kidney damage, so a pancreas transplant may actually prevent the need for a kidney transplant in the future. Liver Disease and Liver Transplants Hepatitis, Alcoholism Induced Cirrhosis and idiopathic (non-alcoholic) cirrhosis, are among the leading causes of liver failure. For these conditions and many others that cause liver failure, a Liver Transplant is often the only option for treatment. Lung Disease and Lung Transplants COPD, or Chronic Obstructive Pulmonary Disease, is the most common disease process that leads to lung failure and the need for a Lung Transplant. Lung transplant patients may receive only one lung, or with some conditions such as cystic fibrosis, two lungs may be transplanted. Multivisceral Organ Transplants A multivisceral organ transplant is a type of transplant surgery that includes more than one organ, such as a Heart/Lung Transplants, a heart/kidney transplant or a kidney/pancreas transplant. In pediatric patients, multivisceral transplants are typically heart/lung or a combination that includes a small intestine transplant. After an Organ Transplant Coping after an Organ Transplant isn't always easy, even though the long awaited organ transplant has finally happened. There are worries about Organ Rejection, the side effects of transplant medications like Gout and weight gain. There are also very emotional topics like writing the family of the organ donor and considering the future of beloved pets. Organ Transplant, Rejection Prophylaxis Medications

Drugs associated with Organ Transplant, Rejection Prophylaxis The following drugs and medications are in some way related to, or used in the treatment of Organ Transplant, Rejection Prophylaxis. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. Imuran( azathioprine) antirheumatics, immunosuppressants Cellcept (mycophenolate mofetil) selective immunosuppressants Cytoxan (cyclophosphamide) alkylating agents Prograf (tacrolimus) calcineurin inhibitors Neoral (cyclosporine) calcineurin inhibitors Rapamune (sirolimus) - calcineurin inhibitors Sandimmune (cyclosporine) - calcineurin inhibitors Gengraf (cyclosporine) - calcineurin inhibitors Zenapax (daclizumab) interleukin inhibitors Simulect (basiliximab) interleukin inhibitors Azasan (azathioprine) - antirheumatics, immunosuppressants Zortress (everolimus) mTOR inhibitors, selective immunosuppressants Neosar (cyclophosphamide) alkylating agents Cytoxan Lyophilized (cyclophosphamide) alkylating agents Human organ and tissue transplantation Transplantation of human organs and tissues, which saves many lives and restores essential functions for many otherwise untreatable patients, both in developing and developed countries, has been a topic for ethical scrutiny and health care policy-making for more than thirty years. In 1991, the World Health Assembly approved a set of Guiding Principles (see link below) which emphasize voluntary donation, non-commercialization and a preference for cadavers over living donors and for genetically related over non-related donors. While they have had a great influence on professional codes and legislation, these Principles do not directly address safety concerns and they face challenges from leaders in the field who urge that policies be changed to allow the use of "incentives" to increase the numbers of organs for transplantation, from the involvement of organ donation programs in commercialized tissue operations, and from "organ trafficking" (such as that described in the 10 May 2003 Lancet) which apparently occurs in a number of countries where payment for organs is supposedly outlawed. In response to a request from the Government of Colombia, the Ethics department (ETH), along with what is now the Department of Essential Health Technologies (EHT/HTP), undertook a study of the current issues in organ and tissue transplantation. On 28 May 2003, the WHO Executive Board, having considered the resulting report from the Secretariat, requested that the subject be reexamined and a preliminary report submitted at its next meeting in January 2004. ETH/SDE and EHT/HPT, with advice from a wide range of experts and special support from transplant officials in Spain, the United States, and France, jointly carried out a consultation process which culminated in a meeting in Madrid from 6-9 Oct. 2003, at which 37 clinicians, ethicists, social scientists, and government officials from 23 countries, representing all WHO regions and all levels of economic development, closely analysed issues of global concern regarding the ethics, access and safety of tissue and organ transplantation. The report by the Secretariat produced by EHT

and ETH was accepted by the Executive Board, which on 22 January 2004 adopted a resolution recommending action by the World Health Assembly in May 2004. On 22 May 2004, the 57th World Health Assembly adopted a slightly amended version of the resolution. The WHO Secretariat is now at work on the tasks set forth in that resolution and will report back at a later date to the Assembly. Draft guiding principles on human organ transplantation Introduction 1. In resolution WHA40.13, adopted in May 1987, the Fortieth World Health Assembly requested the Director-General "to study, in collaboration with other organizations concerned, the possibility of developing appropriate guiding principles for human organ transplants". 1 The response to this request was initiated in June 1989 following the adoption by the Forty-second World Health Assembly, in May 1989, of resolution WHA42.5 (Preventing the purchase and sale of human organs). 2. In order to take due account of the diversity in systems of health care and law, and of their social, cultural, religious and medical circumstances, the DirectorGeneral initiated a process of consultation involving a broad range of organizations and individual experts. 2 The principal initiatives were the establishment of an informal working group at WHO headquarters (with representatives from all relevant WHO programmes, as well as the Secretary-General of CIOMS) and the convening of an informal consultation on organ transplantation in Geneva (2-4 May 1990), 3 with international experts in organ transplantation, medical ethics, health policy and law, and representatives of intergovernmental and nongovernmental organizations. 3. The consultation expressed the view that it was "indeed feasible to develop the Guiding Principles that had been called for in resolution WHA40.13" and reviewed an initial draft of a set of Guiding Principles. On the basis of the outcome of the consultation as set forth in its report, the initial draft was amended and widely distributed for comment to all participants and to other experts on medical, legal, ethical, cultural, religious and health policy aspects of organ transplantation. It was also sent for comment to all the WHO regional offices. A second informal consultation, with smaller membership, was convened in Geneva on 3 and 4 October 1990, 4 in order to review the second draft of the Guiding Principles in the light of the comments and suggestions received, and to prepare a third draft from which the final draft is derived (see below). 4. The draft Guiding Principles are presented as a considered response to the 1987 and 1989 Health Assembly resolutions and as a link in a process that may lead to consideration by the Forty-fourth World Health Assembly of the adoption of Guiding Principles on Human Organ Transplantation, for recommendation to Member States under Article 23 of the Constitution. Guiding principles on human organ transplantation Preamble 1. As the Director-General's report to the seventy-ninth session of the Executive Board pointed out, human organ transplantation began with a series of experimental studies at the beginning of this century. That report drew attention to some of the major clinical and scientific advances in the field since Alexis Carrel was awarded the Nobel Prize in 1912 for his pioneering work. Surgical transplantation of human organs from deceased, as well as living, donors to sick and dying patients began after the Second World War. Over the past 30 years, organ transplantation has become a worldwide practice and has saved many thousands of lives. It has also improved the quality of life of countless other persons. Continuous improvements in medical technology, particularly in relation to tissue "rejection",

have brought about expansion of the practice and an increase in the demand for organs. A feature of organ transplantation since its commencement has been the shortage of available organs. Supply has never satisfied demand, and this has led to the continuous development in many countries of procedures and systems to increase supply. Rational argument can be made to the effect that shortage has led to the rise of commercial traffic in human organs, particularly from living donors who are unrelated to recipients. There is clear evidence of such traffic in recent years, and fears have arisen of the possibility of related traffic in human beings. Health Assembly resolutions WHA40.13 and WHA42.5 are an expression of international concern over these developments. 2. These Guiding Principles are intended to provide an orderly, ethical, and acceptable framework for regulating the acquisition and transplantation of human organs for therapeutic purposes. The term "human organ" is understood to include organs and tissues but does not relate to human reproduction, and accordingly does not extend to reproductive tissues, namely ova, sperm, ovaries, testicles or embryos, nor is it intended to deal with blood or blood constituents for transfusion purposes. The Guiding Principles prohibit giving and receiving money, as well as any other commercial dealing in this field, but do not affect payment of expenditures incurred in organ recovery, preservation and supply. Of particular concern to WHO is the protection of minors and other vulnerable persons from coercion and improper inducement to donate organs. Organs and tissues (referred to in this text as "organs") may be removed from the bodies of deceased and living persons for the purpose of transplantation only in accordance with the following Guiding Principles. Guiding principle 1 Organs may be removed from the bodies of deceased persons for the purpose of transplantation if: (a) Any consents required by law are obtained; and (b) There is no reason to believe that the deceased person objected to such removal, in the absence of any formal consent given during the person's lifetime. Guiding principle 2 Physicians determining that the death of a potential donor has occurred should not be directly involved in organ removal from the donor and subsequent transplantation procedures, or be responsible for the care of potential recipients of such organs. Guiding principle 3 Organs for transplantation should be removed preferably from the bodies of deceased persons. However, adult living persons may donate organs, but in general such donors should be genetically related to the recipients. Exceptions may be made in the case of transplantation of bone marrow and other acceptable regenerative tissues. An organ may be removed from the body of an adult living donor for the purpose of transplantation if the donor gives free consent. The donor should be free of any undue influence and pressure and sufficiently informed to be able to understand and weigh the risks, benefits and consequences of consent. Guiding principle 4 No organ should be removed from the body of a living minor for the purpose of transplantation. Exceptions may be made under national law in the case of regenerative tissues.

Guiding principle 5 The human body and its parts cannot be the subject of commercial transactions. Accordingly, giving or receiving payment (including any other compensation or reward) for organs should be prohibited. Guiding principle 6 Advertising the need for or availability of organs, with a view to offering or seeking payment, should be prohibited. Guiding principle 7 It should be prohibited for physicians and other health professionals to engage in organ transplantation procedures if they have reason to believe that the organs concerned have been the subject of commercial transactions. Guiding principle 8 It should be prohibited for any person or facility involved in organ transplantation procedures to receive any payment that exceeds a justifiable fee for the services rendered. Guiding principle 9 In the light of the principles of distributive justice and equity, donated organs should be made available to patients on the basis of medical need and not on the basis of financial or other considerations. Ethics of Organ Transplants On the face of it, there seems to be little reason to question the ethics behind transplanting organs. Apparently one of the greatest achievements of modern surgery, tens of thousands of people are given a new lease on life through the selfless altruism of others who choose to find hope in the midst of tragedy, literally giving of their own bodies in the effort to save others. But this really is more appearance than fact, because right under the surface lurks a morass of ethical dilemmas and controversies which have threatened to undermine the entire practice of transplanting organs. These problems have only grown in scope as new medical advances have been made in recent years, with little prospect of an easy resolution any time soon. What are the sources of organs used in transplantation? How can we make the procurement system more efficient? Should we pay for organs? Should someone who has already received one transplant be allowed a second one? Should alcoholics be given liver transplants? Are transplants really worth the tremendous costs? Lying at the heart of most of these ethical debates are the twin questions of procurement and distribution. How do we get organs, and how do we decide who will receive the implants? There are always fewer donors than there are potential recipients, and that's why some 5,000 people die every year while waiting for new organs. As far as distribution goes, everyone has to be able to pay in order to receive a transplant - and that is why many poor people never undergo the process. Overall, transplants are a procedure for people with lots of money or lots of insurance. But should the choice of who gets new organs also depend upon social worth? That is to say, should a doctor get a new organ but a prisoner be refused? What about alcoholics - should they be denied new livers because they "deserve" what has happened to them? Procurement is also a problem, especially because not everyone agrees when "death" occurs. Does it happen when the heart and lungs stop, when the entire brain ceases to have activity, or just when the "higher functions" stop? This is an

important issue, because no one wants to take organs from someone still "alive," but waiting for "whole brain death" can leave many organs unusable. And what about the question of consent? Right now, someone has to directly agree for transplantation in order for organs to be removed - but should the policy be changed so that consent is automatically assumed unless someone says "no"? Because most people can live just fine with only one kidney, it is something which can be donated while you are still alive - but should you be allowed to sell it, or is it not possible for there to be genuine consent in such a grave matter? Even the idea that organ transplants represent a great achievement in medicine is somewhat faulty. As Ronald Munson explains in this book "Raising the Dead," real medical miracles involve causing a person's illness to disappear - the example of antibiotics is the clearest and most common. Organ transplants do not do this however: because a recipient has to take anti-rejection drugs for the rest of their lives, always fearing an infection which will get past their now-suppressed immune system, transplants simply trade one acute illness for another chronic condition. Transplants aren't a miracle, but they do work - ideally, they are a stopgap measure until something more permanent and effective can be developed. Fortunately, there does exist such a possibility on the horizon, but it causes even more controversy than anything discussed so far. Eventually, people may be able to simply have replacement organs grown from their own DNA, eliminating matters of procurement, distribution, and even organ rejection. But this will apparently require the use of embryonic stem cells developed with cloning technology, opening up a host of different ethical debates. These two recent books are very complimentary, each with their own strengths and weaknesses. Munson's book does not cover nearly as much ground as Caplan's, but it does cover all of the most basic and most important issues. Munson also makes extensive use of examples of how people - mostly real, but sometimes hypothetical - have to deal with organ transplants, both as donors and as recipients. This concretizes the ethical arguments and helps to make sure that we don't forget that this isn't a simply an abstract discussion about ethics. What we are dealing with, and what we should not forget, is that this is a discussion about life and death - who lives, who dies, and why. There are real people out there who are suffering, and decisions about the ethics of organ transplants will have a tremendous impact upon them. Because Munson's book is newer, it covers a few recent topics like the aforementioned issues regarding stem cell research and the growth of new organs. Munson's book is also aimed at people who don't have much experience either with medicine or with ethical philosophy, making it a good introduction for the average reader. However, Caplan's book, based upon the contributions from such a wide variety of professionals in medicine and bioethics, ends up providing a great deal more information - both over a wider range of topics and with more depth. The 34 articles are usually reprints form medical journals, and as such they are generally written for an audience of medical professionals. Lay readers can still get a lot out of it, but they will need to read a bit more carefully. Thus, Caplan's is superior for anyone seeking to study the topic more thoroughly - it would, for example, be perfect for a class on bioethics. Organ Donation in the Philippines

In the Philippines, being an organ donor is atypical, and for a country fraught with false notions and superstitions, launching organ donor awareness is easier said than done. Perhaps another contributing factor to Filipinos apathy on organ donation is their lack of knowledge on the subject and also that information about it is hard to find. One of the main reasons research show is that Filipinos dont know exactly about what they need to do in order to become one. Perhaps the word registration to an average Filipino is equivalent to long queues, pages and pages of forms to fill out answering questions they dont understand, in short, a waste of time. What they dont know is that the most important way of registering to become an organ donor is to talk about it with ones friends and family. In that small way, an individual would already have registered his or her wishes to people whom he knows will carry out what he wants if and when the individual will pass away. It is most advisable as well that a person who has decided to donate his organs when he dies, is to discuss this decision with the person who will have the final say. For example if you were single and you have decided to donate your organs when the time comes, you would communicate your decision to your parents. Or, if you were a husband who has come to such a decision as well, you would tell your wife. Yes, there are forms to fill out and an organ donor card that can be issued to a person once a decision like this has been made but as was stated earlier, a persons talking this kind of choice over with family and friends already ensures that his or her wishes be carried. The forms are merely for formality and also for certain situations where in other people need to know as well. A common example of this is when an individual meets an accident and dies as a result and there is no one available to let the medical people know of the said individuals wishes and by the time the family is able to communicate with the medical people, it is already too late for the organs to be harvested. In principle, contrary to most peoples common notion those only organs such as the heart, liver, kidneys and eyes are what they can donate and can be transplanted. This notion is actually not entirely true as facts said that currently, transplanted human tissues include bone, corneas, skin, heart valves, veins, cartilage and other connective tissues. Tissues such as these can be used to treat patients suffering from congenital defects, blindness, visual impairment, trauma, burns, dental defects, arthritis, cancer, vascular and heart disease. In addition, many heart valves are used to treat children with congenital defects of their own heart valves. References: Munson, R. (2009). Raising the dead: organ transplants, ethics and society. United Kingdom: Oxford University. Caplan, A. and Coehlo, D. (2009). The ethics of organ transplants: the current debate. Prometheus Publishing Inc. Department of Ethics, Trade, Human Rights and Health Law (2004). Bibliography on ethics and and organ transplantation. Geneva. http://health.howstuffworks.com/human-body/parts/organ-transplant.htm http://www.nlm.nih.gov/medlineplus/organtransplantation.html

http://socyberty.com/society/the-philippines-and-organdonation/#ixzz1QMRse24g http://www.wecareindia.com/organ-transplant.html http://www.who.int/ethics/topics/transplantation_guiding_principles/en/index.html