Download presentation
1
ORGAN DONATION AND ALLOTRANSPLANTATION
Ana Montesinos Mayoral
2
INTRODUCTION Transplantation is the transfer of cells, tissues or organs alive, from a person to another, or for a part of the body to another part of it, with the purpose of restoring a lost function Organs or tissues for donation: Heart, kidneys, liver, lungs… Pancreas, intestine Bones, cornea, skin, heartvalves Nerves , veins
3
HISTORY 300 B.C. Indians (repairing wounds by skin transplantation)
The first transplant assumed as such is immortalized in a painting of Fra Angelico, of , where we can see the saint Cosme and the Saint Damian transplantating an Ethiopian's leg 16 th century: Gasparo Tagliacozzi (repairing nose-skin transplantation)- observed immune reaction
4
HISTORY 19 th century 1818: First human to human blood transfusion
1878: First successful human to human bone transplant 1896: First bone marrow transplant 20 th century (1/2) 1905: Eduard Zirm- corneal transplant (restoring sight) 1912: kidney transplantation on dogs, connecting blood vessels (Nobel prize) 1936: Yu Yu Wronoy- Human kidney transplantation from dead donor (the pacient died in few days)
5
HISTORY 20 th century (2/2) 1954: Joseph E. Murray- Brigham and Women’s Hospital (Boston, USA)- The first successful kidney transplant (from a twin to the other twin) The pacient lived 8 years 1960: Peter Medawar- Nobel Prize for discovering of acquired immune tolerance (Beginning of anti-rejection drugs) 1960´s: First lung, pancreas, liver transplant 1967: Christiaan Barnard-SouthAfrica-First heart transplantation. The pacient lived 18 days, died on pneumonia.
6
HISTORY In Portugal, the first transplant was made by Linhares Furtado, in Coimbra, on 20 th July 1969 (kidney transplant) 2005: Baltimore Hospital- pioneered “domino chain”- It is initiated when an altruistic donor donates an organ to a patient who has a willing but incompatible donor. This incompatible donor then "pays it forward" and passes on the generosity to another recipient who also had a willing but incompatible donor.
7
“DOMINO CHAIN”
8
HISTORY 2010: SPAIN- First full face transplantation (Hospital Universitario Valle de Hebrón, Barcelona)
9
TYPES OF TRANSPLANTATION
Allotransplantation: Is the transplantation of cells, tissues or organs to a recipient from a genetically non-identical donor on the same species. Living donor transplantation Cadaveric donor transplantation Foetal tissue transplantation Autotransplantation: Is the transplantation of organs, tissues or proteins from one part o the body to another in the same individual. Xenotransplantation: Is the transplantation of living cells, tissue or organs from one specie to another (Ex: pigs-humans) Isograft: Is a graft of tissue between two individuals who are genetically identical (Ex: Monozygotic twins)
10
LIVING DONOR TRANSPLANTATION
The selection process of a living donor varies significantly depending on the organ to transplant . In general , the donor should be a healthy individual , mentally able to assert their donation without pressures of emotional or socio- economic order. In the case of kidney or liver donation in Portugal are accepted as donors , relatives, spouses , friends or anyone else , regardless of whether any blood relationship (Lei nº 22/2007, de 29 de Junho) Before being accepted as a donor , the individual has to pass several physical, laboratory , radiological tests , in order to detect any factors that could make the donation any riskier. If one of these factors is detected , the individual will be rejected as a donor .
11
LIVING DONOR TRANPLANTATION
ADVANTAGES Decrease waiting-list Better timing for procedure (previous treatment can be finished) Lower immune reaction and lower rejection rate (in case of relatives) DISADVANTAGES Huge pressure on prospective donors Exploitation of donors Insufficient knowledge and informedness of donors and their families about this possibility Risk of nephrectomy (kidney disease) Donor lives with one kidney
12
LIVING DONOR TRANSPLANTATION
13
CADAVERIC DONOR TRANSPLANTATION
Concept: An organ or tissue donation from a donor who has already died. In Portugal, the causes of death are still mainly of medical origin (71% in 2009 vs 74% in 2010) Hemmorrhagic stroke is the cause of death in 50% (n=161) of the donors, followed by other traumas. The causes less frequiently pointed are Tumor and Work Accident.
14
FETAL TISSUE TRANSPLANTATION
It´s the implant of tissue from an aborted fetus to a patient for treatment of disease. Human fetal transplantation is still experimental. Using fetal tissue for transplantation: Fetal tissue transplantation may be able to overcome the failures of traditional medical and surgical therapy to ameliorate several diseases, most notably Parkinson´s disease and insulin-dependent diabetes mellitus.
15
FETAL TISSUE TRANSPLANTATION
ETHICAL ISSUES Are fetal rights violated by the use of fetal tissue? Is there a moral danger that the potencial of fetal tissue donation will encourage elective abortions? What criteria should be used to select fetal tissue transplant?...
16
CADAVERIC DONOR TRANSPLANTATION
FUNDAMENTAL QUESTION WHEN IS THE PERSON CONSIDERED DEAD?
17
WHEN IS THE PERSON CONSIDERED DEAD?
BRAIN DEATH Brain death means that all brain and brain stem function has irreversibly ceased, while circulatory and ventilatory functions are maintained temporarily The clinical diagnosis of brain death rests on three criteria: (a) irreversibility of the neurologic insult; (b) absence of clinical evidence of cerebral function; and most important, (c) absence of clinical evidence of brain stem function.
18
SYSTEM OF CONSENT OPT-IN SYSTEM Potential donors must express their consent during the life, otherwise they do not donate their organs OPT-OUT SYSTEM There is presumptive consent from every person, unless the person expresses refusal to donate (Ex: Portugal)
19
SYSTEM OF CONSENT
20
OPT-OUT SYSTEM IN PORTUGAL
In Portugal, any national or foreign citizen who lives in the portuguese territory, is considered a donor since birth. It´s not necessary to perform any application, registration or authorization for the donation. Those who do not wish to donate their organs after death must register in “Registro Nacional de Não Dadores” (RENNDA) The Decreto-lei 244/94, de 22 de abril, rules REENDA
21
SYSTEM OF CONSENT OPT-IN SYSTEM OPT-OUT SYSTEM
Lower percent of population sign the consent (90 percent of Americans agree with donation, but only 30 percent of them consented to donate their organs). Icky and difficult for persons to think about it. Need of education and publicity in media. Connection of the consent form with the issuance of driver’s license. OPT-OUT SYSTEM Much higher percentage of cadaveric donors (more than 90 percent). People do not have to solve this issue, only if they are strictly against it. Questionable role of family. Poor informed society. Missing of the consent.
22
SPAIN (2013)- Organización Nacional de Transplantes (ONT)
STATISTICS SPAIN (2013)- Organización Nacional de Transplantes (ONT) 4279 transplants 1655 donors donors per million people Decreasing number of patients in waiting-list (5513 in 2012 vs in 2013) Only 15.16% families said “no” to donation 30000 bone marrow donations
23
PORTUGAL (until 2010)- Sociedade Portuguesa de Transplantação (SPT)
STATISTICS PORTUGAL (until 2010)- Sociedade Portuguesa de Transplantação (SPT)
24
STATISTICS
25
STATISTICS
26
INTERNATIONAL AND NATIONAL LAW ABOUT TRANSPLANTATION
International Law Additional Protocol to the Convention of Human Rights and Biomedicine concerning transplantation of organs and tissues of human origin. Since 1st May 2006 Applies the Principles of the Convention to the field of organ and tissue transplants, respecting its main objectives: protecting the dignity and integrity of the human being and protecting the rights and fundamental freedoms, with regard to advances in Medicine and Science.
27
INTERNATIONAL AND NATIONAL LAW ABOUT TRANSPLANTATION
The Principles: Equality of access to patients in the transplant services; Transparency of rules for allocation of organs and tissues; Setting safety standards; Gratuity of donations; Good information for all involved; Confidentiality; Punishments in case of violation.
28
INTERNATIONAL AND NATIONAL LAW ABOUT TRANSPLANTATION
Constituição da República Portuguesa Part I: Contains provisions which supervise fundamental values of bioethics Principle of Equality (13º) Right to Life (24º) Right to Humane Treatment (25º) Right to Health (64º)
29
INTERNATIONAL AND NATIONAL LAW ABOUT TRANSPLANTATION
Lei 12/93, de 22 de Abril Rules the harvesting and transplantation of organs and tissues of human origin It was amended by Lei 22/2007, de 29 de Junho and Lei 12/2009, de 26 de Março
30
INTERNATIONAL AND NATIONAL LAW ABOUT TRANSPLANTATION
Additional national legislation Lei n.º 141/99 da Assembleia da República (Criteria of brain death) Decreto-Lei n.º 244/94 de 26 de Setembro (National Register of No-Donors) Portaria n.º 31/2002 de 08 de Janeiro (Transplant Centers)
31
“ILEGAL ORGAN TRADE” According to the World Health Organization (WHO), illegal organ trade occurs when organs are removed from the body for the purpose of commercial transactions. Organ traffic is the third most lucrative crime in the world. It occurs especially in some Asian countries with a particularly permissive legislation. Many people travel to get a transplant, without questioning how the agency obtained the organ and without knowing that the operation hasn’t any medical guarantee, since neither the giver nor the receiver is followed later.
32
ETHICAL ISSUES OF TRANSPLANTATION
Financial advantageous of transplantation – often lower costs than medical treatment of ill person Family acceptance of death takes a while Habits and rites Human body is not a property Unity of soul and body Biological ethic neutral value of such procedure Biomass
33
RELIGION Christianity – supports donation
Jehovah's Witnesses – cancelled prohibition of transplantations in 1967, but it is not clear, how to perform it, when blood transfusion is forbidden. Orthodox Jewish (not reformed and liberal ones) does not allow the transplantations, which are terminating human life by human extraction.
34
RELIGION Islam different scholars
generally organ donations are not permitted some of the schools permit live donations some of them also cadaveric donations, if it is not transplantation of organ, upon which the life depend (heart, liver), because it kills the soul but not unconditionally, they have their own rules which must be fulfilled
35
RELIGION Buddhism Allows, but let every single person to decide on his own Tibetan Buddhists believe in consciousness after death, and such a person/body cannot be disturbed, so cadaveric transplants are not possible for them
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.