Lita_Stasis_Foundation_Lecture_on_ Organ Donation[1]

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Benefits of Donating Vital Organs for Transplantation Ana Lita , Ph.D. Director – Global Bioethics Initiative New York

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Historical Perspective The Stasis Foundation Research Park biotechnology research involves the cryostorage of biological materials. The ongoing research projects concentrate on the design and development of cooling systems and storage devices for the cryopreservation of: organs for transplantation gametes and embryos for fertility purposes; tissues for regenerative medicine; whole mammalian organisms, including human patients; DNA, including those of near extinct species. The Stasis Foundation Research Park is a federally tax exempt 501(c)(3) not-for-profit charitable corporation that conducts medical and biotechnology research .

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Organ Transplantation An organ transplant is a surgical operation where a failing or damaged organ in the human body is removed and replaced with a new one. An organ is a mass of specialized cells and tissues.

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History of Organ Transplantation The first successful kidney transplant took place on Dec. 23, 1954 in Boston. Richard Herrick received a kidney from his identical twin brother, Ronald. Richard survived for eight years.

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Transplantable Organs/Tissues Organs Tissues Heart Lungs Liver Kidney Pancreas Face Hands Leg Bone Uterus Small Bowel Thymus Ovary Mouth Tongue Cornea Ear/Nose Skin Stomach Womb Spinal Cord Bone Marrow Brain Skeleton Gall Bladder Tendon

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Scarcity of Organs Problem facing both the developing and developed world: supply-demand Transplant Trends Waiting list candidates as of yesterday 4:44am 112,834 Active waiting list candidates as of yesterday 4:44pm 72,824 Transplants January - August 2011 18,953 Donors January - August 2011 9,409 *Active Candidate - A transplant candidate eligible to be considered for organ offers at a given point in time. Some transplant candidates are temporarily classified as “inactive” by their transplant center because they are medically unsuitable for transplantation or need to complete other eligibility requirements.

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US - The United Network for Organ Sharing (UNOS) On average, 106 people are added to the nation's organ transplant waiting list each day - one every 14 minutes. On average, 68 people receive transplants every day from either a living or deceased donor. On average, 17 patients die every day while awaiting an organ - one person every 85 minutes. In 2002 about 6,187 individuals died on the U.S. organ transplant waiting list because the organ they needed was not donated in time. ( www.unos.org ) Scarcity of Organs

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OPTN o perated by UNOS Organ Procurement and Transplantation Network (OPTN) operated by the United Network for Organ Sharing (UNOS) is an independent nonprofit organization working under contract with the U.S. Department of Health and Human Services. The Organ Procurement and Transplantation Network (OPTN) maintains the only national patient waiting list and features the most comprehensive data available in any single field of Medicine.

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Tissue engineering tied up to cloning and stem cells research The goal of tissue engineering is to repair organ pathologies such as those acquired congenitally or by cancer, trauma, infection, or inflammation. It is based upon the foundations of cell transplantation and materials science. Tissue can be engineered 1) in vivo - by stimulating the body's own regeneration response with the appropriate biomaterial, or 2) ex vivo - cells can be expanded in culture, attached to a scaffold and then reimplanted into the host. Cutting Age Biotechnology

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Cutting Age Biotechnology The grown trachea before the operation performed at Bristol University using tissue engineering British doctors help perform world's first transplant of a whole organ grown in lab in 2008

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Cutting Age Biotechnology Miniature human livers grown in laboratory: Scientists have taken a leap towards creating organs for patients after successfully growing miniature human livers in the laboratory at Wake Forest University in 2010 . Cutting Age Biotechnology Scientists have grown walnut sized human livers and hope the technique will eventually allow livers to be grown for transplant into patients.

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Xenotransplantation involves the transplantation, implantation or infusion into a human recipient of either cells, tissues, or organs from a nonhuman animal source. Genetically Engineering Pigs for Xenotransplantation One of the problems holding back the use of other species to grow organs for transplant into humans is the presence of retroviruses in their genomes that could activate in humans and cause a devastating infection. There is even a risk that such an infection could turn out to be transmissible to other humans. Xenotransplantation

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Organ donation is the process by which a person can donate a healthy /vital organ to replace the unhealthy organ of another person. Types of donation : Deceased - some organs are donated after the donor has died; Living - some organ donations are made by healthy friends or relatives who make the decision to help a loved one who is experiencing organ failure . Organ Donation

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In the US : There are no medical expenses associated with being an organ donor of any type; insurance or the agency responsible for recovering the organs will pay for the costs of organ recovery. Living organ donors may have financial problems outside of medical expenses if they do not have sick time or disability pay during their recovery, but they are in no way charged to be a donor. There are no costs to be an organ donor of any kind . All expenses are paid by the insurance company of the person you are donating to if you are a living donor, or by the organ procurement organization that recovers organs from a deceased donor. Medical Expenses

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Respect for individuals – “do unto others as you would have them do unto you” Autonomy- the ability to make decisions for oneself Voluntary consent- a consent that cannot be presumed Altruism - an organ should be donated as a gift only Ethical Framework of Organ/Tissue

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Donor Cards Consent to donate made while still living on a donor card or in an advance directive Family member consent to remove the organs of a deceased person Donor Consent

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Incentives: some of the most frequently debated Give assistance to families of a donor with funeral costs Donate to a charity in the deceased person’s name Offer recognition and gratitude incentives like a plaque or memorial Provide financial incentives Strategies to Increase Deceased Donations

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Education: based on the idea of “the gift of life” Mandated choice: indicate people’s wishes regarding organ donation on income tax forms or driver licenses Presumed consent: organs are taken after death, unless a person specifically requests to not donate while still living Strategies to Increase Deceased Donations

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U sing organs taken from prisoners sentenced to death- China stands alone in continuing the use of organs of executed prisoners for transplant surgery Strategies to Increase Deceased Donations

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Organ Donations in Texas Donors in Texas by Donor Type /Current Situation/ Donors Recovered = January 1, 2005 – August 11, 2011 For Area= Texas *Based on OPTN data as of August 11, 2011 Total Organs 2011 2010 2009 2008 2007 2006 2005 All Donor Types 6,750 433 1,188 1,134 1,058 1,011 987 939 Deceased Donor 4,052 254 646 613 639 670 631 599 Living Donor 2,698 179 542 521 419 341 356 340

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Organ Donations in Texas Current TX Waiting List *Based on OPTN data as of August 11, 2011 All Organs Kidney Liver Pancreas Kidney / Pancreas Heart Lung Heart / Lung Intestine Reg. 12,451 9,267 2,326 71 166 428 184 8 1

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Organ Donations in Texas Transplants in the Texas by Recipient Ethnicity Donors Recovered = January 1, 2005 – August 11, 2011 For Area= Texas *Based on OPTN data as of August 11, 2011 Total O. 2011 2010 2009 2008 2007 2006 2005 All ethnicities 13,888 948 2,368 2,190 2,166 2,165 2,052 1,999 White 6,374 445 1,091 976 961 1020 934 947 Black 2,444 168 443 425 386 361 341 320 Hispanic 4,490 295 746 711 718 690 680 650 Unknown 0 0 0 0 0 0 0 Asian 426 33 65 60 72 57 72 67 American Indian/ Alaska Native 29 3 4 3 6 6 7 0 Pacific Islander 18 1 6 2 1 5 2 1 Multiracial 107 3 13 13 22 26 16 14

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The cultural resistance has created a striking imbalance in the number of donations in the region compared with the rest of the state. The Texas Organ Sharing Alliance, said that in its South Texas — only18 people out of 1.8 million donated organs in 2010. The national average is about 26 donors per million, said the alliance’s regional manager. “The culture we have here buys into the myth that if I am not whole, I won’t go to heaven.” South Texas: Fewer Organ Donations

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Organ regulated markets based on financial incentives only Other incentives such as health, life, and disability insurance Education about the safety of transplantation as a medical therapy Education about cost effectiveness of organ transplants versus dialysis Strategies to Increase Living Organ Donations

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Glenda Dawson Donate Life - Texas Registry Is the Donor Education, Awareness, and Registry Program of Texas. Texans can register to be organ, tissue and eye donors online by visiting Donate Life - Texas Registry, or when they renew their driver license or personal identification card. The Glenda Dawson Donate Life - Texas Registry is the state program responsible for managing the donor registry and donor education projects. The program is funded by a $1 voluntary contribution that Texans can make when renewing their drivers licenses or identification card, or when registering their motor vehicle . Donate i n Texas http://www.dshs.state.tx.us/organdonation/default.shtm

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Cryopreservation of organs became an active area of research in the 1950s as a result of the rediscovery of the cryoprotective properties of glycerol The goal of organ vitrification remains optimistic and the prospects for success had never been more promising. Organ Cryopreservation Organ Max (hours) Norm (hours) Kidney 72 48 Liver 48 30 Pancreas 72 24 Heart 12 6 These times are adequate for air transplantation between major centers within a continent

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