1. What do you know about organ transplants? Which organs can be transplanted? Should everyone be entitled to a new organ?

2. Your heart beats 70 times per minute (on average at rest). How many times does your heart beat… each hour each day each week each year in the average life time of 80 years?

3. We are learning to… make decisions based on scientific and social evidence explain how medical developments have enabled scientists to advance their abilities

4. Task In pairs, place the cards in order of when the development happened. Extension: Consider what has helped these developments to happen. Where will they lead in the next few years?

5. First Successful Heart Transplant Dr. Christiaan Barnard, in Cape Town, South Africa, transplants the heart of an 18-year- old female car accident victim into Louis Washkansky. He dies 18 days later of pneumonia. (j) First Combination Heart, Liver, and Kidney Transplant Surgeons at Presbyterian Hospital in Pittsburgh, Pennsylvania, transplant a heart, liver, and kidney into a 26-year-old woman. She survives for four months. ( k ) Research into Rejection British scientist Peter Medawar discovers that animal embryos exposed to foreign tissues do not reject the tissues and concludes that rejection of a transplant is based on immunologic factors. Much later a winner of the 1960 Nobel Prize in Medicine. (i) First Tongue Transplant A team of Austrian doctors at Vienna's General Hospital performs a 14-hour tongue transplant on a 42-year-old man suffering from a malignant tumour affecting his tongue and jaw. Whatever next! (l)

6. First Successful Cornea Transplant The first corneal transplant. Few other surgeons match Zirm's success until after the Second World War, when very fine needles and finer silk become available. (e) First Successful Liver Transplant Dr. Thomas E. Starzl of the University of Colorado performs the first successful liver transplant. The liver functions for 13 months. Surprisingly this was before a heart transplant ! (f) First Successful Heart-Lung Transplant Dr. Bruce Reitz of Stanford University in California, performs the first successful heart-lung transplant. Cyclosporine is experimentally used to combat rejection. (g) First Womb Transplant Dr. Wafa Fageeh from Jeddah, Saudi Arabia, transplants the uterus of a 46-year- old into a 26-year-old woman. The uterus produces two menstrual periods before it fails after three months and has to be removed. Following the success of most other organ transplanting the recent trends of IVF treatment eventually lead to this innovative surgery. (h)

7. First Successful Live Donor Kidney Transplant The transplant is from Ronald Herrick into his identical twin Richard. This was a major breakthrough in organ transplantation. (a) Xenotransplant – First Attempted Pig Heart Transplant Dr. Ross of the National Heart Hospital in London attempts the transplant of a pig heart into a patient, but the heart ceases functioning in minutes. This research was as a result of successful human transplantation. (b) Transplantation of all Abdominal Organs In order to transplant a new kidney, pancreas, stomach, liver, large and small bowel, and one iliac artery, doctors at the University of Miami in Florida remove all abdominal organs from a patient with Gardner's syndrome. (c) First Face Transplant Surgeons carried out the world's first face transplant in France. Surgeons in Britain and the United States say they are now also ready to graft the face of a dead person on to someone who has been facially disfigured. ( d )

8. OrderLetterItemDate 1eCornea transplant1905 2iResearch into rejection1950 3aLive kidney transplant1954 4fLiver transplant1963 5jHeart transplant1967 6bXenotransplant1968 7gHeart-lung transplant1981 8kHeart, liver, kidney transplant1984 9cAll abdominal organ transplant1995 10hWomb transplant2000 11lTongue transplant2003 12dFace transplant2005 Until tissue rejection was overcome, transplant developments were impossible

9. The Choice is yours James or Jessica? The choice is yours Royal Western Trust Hospital Cardio – thoracic specialist ward Established 1978

10. Heart disease is one of the most common causes of death each year in the UK Many people have bypass, pacemakers and valve surgery This still leaves a large number requiring a new heart Some types of heart disease are inherited Smoking, drinking and obesity increases the risk Developments in medicine have helped more people to survive even if their organs are damaged and diseased. Health workers are faced with economic, ethical and social decisions about how to treat patients with serious medical conditions. Sometimes the decisions have life threatening consequences…You need to use sound scientific evidence and ignore your feelings.

11. James Silverman, age 48 years. James is divorced with 3 children. He is currently in a relationship. His heart disease is lifestyle related – he had a stressful job and worked long hours. He ate junk food regularly and was a smoker. He rarely exercised and had by-pass surgery two years ago. Jessica Carmel, age 17 years. Jessica is a typical teenager who just wants to be normal. She was born with heart problems and as a result has lived with the constant worry and depression that this brings. She has attempted suicide in the past. It’s not as simple as you think. Making ‘life & death decisions must be backed by scientific (medical) evidence and ethical reasons– not just ‘gut feelings!

12. Task 1.In pairs, read the patient information and complete the Clinical Summary Cards. Each person to should complete one card. 2.Discuss your findings and make a decision about who gets the heart. 3.Complete the report (in your exercise book) and explain the reasons for your choice. Who do you feel should receive the heart? Why? (C) Who do you think should get the heart? Why? (C) Explain the scientific reasons for your choice? (B) Were there any ethical reasons for you decision? If so, explain them. (A) Extension Find out if there are any alternatives for your patients. Would any of these be an option? 4. Ask your partner to read through your report and RAG it. RED = no scientific reasons given in support of the decision AMBER = some scientific reasons but not explained well GREEN = strong scientific reasons in support of the decision

13. Pyramid Back to Plenaries Question you have about the lesson Things you have been reminded of today Things you have learned today