DOCSLIB.ORG

Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges E. K. Massey, F. Ambagtsheer, W. Weimar (Eds.) Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges PABST E. K. Massey, F. Ambagtsheer, W. Weimar (Eds.) Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges PABST SCIENCE PUBLISHERS Lengerich Bibliographic information published by Die Deutsche Nationalbibliothek Die Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available in the Internet at <http://dnb.ddb.de>. This work is subject to copyright. All rights are reserved, whether the whole or part of the mate- rial is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a spe- cific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The authors and the publisher of this volume have taken care that the information and recommen- dations contained herein are accurate and compatible with the standards generally accepted at the time of publication. Nevertheless, it is difficult to ensure that all the information given is entirely accurate for all circumstances. The publisher disclaims any liability, loss, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this volume. © 2017 Pabst Science Publishers · D-49525 Lengerich Internet: www.pabst-publishers.de, www.pabst-science-publishers.com E-mail: [email protected] Print: ISBN 978-3-95853-292-2 eBook: ISBN 978-3-95853-293-9 (www.ciando.com) Formatting: µ Printed in Germany by KM-Druck, D-64823 Gross-Umstadt Contents Preface Introduction Emma K. Massey, Frederike Ambagtsheer, Franco Citterio, Willem Weimar ............... 11 The role of ethics in the early history of transplantation Michael A. Bos ............................................................. 15 1. Ethical, Legal and Cultural Aspects Summary of Workshop 2: ‘Common problems and national approaches to death and deceased donation’ Thomas Gutmann & Medard Hilhorst ........................................... 25 Common problems and national approaches to death and deceased donation: the Italian approach Marco Vergano & Francesca Baroncelli .......................................... 27 Organ transplantation and assisted dying: where, when, how and why? Deborah Ummel & Mélanie Vachon ............................................ 32 Pre-mortem interventions facilitating organ retrieval: the new Swiss legal framework Mélanie Levy .............................................................. 37 Age and generational relations in organ donation: an emerging field of empirical research and ethical controversy Mark Schweda & Sabine Wöhlke ............................................... 44 Renal transplantation in the Middle East: challenges and opportunities Ala A. Ali ................................................................. 52 Panorama of kidney transplantation in Algeria Khadidja Habchi, Ali Benziane, Mohamed Laib, Aldjia Lamri & Messaoud Saidani ......... 57 2. Living Donation Informing the living donor: practical approaches to moral dilemmas Lisa Burnapp .............................................................. 61 5 Contents The impact of volunteers on unspecified living kidney donation in the UK Christopher Burns-Cox, Paul van den Bosch, Paul Gibbs, Jan Shorrock & Bob Wiggins ...... 66 Live donor autonomy and professional protectionism; inconsistency in medical aspects of live donor evaluation Ian D. Dittmer ............................................................. 69 Is it ethical to offer priority points to compatible pairs participating in kidney exchange programs? Marie-Chantal Fortin ........................................................ 75 The ethics of shifting the US framework of living kidney donation from a disincentive to an incentive based model Giuliano Testa, Steven Hays & Hoylan T. Fernandez ................................. 82 3. Psychological Aspects Summary of Workshop 5: ‘Psychosocial evaluation, support and education of living organ candidates’ Inês Mega & Emma Massey ................................................... 89 The role of an independent living donor advocate: discussion of implementation options for the European setting Rebecca E. Hays. 91 Psychosocial profile of potential kidney recipients and their living non-related donors Susana M. Bayardo, Silvia R. Groppa, Cora Giordani, Cesar Mombelli, Guillermo Rosa Diez & Nora Imperiali ........................................... 98 Quality of Life comparison between haemodialysis patients and expanded criteria kidney transplants Chalini Lankage, Hannah-May Elmasry, Hannah Maple, Nizam Mamode & Nicos Kessaris ............................................... 105 Using the Canadian code of ethics for psychologists to determine the acceptability of organ donation following medical assistanceb to die Marie Achille .............................................................. 113 4. Pediatric Donation and Transplantation Summary of Workshop 4: ‘Pediatric donation and transplantation’ Marion Siebelink & Karl-Leo Schwering .......................................... 125 Impact of living transplantation on family dynamics Karl-Leo Schwering, Kristof Thys, Laure Rougier, Isabelle Aujoulat ...................... 127 6 Contents Under what conditions should minors be considered as potential hematopoietic stem cell donors: a review of guidance documents Miha Orazem & Kristof Thys ................................................... 129 Recent changes in child-organ donation in the UK & what next Joe Brierley ................................................................ 138 5. Organ Trade Summary of Workshop 6: ‘Understanding the human organ trade?‘ Michael A. Bos ............................................................. 145 A critical analysis of organ ‘trafficking’ and the prevailing law enforcement response Seán Columb .............................................................. 149 Illegal transplants and medical responsibility under the light of law and ethics Athina Koufou ............................................................. 155 Current status of organ harvesting from prisoners in China Huige Li .................................................................. 161 Neo-cannibalism and ISIS: organs and tissue trafficking during times of political conflict and war Nancy Scheper-Hughes ...................................................... 166 6. Deceased Donation Summary of Workshop 1: ‘Clinical research in deceased donation: which medical, ethical, legal and societal aspects have to be taken into account?’ Rutger Ploeg & Bernadette Haase ............................................... 177 Directed deceased donation: beyond the impartial allocation dogma Medard Hilhorst ............................................................ 182 Keeping consent in context: what is consent to deceased donation and from whom do we need it? David Shaw ............................................................... 190 Influence of annual educational meetings with icu specialists on rates of deceased donation Eva Šteina & Janis Jushinskis ................................................... 197 7. Public Issues & Communication Summary of Workshop 3: ‘Public issues in organ donation and transplantation’ David Rodríguez-Arias ....................................................... 203 7 Contents An exploration of experiences in campaigns on organ donation in The Netherlands Jeantine M. M. P. J. Reiger-van de Wijdeven ....................................... 205 Partnerships between media and ethics: students peer-to-peer campaigns for organ donation Mihaela Frunză & Ariana Guga ................................................. 213 Undergraduate healthcare students’ knowledge toward organ donation: a survey in an Italian university Lisa Giovannini, Francesco Fontana, Marika Massari & Gianni Cappelli .................. 222 Shifts in public perceptions of deceased organ donation in Denmark: lessons learned about public acceptability Klaus L. Hoeyer ............................................................ 231 Analysis of studies on communication in organ donation and transplantation Marie Lingemann, Danica Avsec, Bernarda Logar Zakrajšek & Thomas Breidenbach ...................................................... 237 FOEDUS Work Package 7 – international approach in communication Thomas Breidenbach, Marie Lingemann, Bernarda Logar Zakrajšek & Danica Avsec ............................................................ 245 Corresponding Authors. 251 Index of Authors ......................................................... 254 8 Preface Introduction In organ transplantation, there is growing emphasis on the ethical, legal and psychosocial aspects. Every three years ELPAT organizes an international conference on the ethical, legal and psycho- social aspects of organ transplantation. ELPAT is a subdivision of the European Society for Organ Transplantation (ESOT). In April 2016 the 4th ELPAT congress was held in an ancient convent dating from 1600: the Angelicum Congress Center in Rome, Italy. This central locus for theological and philosophical debate and learning was an ideal setting for the ELPAT conference. Three hundred and seventy eight delegates from 44 countries
Load more

Recommended publications
  • Four Cases of Corneal Perforation in Patients with Chronic Graft- Versus-Host Disease
    Molecular Vision 2011; 17:598-606 <http://www.molvis.org/molvis/v17/a68> © 2011 Molecular Vision Received 21 October 2010 | Accepted 15 February 2011 | Published 25 February 2011 Four cases of corneal perforation in patients with chronic graft- versus-host disease Emi Inagaki, Yoko Ogawa, Yukihiro Matsumoto, Tetsuya Kawakita, Shigeto Shimmura, Kazuo Tsubota Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan Purpose: To report the clinical features and investigate the underlying pathological processes of spontaneous corneal perforation in patients with ocular chronic graft-versus-host disease (cGVHD). Methods: A full ophthalmological evaluation of corneal perforation in four patients with cGVHD was performed. Three of them underwent deep anterior lamellar keratoplasty and samples from two of three patients were used for histopathological analyses. Results: Three patients were successfully treated by corneal transplantation. One patient was treated with a therapeutic soft contact lens, and the wound healed within 2 days. The common clinical features of these patients were (1) the presence of definite dry eye related to cGVHD in 3 of 4 patients and probable dry eye in one patient, (2) a central or paracentral site of corneal ulceration and perforation, with no sign of infection, and (3) prior use of a topical or systemic corticosteroid, and/or topical non-steroidal anti-inflammatory drugs. Immunohistochemical findings revealed an increased number of cluster of differentiation 68+ (CD68+) macrophages and matrix metalloproteinase 9 (MMP-9) expression in the tissue surrounding the perforation. Conclusions: Our report extends current information on the clinical features and pathological processes of corneal perforation in cGVHD by showing increased MMP-9 expression and the accumulation of CD68+ positive macrophages in the affected areas.
    [Show full text]
  • Fast Facts & Stats
    FAST FACTS & STATS “Of all the senses, sight must be the most delightful.” ~ Helen Keller More sensory neurons are dedicated to vision than the other four senses combined, and giving the gift of sight – through cornea donation – can be life-giving and life-changing. But what does it really mean? “Eye donation” doesn’t mean the entire eye is transplanted; instead, only the cornea (the clear, dome-shaped surface that covers the front of the eye) is replaced, restoring sight for those with cornea-related blindness. The entire eye can be used for research and education, potentially helping untold thousands of people regain their sight as researchers gain new understanding of the cause and effects of eye conditions that lead to blindness. Historical facts: · The first human corneal transplant was performed in 1905 by Dr. Eduard Zirm in Olomouc, Czechoslovakia. · The first U.S. transplant was performed in New York City by Dr. R. Townley Paton in 1937. · The first eye bank – a non-profit organization that recovers, evaluates, prepares and distributes eyes donated for use in corneal transplantation, research and education – opened in 1944 in New York City. · The Eye Bank Association of America, established in 1961, is the oldest transplant association and was formed by a group of ophthalmologists and eye bankers. Statistics: · 50,930: Number of corneas provided for transplant in the U.S. in 2017, meeting 100% of U.S. demand. · 33,367: Number of corneas exported, helping restore sight worldwide. · 12 million: Corneal disease cases worldwide that result in blindness or visual impairment— and that could be reversed with cornea transplants.
    [Show full text]
  • Exploring Vigilance Notification for Organs
    NOTIFY - E xploring V igilanc E n otification for o rgans , t issu E s and c E lls NOTIFY Exploring VigilancE notification for organs, tissuEs and cElls A Global Consultation e 10,00 Organised by CNT with the co-sponsorship of WHO and the participation of the EU-funded SOHO V&S Project February 7-9, 2011 NOTIFY Exploring VigilancE notification for organs, tissuEs and cElls A Global Consultation Organised by CNT with the co-sponsorship of WHO and the participation of the EU-funded SOHO V&S Project February 7-9, 2011 Cover Bologna, piazza del Nettuno (photo © giulianax – Fotolia.com) © Testi Centro Nazionale Trapianti © 2011 EDITRICE COMPOSITORI Via Stalingrado 97/2 - 40128 Bologna Tel. 051/3540111 - Fax 051/327877 [email protected] www.editricecompositori.it ISBN 978-88-7794-758-1 Index Part A Bologna Consultation Report ............................................................................................................................................7 Part B Working Group Didactic Papers ......................................................................................................................................57 (i) The Transmission of Infections ..........................................................................................................................59 (ii) The Transmission of Malignancies ....................................................................................................................79 (iii) Adverse Outcomes Associated with Characteristics, Handling and Clinical Errors
    [Show full text]
  • Xenotransplantation: Past, Present, and Future
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Curr Opin Manuscript Author Organ Transplant Manuscript Author . Author manuscript; available in PMC 2018 December 01. Published in final edited form as: Curr Opin Organ Transplant. 2017 December ; 22(6): 513–521. doi:10.1097/MOT.0000000000000463. XENOTRANSPLANTATION: PAST, PRESENT, AND FUTURE Burcin Ekser, MD, PhD1, Ping Li, PhD1, and David K.C. Cooper, MD, PhD2 1Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA 2Xenotransplantation Program, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA Abstract Purpose of review—To review the progress in the field of xenotransplantation with special attention to most recent encouraging findings which will eventually bring xenotransplantation to the clinic in the near future. Recent findings—Starting from early 2000, with the introduction of Gal-knockout pigs, prolonged survival especially in heart and kidney xenotransplantation was recorded. However, remaining antibody barriers to nonGal antigens continue to be the hurdle to overcome. The production of genetically-engineered pigs was difficult requiring prolonged time. However, advances in gene editing, such as zinc finger nucleases, transcription activator-like effector nucleases, and most recently CRISPR technology made the production of genetically-engineered pigs easier and available to more researchers. Today, the survival of pig-to-nonhuman primate heterotopic heart, kidney, and islet xenotransplantation reached >900 days, >400 days, and >600 day, respectively. The availability of multiple-gene pigs (5 or 6 genetic modifications) and/or newer costimulation blockade agents significantly contributed to this success. Now, the field is getting ready for clinical trials with an international consensus.
    [Show full text]
  • History of Corneal Transplantation, Eye Banking and the EBAA The
    History of Corneal Transplantation, Eye Banking and the EBAA The Success of Early Corneal Transplants In 1905, when Eduard Konrad Zirm, MD, performed the first successful corneal transplant, a long line of corneal transplantation, research and techniques began. During its existence, Zirm’s eye bank, located in a rural area of Austria, treated over 47,000 patients. Not many years later in 1914, Anton Elschnig, MD, also of Austria, performed the second successful corneal transplant and over the next two decades, he would make various contributions to the study of peri-operative infection and pre-operative preparation. The 1920s and 1930s would find Russian ophthalmologist Vladimir Filatov refining lamellar keratoplasty and developing a new method for full thickness keratoplasty. He also used a donor cornea from a cadaver for a penetrating keratoplasty in the 1930s. Ramon Castroviejo, a Spanish ophthalmologist, was an influential figure in both European and American developments in corneal transplantation, particularly from the 1920s through the 1940s. During his research fellowship at the Mayo Clinic, he developed a double-bladed knife for square grafts and conducted research that culminated in the development of new keratoplasty techniques. The Beginnings of Eye Banking and the EBAA The 1940s not only brought improvements to corneal transplantation, but also an incentive to mainstream those procedures into eye banking. R. Townley Paton, a renowned American ophthalmologist who was trained at Johns Hopkins in Baltimore, had established his own practice and had become affiliated with Manhattan Eye, Ear & Throat Hospital, where he began performing corneal transplants with privately-acquired tissue. After performing many corneal transplants, Paton came to the conclusion that a formal system of eye collection needed to be developed – thus, the eye bank was born.
    [Show full text]
  • Surgical Strategies to Improve Visual Outcomes in Corneal Transplantation
    Eye (2014) 28, 196–201 & 2014 Macmillan Publishers Limited All rights reserved 0950-222X/14 www.nature.com/eye 1,2 CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM Surgical strategies MS Rajan to improve visual outcomes in corneal transplantation Abstract rehabilitating patients who had lost their corneal transparency to infection, The recent years have brought about a sea degeneration, or dystrophy.1 Penetrating change in the field of corneal transplantation keratoplasty (PK), which involves whole- with penetrating keratoplasty being phased organ transplantation, has inherent problems to newer lamellar keratoplasty techniques for related to multiple sutures, high degrees of a variety of corneal pathology. Improved and induced astigmatism, increased risk of innovative surgical techniques have allowed endothelial rejection, and poor long-term graft selective replacement of diseased host survival.2–4 All these factors limit early visual corneal layers with pre-prepared healthy recovery and compromise long-term visual donor corneal lamellae for anterior corneal stability in patients undergoing penetrating disorders such as keratoconus and posterior keratoplasty.Therefore,recentyearshaveseen corneal disorders such as Fuch’s corneal considerable improvements in techniques endothelial dystrophy. The results of lamellar to overcome such limitations. Current techniques are encouraging, with rapid visual developments in lamellar keratoplasty have rehabilitation and vastly reduced risk of enabled partial-thickness corneal transplants immune-mediated transplant
    [Show full text]
  • Ethical Issues in Living-Related Corneal Tissue Transplantation
    Viewpoint Ethical issues in living-related corneal J Med Ethics: first published as 10.1136/medethics-2018-105146 on 23 May 2019. Downloaded from tissue transplantation Joséphine Behaegel, 1,2 Sorcha Ní Dhubhghaill,1,2 Heather Draper3 1Department of Ophthalmology, ABSTRact injury, typically chemical burns, chronic inflamma- Antwerp University Hospital, The cornea was the first human solid tissue to be tion and certain genetic diseases, the limbal stem Edegem, Belgium 2 transplanted successfully, and is now a common cells may be lost and the cornea becomes vascula- Faculty of Medicine and 5 6 Health Sciences, Dept of procedure in ophthalmic surgery. The grafts come from rised and opaque, leading to blindness (figure 1). Ophthalmology, Visual Optics deceased donors. Corneal therapies are now being In such cases, standard corneal transplants fail and Visual Rehabilitation, developed that rely on tissue from living-related donors. because of the inability to maintain a healthy epithe- University of Antwerp, Wilrijk, This presents new ethical challenges for ophthalmic lium. Limbal stem cell transplantation is designed to Belgium 3Division of Health Sciences, surgeons, who have hitherto been somewhat insulated address this problem by replacing the damaged or Warwick Medical School, from debates in transplantation and donation ethics. lost limbal stem cells (LSC) and restoring the ocular University of Warwick, Coventry, This paper provides the first overview of the ethical surface, which in turn increases the success rates of United Kingdom considerations generated by ocular tissue donation subsequent sight-restoring corneal transplants.7 8 from living donors and suggests how these might Limbal stem cell donations only entail the removal Correspondence to be addressed in practice.
    [Show full text]
  • AMRITA HOSPITALS AMRITA AMRITA HOSPITALS HOSPITALS Kochi * Faridabad (Delhi NCR) Kochi * Faridabad (Delhi NCR)
    AMRITA HOSPITALS HOSPITALS AMRITA AMRITA AMRITA HOSPITALS HOSPITALS Kochi * Faridabad (Delhi NCR) Kochi * Faridabad (Delhi NCR) A Comprehensive A Comprehensive Overview Overview A Comprehensive Overview AMRITA INSTITUTE OF MEDICAL SCIENCES AIMS Ponekkara P.O. Kochi, Kerala, India 682 041 Phone: (91) 484-2801234 Fax: (91) 484-2802020 email: [email protected] website: www.amritahospitals.org Copyright@2018 AMRITA HOSPITALS Kochi * Faridabad (Delhi-NCR) A COMPREHENSIVE OVERVIEW A Comprehensive Overview Copyright © 2018 by Amrita Institute of Medical Sciences All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means —electronic, mechanical, photocopying, recording, or otherwise without permission of the publisher. Published by: Amrita Vishwa Vidyapeetham Amrita Institute of Medical Sciences AIMS Ponekkara P.O. Kochi, Kerala 682041 India Phone: (91) 484-2801234 Fax: (91) 484-2802020 email: [email protected] website: www.amritahospitals.org June 2018 2018 ISBN 1-879410-38-9 Amrita Institute of Medical Sciences and Research Center Kochi, Kerala INDIA AMRITA HOSPITALS KOCHI * FARIDABAD (DELHI-NCR) A COMPREHENSIVE OVERVIEW 2018 Amrita Institute of Medical Sciences and Research Center Kochi, Kerala INDIA CONTENTS Mission Statement ......................................... 04 Message From The Director ......................... 05 Our Founder and Inspiration Sri Mata Amritanandamayi Devi .................. 06 Awards and Accreditations .........................
    [Show full text]
  • Their Functional Status in Transplantation Levels of Foxp3 In
    Levels of Foxp3 in Regulatory T Cells Reflect Their Functional Status in Transplantation Sunil K. Chauhan, Daniel R. Saban, Hyung K. Lee and Reza Dana This information is current as of September 27, 2021. J Immunol 2009; 182:148-153; ; doi: 10.4049/jimmunol.182.1.148 http://www.jimmunol.org/content/182/1/148 Downloaded from References This article cites 25 articles, 7 of which you can access for free at: http://www.jimmunol.org/content/182/1/148.full#ref-list-1 Why The JI? Submit online. http://www.jimmunol.org/ • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication *average by guest on September 27, 2021 Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 Copyright © 2009 by The American Association of Immunologists, Inc. All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. The Journal of Immunology Levels of Foxp3 in Regulatory T Cells Reflect Their Functional Status in Transplantation1 Sunil K. Chauhan,* Daniel R. Saban,* Hyung K. Lee,* and Reza Dana2*† Foxp3 expressing CD4؉CD25؉ regulatory T cells (Tregs) have been shown to prevent allograft rejection in clinical and animal models of transplantation.
    [Show full text]
  • Clinical Efficacy of Therapeutic Keratoplasty Using Corneal Xenografts in Patients with Corneal Ulcers
    Romanian Journal of Ophthalmology, Volume 63, Issue 3, July-September 2019. pp:257-263 GENERAL ARTICLE Clinical efficacy of therapeutic keratoplasty using corneal xenografts in patients with corneal ulcers Turchyn Mykola*, Marushchak Mariya**, Krynytska Inna**, Klishch Ivan** *Otolaryngology and Ophthalmology Department, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine **Functional and Laboratory Diagnosis Department, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine Correspondence to: Prof. Mariya Marushchak, Department of Functional and Laboratory Diagnosis, I. Horbachevsky Ternopil State Medical University, Majdan Voli 1, Ternopil 46001, Ukraine, E-mail: [email protected] Accepted: July 14th, 2019 Abstract Objective. to assess the clinical efficacy of keratoplasty using a corneal xenograft in patients with corneal ulcers of various etiologies. Methods. A total of 46 patients (49 eyes) with complicated corneal ulcers (perforated or with impending perforation) have been operated. Freeze-dried corneal xenografts have been used for keratoplasty. Results. Our results showed that postoperative period after xenogeneic keratoplasty in patients with corneal ulcers was uneventful and the transplant underwent gradual resorption. In all patients with non-infected corneal erosions, ulcers healed completely and corneal fistulas were fully closed. The implanted corneal xenograft undergoes complete resorption between 2 to 3 months. Conclusions. Given the shortages of donor material, the demonstrated efficacy of using corneal xenografts in patients with complicated corneal ulcers requiring therapeutic keratoplasty allows recommending corneal xenografts for wide use to relieve inflammation and to preserve the eye. Keywords: corneal ulcers, keratoplasty, corneal xenograft Introduction from 6.1 to 38.4% of all eye injuries, according to various authors [2,3]. Corneal disorders are one of the leading Regardless of recent advances in causes of blindness and impaired vision.
    [Show full text]
  • Current Progress in Corneal Xenotransplantation
    Chapter 3 Current Progress in Corneal Xenotransplantation Mee Kum Kim Additional information is available at the end of the chapter http://dx.doi.org/10.5772/intechopen.69144 Abstract Blindness is a devastating situation, and one of the common causes is corneal blindness. Corneal transplantation is the standard treatment for the corneal blindness. The lack of human donors demands the exploration of alternative treatments such as corneal xeno‐ transplantation and bioengineered corneas. We review the researches regarding immu‐ nological and physio‐anatomical barriers of corneal xenotransplantation, recent progress of corneal xenotransplantation in nonhuman primate studies, and updates of regulatory guidelines to conduct clinical trials for corneal xenotransplantation. The current develop‐ ment of genetically‐engineered and gene‐editing technologies suggests that the promise much for the field of xenotransplantation. A clinical trial of xenotransplantation using a cellular porcine corneal stroma has already been conducted; however, safety concerns have not been reported so far. With regard to the regulatory aspects and preclinical ‐effi cacies, corneal xenotransplantation has become one of the clinically realistic options as human substitutes and progress in recent research is promising to advance corneal xeno‐ transplantation field. Keywords: cornea, clinical trial, nonhuman primate, regulatory guidelines, transplantation, xenotransplantation 1. Introduction Blindness is a devastating situation with an estimated 39 million cases worldwide, and one of the common causes is corneal blindness [1]. Corneal transplantation is the standard treat‐ ment for the corneal blindness. According to “Cost‐benefit analysis of corneal transplant,” which had been reported by Eye Bank Association of America and the Lewin group in 2013, the net lifetime benefit from the transplantation was estimated at $118,000, whereas the med‐ ical cost of the transplant was $16,500 [2].
    [Show full text]
  • Juntendo Medical Journal 2017
    Special Reviews Juntendo Medical Journal 2017. 63(1), 2-7 A New Immunotherapy Using Regulatory T-Cells for High-Risk Corneal Transplantation TAKENORI INOMATA＊ ＊Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan Corneal transplantation is the most commonly performed tissue transplantation worldwide. Despite very high (above 90%) survival rates in recipients with nonvascularized and noninflamed graft beds, survival rates significantly decline (under 50%) when grafts are placed onto vascularized or inflamed host beds associated with conditions such as previous graft rejection, infection, or trauma. These results are seen despite treatment with high doses of nonspecific immunosuppressive medications, which often do not promote long-term survival. Therefore, new strategies are required to modulate the immune system without conventional immunosuppressive agents and improve transplant survival in“high-risk”patients with inflamed host beds. Regulatory T-cells (Treg) are key modulators of the immune response and may play a crucial role in a new therapy for high-risk corneal transplantation. Here we introduce the murine high-risk corneal transplantation model and review the implications of Tregs for corneal transplantation. Key words: corneal transplantation, regulatory T-cell, high-risk corneal transplantation, neovascularization Introduction eyeʼs refractive power. The cornea has three layers, including the epithelium, stroma and endothelium, 1. Outline of corneal transplantation divided by Bowmanʼs membrane and Descemetʼs The first corneal transplantation was successfully membrane respectively. Corneal transplantation is performed by Dr. Eduard Zirm in 1905 1). Along with a surgical procedure where a damaged or diseased the growing demand for corneal transplantation, the cornea is replaced by donated corneal tissue. first institutional eye bank was born in New York in Corneal transplantation has evolved into an array of 1944.
    [Show full text]