Tag: transplant recipients

Bioethics News

CRISPR, Pigs, Organs, Ethics: Some Key Considerations

Michael S. Dauber, M.A., GBI Visiting Scholar

Luhan Yang and members of her research team at eGenesis have taken a crucial step in growing organs in animals that may be used to provide organs for therapeutic transplants in humans, according to a study published in Science Magazine on Thursday, August 10th. Researchers involved in the study used CRISPR, a genetic editing technique, to “knock out” 25 genes that cause porcine endogenous retroviruses (sometimes referred to as “PERV genes”) that make ordinary pig organs unsuitable for transplants because PERVs can infect human transplant recipients. The result was the birth of 37 baby pigs without PERV genes.

The move comes at a time when CRISPR experiments are becoming increasingly popular. Last week, a team led by Shoukhrat Mitalipov published the results of the first successful attempt to modify human embryos using CRISPR by American scientists in Nature. The researchers successfully deleted a gene responsible for several fatal heart conditions.

While the results are a significant step in developing techniques for growing organs suitable for human transplantation, scientists must still travel a long road before any human patients will receive such organs. Researchers will need to determine whether or not organs from pigs developed using CRISPR can be safely and effectively transplanted into other animals first. Another hurdle is the cost and complexity of the technique: Yang’s experiments with her team involved embryos produced through cloning, an expensive technique that is not always completely effective: indeed, in Yang’s study, only a few of the cloned embryos were viable.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

ORGAN DONATION AFTER MEDICAL AID IN DYING

Jennifer A. Chandler describes some of the ethical and legal challenges surrounding organ donation following medical assistance in dying.

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Today, it is medically possible to donate organs following death brought about by medical assistance in dying. This currently happens in countries like Belgium and the Netherlands. People with neurodegenerative conditions like amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, or multiple sclerosis (MS) are eligible to donate organs. Those with cancer, however, are not eligible because of risks to recipients.

In Canada, people with neurodegenerative conditions who satisfy the legal eligibility criteria for assisted dying may also meet the medical eligibility criteria for organ donation. However, this possibility raises novel ethical, legal, and policy issues that must be carefully considered. The following four hypothetical cases illustrate some of these issues.

CASE 1 – A patient seeks assisted dying and wants to donate to a family member.

Some provinces allow people to direct their organ donations to relatives after they die. Some patients who choose assisted dying may derive some comfort from being able to help a family member in this way. There is the risk, however, that patients may feel pressured to seek assisted dying, in part, to benefit a sick relative.

CASE 2 – A family member is asked to consent to cornea donation for a loved one who passed away through assisted dying. The patient was not asked about this before his death because he was not registered as an organ donor, and nobody wanted to burden him with the decision. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Living Kidney Donors Often Pay Their Own Expenses

December 22, 2016

(Reuters) – Most living kidney donors pay at least some of the expenses related to donation themselves, which may limit how many people can afford to provide organs to transplant recipients, a U.S. study suggests. Researchers examined survey data from 796 living kidney donors on how much they spent for out-of-pocket medical costs as well as indirect expenses such as lost income or travel bills associated with donation. Overall, 78 percent of the donors shouldered some costs themselves, and 21 percent of them reported more than $500 in out-of-pocket medical bills and other expenses, the study found.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Biomarkers Can Help Guide Immune-Suppressing Treatment After Organ Transplantation

March 18, 2016

(Medical Xpress) – Recently discovered biomarkers may provide valuable new approaches to monitoring immunosuppressive drug therapy in organ transplant recipients—with the potential for individualized therapy to reduce organ rejection and minimize side effects, according to a special article in the April issue of Therapeutic Drug Monitoring, official journal of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Good Match Not Always Needed for Living Donor Kidney Transplant

March 11, 2016

(Reuters) – Transplanting a mismatched kidney from a living donor may lower the risk of death more than not doing a transplant at all, according to a new study that could open the door to more operations. A long-term study found that transplant recipients whose immune systems were technically incompatible to the donated kidney – because they had so-called anti-HLA antibodies – were more likely to be alive eight years later than people who did not receive a transplant or waited to get an organ from a deceased donor.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Cleveland Clinic Performs First U.S. Uterus Transplant

by Craig Klugman, Ph.D.

Almost like Aphrodite herself, surgeons at the Cleveland Clinic this week may have given fertility to a 26-year-old woman through a 9-hour uterus transplant operation. The transplanted uterus was from a deceased woman. This was the first such surgery in the United States, though it has been performed previously in Sweden and Turkey. Of the 9 women in Sweden who had the procedure, 4 have given birth.

The American patient had uterine factor infertility, which result from fibroids, scarification, genetics, or not having developed a uterus. For the surgeons and patients, this technique offers a way for the patient to potentially carry a child to term.

In the U.S., the Cleveland Clinic’s method involved the patient undergoing in vitro fertilization techniques to produce at least 10 frozen embryos. Then a donor was sought and her next of kin had to sign a special informed consent document for the procedure. The patient and her new uterus will be given a year to heal at which point an embryo will be defrosted and doctors will implant it. The embryos will be transferred one at a time. If one does implant, the resulting baby will be delivered by Caesarean section.

The benefit to this involved operation is clear, a woman is given the ability to gestate an embryo. She has a genetically-related child which she carried.

The risks are not slight. The potential mother will have to take immune suppressants—drugs that in the long term are known to include greater risk of infection, cancer, cardiovascular disease, and bone marrow suppression.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Four things Christians need to know about ethics #2

Understanding the problems of consequential ethics

Another very common ethical idea in our surrounding culture is that the morality of an action can be determined by its consequences. If one’s sense of morality is primarily based on feelings, but the there are situations in which feelings are unclear then one can look at the consequences of an action to determine if it is right or wrong. In moral philosophy this way of seeing ethics is represented best by utilitarianism, but for many in the culture around us the consequential ethics they use is not as well thought through as utilitarian ethical theory. It is primarily the simpler idea that one can morally justify doing something that would otherwise be wrong if the outcome is good.

This is not a way of thinking that is compatible with biblically grounded Christian ethics. We should be concerned about the consequences of our actions, but there is a clear understanding among Christian ethicists that consequential ethics can lead to many wrong moral decisions. The value and dignity of persons in the minority or otherwise on the fringes of society can be abandoned when decisions are made on the basis of the good of the majority. It does not fit with a biblical understanding of moral truth to say that we can do what is wrong to achieve a good outcome. The ends do not justify the means. Consequential arguments are commonly false rationalizations to justify ourselves for doing something we know to be wrong. King Saul tried to justify his disobedience of God’s command to kill the livestock of the Amalekites by saying that bringing the best of the animals home with him would allow him to give them to God as sacrifices.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals, August 2015 by Aaron Seaman

In addition to special issues highlighted earlier this month on Somatosphere — Limn (on “Ebola’s Ecologies“), the Annals of Anthropological Practice (on “Community Health Workers and Social Change: Global and Local Perspectives“), and Social Theory & Health (entitled “Theorising Health Inequalities” — the month provided, as always, a bevy of good reading, including a special section of Social Studies of Science on the ontological turn (see below). Enjoy!

American Ethnologist

Biomedicine, the whiteness of sleep, and the wages of spatiotemporal normativity in the United States
Matthew Wolf-Meyer

The racialization of individuals in the contemporary United States is increasingly accomplished through institutional actors, including scientists and physicians. As genetic health risks, chronic disease treatments, and pharmaceuticals come to define Americans’ understanding of themselves, a fundamental shift is occurring in the way medicine is practiced and its role in the production of subjectivity. Underlying these changes is an expectation of orderly bodies—of “white” bodies that exemplify social and cultural norms of biology and behavior. Fundamental to U.S. medical ideas of normativity is that the white heteronormative subject is the standard against which disorderly and nonwhite subjects are to be judged. I explore these ideas through the history and contemporary world of sleep: the clinical production and interpretation of related scientific data, advertising use of images of sleep-disordered patients who have been “cured,” and experiences of nonwhite Americans within mainstream sleep medicine.

The doctor’s political body: Doctor–patient interactions and sociopolitical belonging in Venezuelan state clinics
Amy Cooper

Patients of Venezuelan state clinics ascribe meanings to doctor–patient interactions that reverberate beyond the immediacy of the clinical encounter to shape political subjectivities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

A Matter of Ethics and Policy in the Era of Regenerative Transplantation in the United States

by Macey L. Henderson and Brianna L Doby

Why do we need to care about the ethical development of health policies that impact research, donation, and transplantation in the United States? The story of Zion Harvey is a good place to start.

Zion lost all of his limbs to amputation from sepsis at the age of two. The infection that ravished his body and took his limbs also caused renal failure, resulting in a successful kidney transplant when he was 4 years old. Like all transplant recipients, Zion must take anti-rejection medications for life, making him a good candidate for hand transplantation. Previously, the ethics of transplanting a child with donor hands instead of fitting them with prosthetics was centered around post-transplant medication harms. In July of 2015, Zion became the first pediatric double hand transplant recipient in a landmark 11 hour operation which took place at the esteemed Children’s Hospital of Philadelphia.

Trauma, birth defects, bone or soft tissue malignancies, and other systemic diseases like diabetes can cause disability and sadly, loss of limbs. Amputations create both physical and psychosocial impacts that can be difficult for an individual in regards to day to day functioning, not to mention the aesthetic challenges posed by living in the world without limbs. Prosthetics are a phenomenal advance in biotechnology allowing for both occupational and psychological improvements for patients, but they don’t mimic the sensations or intricate actions that a human hand does.

Until now, candidacy for hand transplantation has been limited to adults. Why? There are vast complexities associated with hand transplantation.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Investigating Two Claims Against Planned Parenthood: Center of Medical Progress’s Secret Videos

by Craig Klugman, Ph.D.

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.

Ironically, despite the numerous bomb threats while she worked there, her clinic did not perform abortions. I always viewed my mom as doing important community health work for women who could not get services elsewhere because of finances, lack of education, or living in fearful relationships.

By now you have seen parts of the Center for Medical Progress’s videos regarding secretly recorded conversations with two leaders from Planned Parenthood. In their original release (8:51 minutes), the videos were edited to appear to show that Planned Parenthood was selling fetal organs—an illegal and unethical enterprise. As the full video (2:42:22 hours) was released, it became clear that Planned Parenthood was donating organs and only requested to receive reimbursement to cover their costs for preparing and donating the fetal tissue—a legal and (debatably) ethical enterprise.

The Center for Medical Progress pretended to be a biologics company and secretly recorded these conversations. It is a bit of a mysterious organization. They list a postal box as their address. They claim a 30-month investigation, but did not exist on the Internet until a few weeks ago.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.