DOCSLIB.ORG

Communication, Social Organization and the Redefinition of Death a Case Study in the Institutionalization of an Idea

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Communication, Social Organization and the Redefinition of Death a Case Study in the Institutionalization of an Idea University of Pennsylvania ScholarlyCommons Dissertations (ASC) Annenberg School for Communication 1979 Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea Leslie Ann Rado Follow this and additional works at: https://repository.upenn.edu/dissertations_asc Part of the Communication Commons Recommended Citation Rado, Leslie Ann, "Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea" (1979). Dissertations (ASC). 12. https://repository.upenn.edu/dissertations_asc/12 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/dissertations_asc/12 For more information, please contact [email protected]. Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea Abstract One of the problems of most interest to students of communication is the analysis and conceptualization of the social processes by which our common notions of what exists, what is important and what is legitimate are shaped. These notions are social and cultural meanings -- values, norms, practices -- the stuff of social and cultural reality, and they are sometimes most manifest and perceptible when they are changing. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Department Communication First Advisor Larry Gross Subject Categories Communication This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/dissertations_asc/12 COMMUNICATION, SOCIAL ORGANIZATION AND THE REDEFINITION OF DEATH A CASE STUDY IN THE INSTITUTIONALIZATION OF AN IDEA Leslie Ann Rado A DISSERTATION in COMMUNI CATIONS Presented to the Graduate Faculties of the University of Pennsylvania in Partial Ful fillment of the Requirements for the Degree of Doctor of Philosophy. 1979 Graduate Group Chairperson ANNENBERG P 002 1979 R131 --~.- -. .:.. o COPYRIGHT Leslie Ann Rado 1979 TO THE MEMORY OF MY GRANDMOTHER MABEL FLORENCE LEE Who told me just of often enough, "Me name is tough, and I lives on Tough Street. The further down ye go, the tougher it gets, and I lives in the very last house." iii ACKNOHLEDGEMENTS Hith no halting prose either claiming or disclaiming the agonies of writing acknowledgements or dissertations -- the agonies of both are widely recognized -- I take this opportunity to express my deep appreciation to those who helped make this effort less agonizing and less solitary than it might have been. None of this would have been possible without the financial as­ sistance awarded me by the Russell Sage Foundation. Special thanks are due Diana Crane who introduced my project and me to the Foundation. Thanks go secondly to those men who took time from their highly active schedul es to participate in this study. Special thanks are ex­ tended to those who offered suggestions, sent me their offprints, and allowed me access to their personal files. Their willingness to participate in a social analysis of their efforts and social contacts was clearly essential to the success of this study. Several gave con­ tinual access and spent more time helping me than participation in the study demanded: Robert Veatch of the Hastings Center; Alexander Capron of the University of Pennsylvania Law School; Leon Kass, then of the Kennedy Institute of Bioethics and now of the University of Chicago; Don Harper Mills of Los Angeles; Hannibal Hamlin, William Curran, the late Henry Beecher, and E. P. Richardson, all of Harvard University. iv It was only through Diana Crane's efforts and helpful advice that I was able to conduct such a successful survey. And I would never have winded my way.through any of the complexities and frustra­ tions of network analysis without the assistance of Michael Eeley, Klaus Krippendorf, Charles Kadushin, and especially Geoffrey Greene. The several people who at one time or another were members of my doctoral committee contributed to the project in different ways. The late Sol Worth offered several helpful criticisms of my plan of attack at the outset of this study. Virginia Ingersoll consistedly encouraged me both on the east .and west coasts. Ray Birdwhistell warned me (once more) not to come - a-cropper, a state of bei ng to which I came perilously close over the years. Robert Hornik, who joined by re­ quest e£ the last minute, made several incisive criticisms which helped enlarge the significance of the project. Renee Fox graciously offered the resources of the Sociology Department of the University of Pennsylvania for conducting the survey. Our occasional but al- ways exciting talks guided my sights in conducting this study. The study became manageable and viable through Diana Crane's ex- cellent advice and her gentle insi~tence that I keep on the track. We may have exceeded known records for discussing dissertation matters in and from different locales, mostofwhich beginwith the letter "P": Philadelphia, Paris, Princeton, Portland, West Lafayette and Boston. My friend and intellectual guide (not to mention doctoral com­ mittee chair), Larry Gross, deserves special mention. Throughout my graduate career at Penn, his timely suggestions {e.g., "Why don't you look into a course offered in Sociology this fall, the sociology of v culture? A di ssertati on mi ght come out of it.") made all the di f­ ference. He consistently allowed me the freedom to pursue my intel­ lectural interests and connected me to avenues and ideas which gave those interests shape. I was reminded throughout the five years of concern with this project that there were myriads of occupations for my time and con­ cern other than death (and liquid brains) by my close friend, Barbara ,/ Jean Safriet. Her support and encouragement, not to mention fi ne editorial assistance, made all stages of this project less painful than they would otherwise have been. And last, but by no means least, I thank my family. My aunt, Edith Lee, always had time to encourage my effoy'ts, And deep grati- tude is extended to my parents, Doris Everts and Edgar Rad~ who each in different ways made this achievement possible. vi TABLE OF CONTENTS Chapter 1. INTRODUCTION ...... The Institutionalization of the Redefinition of Death . 3 Motives and Goals 4 Conceptual Frameworks 6 The Basic Conceptual Problem 13 Apologia: The Relations of this Study to Other Research 14 Preview 16 Endnotes 19 2. CONDUCT: DEFINITIONS, INSTRUMENTS AND ANALYSES 21 Locating the Definers 21 Operational Defi ni ti ons 22 Contacting the Definers: The Survey 23 Contacting the Definers: The Interviews 32 Managing the Articles: Content Analysis 33 Contacting the Policy-Makers 36 Data Analysis 37 The Rest to Come 38 vi i Chapter Page Endnotes . 40 3. THE HISTORY OF THE REDEFINITION OF DEATH FROM RESEARCH TO STATUTORY DEFINITION . 41 The Development of Life Supporting Technologies and the Role of the Anesthesiologist in Defining Death ............... 43 The Electroencephalograph and the Determination of "Brain Death" ............. 45 Legal Ambiguities and the Definition of Death 46 American EEG Research and Redefining Death 48 Early Cadaver Organ Transplantation 50 The Ciba Symposium: Ethics in Medical Progress 52 The Defi ni ti on of Death and Euthanas i a 54 Modern Concern Over Premature Burial 58 The "Replaceable Muscle" 59 The Harvard Committee 61 1968 . 73 Enter Ethics and the Hastings Center 76 The First Statutory Definition of Death - Kansas, 1970 . ... 88 Maryland Takes the Second Step - 1972 96 From Whole Brain to Neocortical Death 97 A Neurologist Challenges the Redefinition of Death ... 100 The Hasti ngs Criti que of the Kansas Statute . 102 The Hastings Critique of the Harvard Report 107 Tucker v. Lower 110 vi i i Chapter Whose Issue is the Definition of Death? . 113 Vi rgi ni a Res ponds With a Statute 115 Cerebral Angiography . 118 New Mexico Enacts a Statute . 119 The Alaska Statute - What Happened? 122 Trans pl ant Troubl e and the Law i n Cal iforni a 122 The AMA Stand on the Issue as of 1974 129 The ABA Recommends a Statute 129 The NINDS Collaborative Study: The State of the Art of Diagnosing Brain Death in 1975 130 Endnotes . 134 4. THE CULTURAL DEFINERS: WHO THEY ARE 136 Work and Discipline. 136 Origin of Involvement with Redefining Death 140 Organizational Affiliation 145 Academic Affiliation and Geographical Locale 146 Cultural Location: Religion, Religiosity and Professional Generation ........ 148 5. COMMUNICATION ACTIVITIES IN CULTURAL DEFINING 152 The Professional Journal 153 Symposium, Conference and Panel Participation 160 Mass Media Discussions 162 6. SOCIAL ORGANIZATION AMONG CULTURAL DEFINERS 167 Assumptions Concerning the Concepts of "Network", "Communication" and "Social Relationship" 169 The Four Ti es . 175 ix Chapter Page The Structure of Soci a1 Ties Among the Definers 181 Comparison With Other Network Populations 201 Summary . 203 Endnotes 206 7. CONCEPTUAL APPROACH: ARTICLE CONTENT 207 The Content Analysis Scheme .... 207 Results of the Clustering Analysis: The Dyi ng Patient vs. the Common Good ... 238 Conceptual Approach and Social Organization 247 Endnotes 259 8. THE POLICY-MAKERS AND DEFINER/POLICY-MAKER INTERACTION . 260 The Policy-Makers: Who They Are 260 Definer/Policy-Maker Interaction 262 9. THE DYNAMICS OF INSTITUTIONALIZATION 265 Stage I: Medical Evolution .... 265 The Plot Thickens: Conceptual and Ethical Development 268 The Importance of Committee Organization 273 Defining as Diffusion 275 The Power to De fi ne . 280 Stage II: The Evolution of Policy 283 Evolutionary Stages in the Career of an Idea 285 Defining and Policy-Making Compared 286 What Prohibited Consensus? 289 Endnotes . 292 x Chapter Page 10. CONCLUSION: SUMMARY, EPILOGUE AND RECOMMENDATIONS 293 In Sum •• 293 Epil ogue: The Issue Since 1974 301 Concl usi ons 312 Endnotes 328 APPENDICES A 330 B 337 C 348 D 350 INDEX 356 SUPPLEMENTARY BIBLIOGRAPHY ONTHE REDEFINITION OF DEATH 358 BIBLIOGRAPHY .................... 367 xi --- LIST OF TABLES Tabl e Page 1. Universities Where Respondents Obtained Their Terminal Degrees.......................................... 147 2. Discipline by Religious Affiliation in Rounded Percentages ..................•...........................
Load more

Recommended publications
  • History of Lung Transplantation Akciğer Transplantasyonu Tarihçesi
    REVIEW History of Lung Transplantation Akciğer Transplantasyonu Tarihçesi Gül Dabak Unit of Pulmonology, Kartal Kosuyolu Yüksek Ihtisas Teaching Hospital for Cardiovascular Diseases and Surgery, İstanbul ABSTRACT ÖZET History of lung transplantation in the world dates back to the early 20 Dünyada akciğer transplantasyonu tarihçesi, deneysel çalışmala- th century, continues to the first clinical transplantation performed rın yapılmaya başlandığı 20. yüzyılın ilk yıllarından itibaren Ja- by James Hardy in the United States of America in 1963 and comes mes Hardy’ nin Amerika Birleşik Devletleri’nde 1963’te yaptığı to the present with increased frequency. Over 40.000 heart-lung ilk klinik transplantasyona uzanır ve hızlanarak günümüze gelir. and lung transplantations were carried out in the world up to 2011 yılına kadar dünyada 40,000’in üzerinde kalp-akciğer ve 2011. The number of transplant centers and patients is flourishing akciğer transplantasyonu yapılmıştır. Transplantasyon alanındaki in accordance with the increasing demand and success rate in that artan ihtiyaca ve başarılara paralel olarak transplant merkezleri arena. Lung transplantations that started in Turkey at Sureyyapasa ve hasta sayıları da giderek artmaktadır. Türkiye’de 2009 yılında Teaching Hospital for Pulmonary Diseases and Thoracic Surgery Süreyyapaşa Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma in 2009 are being performed at two centers actively to date. This Hastanesi’ nde başlayan akciğer transplantasyonları günümüzde review covers a general outlook on lung transplantations both in iki merkezde aktif olarak yapılmaktadır. Bu derlemede, ülkemiz- the world and in Turkey with details of the first successful lung deki ilk başarılı akciğer transplantasyonu detaylandırılarak dün- transplantation in our country. yada ve ülkemizdeki akciğer transplantasyonu tarihçesi gözden Keywords: Lung transplantation, heart-lung transplantation, his- geçirilmektedir.
    [Show full text]
  • 2004 Final Program
    The International Society for Heart and Lung Transplantation (a forum that includes basic science, the failing heart, and advanced lung disease) Twenty-Fourth Annual Meeting and Scientific Sessions April 21 – 24, 2004 Convening at the Hilton San Francisco San Francisco, CA Final Program Board of Directors President Jon Kobashigawa, MD, Los Angeles, CA President-Elect Alec Patterson, MD, St. Louis, MO Past President Stephan Schueler, MD, Newcastle, United Kingdom Secretary/Treasurer Robert C. Bourge, MD, Birmingham, AL Directors Paul A. Corris, MB, FRCP, Newcastle, United Kingdom F. Jay Fricker, MD, Gainesville, FL Katherine Hoercher, RN, Cleveland, OH Luigi Martinelli, MD, Genova, Italy Keith McNeil, MD, FRACP, Brisbane, Australia Mandeep R. Mehra, MD, New Orleans, LA Soon J. Park, MD, San Francisco, CA Hermann Reichenspurner, MD, PhD, Hamburg, Germany Bruce Rosengard, MD, FRCS, FACS, Cambridge, United Kingdom Heather J. Ross, MD, Toronto, Canada Adriana Zeevi, PhD, Pittsburgh, PA JHLT Editor James K. Kirklin, MD, Birmingham, AL Heart and Lung Transplant Registry Medical Director Marshall I. Hertz, MD, Minneapolis, MN Mechanical Circulatory Support Device Database Medical Director Mario C. Deng, MD, New York, NY Staff Amanda W. Rowe Executive Director Phyllis Glenn Assistant Executive Director Director of Membership Services Lisa Edwards Director of Meetings LeeAnn Mills Director of Operations 14673 Midway Road, Suite 200 Addison, TX 75001 Phone: 972-490-9495 Fax: 972-490-9499 www.ishlt.org [email protected] PAST PRESIDENTS 1981-1982 Michael Hess, MD 1982-1984 Jack Copeland, MD 1984-1986 Terence English, FRCS 1986-1988 Stuart Jamieson, MD 1988-1990 Bruno Reichart, MD 1990-1991 Margaret Billingham, MD 1991-1992 Christian Cabrol, MD 1992-1993 John O’Connell, MD 1993-1994 Eric Rose, MD 1994-1995 John Wallwork, FRCS 1995-1996 Sharon Hunt, MD 1996-1997 William Baumgartner, MD 1997-1998 Leslie Miller, MD 1998-1999 Alan Menkis, MD, FRCS(C) 1999-2000 Robert L.
    [Show full text]
  • Poczet Doktorów Honoris Causa
    2016-przedtytulowa-DHC.pdf 1 4/14/16 2:49 PM 2016-tytulowe-DOKTORZY HC.pdf 1 3/23/16 11:40 AM dr n. med. Ewa Skrzypek Warszawski Uniwersytet Medyczny © Copyright by Rektor Warszawskiego Uniwersytetu Medycznego, Warszawa 2016 Źródła fotografii doktorów honoris causa: Biblioteka Główna Warszawskiego Uniwersytetu Medycznego, Dział Fotomedyczny War- szawskiego Uniwersytetu Medycznego, Dział Zbiorów Specjalnych Głównej Biblioteki Lekar- skiej w Warszawie, Katedra Historii Medycyny Collegium Medicum Uniwersytetu Jagielloń- skiego w Krakowie, Muzeum Uniwersytetu Warszawskiego, Oddział Fotografii Narodowego Archiwum Cyfrowego w Warszawie, Polska Agencja Prasowa, Zbiory Fotografii Archiwum Polskiej Akademii Nauk w Warszawie oraz zbiory własne autorki. Redakcja językowa i korekta: Daisy Miriam Skrzypek Redakcja techniczna: Agnieszka Sierakowska Projekt okładki i stron tytułowych: Maja Sosnowska ISBN: 978-83-7637-383-6 Wydanie drugie uzupełnione i rozszerzone Nakład: 500 egz. Skład i łamanie: Agnieszka Sierakowska Druk i oprawa: Paper&Tinta PRZEDMOWA Tytuł doktora honoris causa jest najwyższą godnością, nadawaną przez Senat uczelni. Statut Warszawskiego Uniwersytetu Medycznego głosi, iż do zgłaszania kandydatów do tytułu uprawnieni są członkowie Rad Wydziałów, posiadający ty- tuł profesora, a wniosek do Senatu zgłasza Rada Wydziału. Dalej Statut podaje opis procedury, która doprowadza do przyznania tej godności osobie, która po- winna wykazywać się wybitnymi osiągnięciami oraz wyróżniać się niekwestiono- wanym autorytetem i postawą moralną, bowiem tytuł honorowy doktora honoris causa jest nadawany w dowód uznania zasług w dziedzinie nauki, kultury i życia społecznego. Utrwalony niezwykle głęboko w tradycji akademickiej zwyczaj wyróżniania dok- toratem honorowym sięga swymi początkami drugiego dziesięciolecia XIX wieku. Uniwersytet Jagielloński – najstarsza polska uczelnia – nadał go po raz pierwszy w 1816 roku dwóm profesorom własnej uczelni.
    [Show full text]
  • Thoracic and Cardiovascular Surgery
    GREAT INSTITUTIONS One Hundred Years of History at Stanford University: Thoracic and Cardiovascular Surgery Y. Joseph Woo, MD, and Bruce A. Reitz, MD The history of thoracic and cardiovascular surgery at Stanford spans a century long period, beginning not long after the founding of Stanford University. Pioneering Stanford surgeons have made landmark discoveries and innovations in pulmonary, transplantation, thoracic aortic, mechanical circulatory support, minimally invasive, valvular, and congenital heart surgery. Fundamental research formed the foundation underlying these and many other advances. Educating and training the subsequent leaders of cardio- thoracic surgery has throughout this century-long history constituted a mission of the highest merit. New Stanford Adult Hospital Semin Thoracic Surg 27:388–397 I 2015 Elsevier Inc. All rights reserved. Central Message Keywords: History, Cardiovascular Surgery, Thoracic Surgery, Transplantation, Aortic Dissection Stanford: Upon a foundation of rigorous scien- tific investigation and dedicated teaching, Stan- ford thoracic and cardiovascular surgeons PRE-STANFORD UNIVERSITY Stanford Faculty in pioneered discoveries and innovations in pul- Lineage tracing of the history of Stanford Cardiothoracic 1914 and led the monary, transplantation, aortic, minimally inva- Surgery could be extended back to 1857, even before the Stanford surgical sive, and congenital heart surgery. founding of Stanford University. Elias Samuel Cooper, a San service at the San Francisco surgeon, authored “Report of an Operation to Francisco General Hospital2 (Fig. 2). Although he practiced a Remove a Foreign Body from Beneath the Heart” published broad spectrum of surgery, much of his clinical and experimental by the San Francisco Medico Chirurgical Association. The work and scholarly publications were in the arena of chest following year in 1858, Cooper founded the first medical surgery.
    [Show full text]
  • Norman Shumway
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Baumgartner et al PRESIDENTIAL BIOGRAPHY Presidentialprovided by BiographyElsevier - Publisher Connector Norman E. Shumway, MD, PhD: Visionary, innovator, humorist William A. Baumgartner, MD,a Bruce A. Reitz, MD,b Vincent L. Gott, MD,a and Sara J. Shumway, MDc Born in Kalamazoo, Michigan, in 1923, Norman Edward sent back into the infantry. He then did three quarters of Shumway, Jr, and his parents (Laura Vandervliet Shumway premed at Baylor University in Waco, Texas. and Norman Edward Shumway, Sr) moved to Jackson, When it was time for Dr Shumway to matriculate to med- Michigan, when he was 1 year of age. His parents’ business ical school, all of the military slots were filled. He took an was operating ‘‘The Home Dairy,’’ which consisted of the interim job at Western State Mental Institution in Memphis, dairy in the back section and a diner up front. He went to Tennessee, where he was an orderly for 6 months. A slot be- the local grade school and was influenced early in a potential came open at Vanderbilt University in 1945, where he career in medicine when one of his classmates died of appen- started medical school. At Vanderbilt he was influenced dicitis. At Jackson High School, Dr Shumway was active on by 2 prominent surgeons of the time: Dr Barney Brooks, the debate team. His team was highly successful and won the Chief of Surgery, and Dr Cobb Pilcher, Chief of Neurosur- Michigan state championship in his senior year and then gery.
    [Show full text]
  • Newsletteralumni News of the Newyork-Presbyterian Hospital/Columbia University Department of Surgery Volume 12 Number 1 Spring 2009
    NEWSLETTERAlumni News of the NewYork-Presbyterian Hospital/Columbia University Department of Surgery Volume 12 Number 1 Spring 2009 Outliers All requires several iterative improvements and sometimes a leap of faith to cross a chasm of doubt and disappointment. This process is far more comfortable and promising if it is imbued with cross- discipline participation and basic science collaboration. Eric’s early incorporation of internist Ann Marie Schmidt’s basic science group within his Department continues to be a great example of the pro- ductivity that accrues from multidiscipline melding. Several speakers explored training in and acceptance of new techniques. The private practice community led the way in training and early adoption of laparoscopic cholecystectomy, which rapidly supplanted the open operation, despite an early unacceptable inci- dence of bile duct injuries. Mini-thoracotomies arose simultaneous- ly at multiple sites and are now well accepted as viable approaches to the coronaries and interior of the heart; whereas, more than a de- cade after their introduction, video assisted lobectomies for stage I, non-small-cell lung cancer account for <10% of US lobectomies. Os- tensibly, this reluctance reflects fear of uncontrollable bleeding and not doing an adequate cancer operation, neither of which has been a problem in the hands of VATS advocates. The May 8, 2009, 9th John Jones Surgical Day was a bit of an Lesions that are generally refractory to surgical treatment, outlier because the entire day was taken up by a single program, ex- such as glioblastomas and esophageal and pancreas cancers merit cept for a short business meeting and a lovely evening dinner party.
    [Show full text]
  • Transplant Updates
    Heart Transplantation A Half Century of Progress April 6, 2019 David D’Alessandro, M.D. Surgical Director, Cardiac Transplantation and Mechanical Circulatory Support Disclosures • None 2 Heart Transplantation • How did we get there? • How far have we come? • Where are we going? The danger of touching the heart "Surgery of the heart has probably reached the limits set by Nature to all surgery. No method, no new discovery, can overcome the natural difficulties that attend a wound of the heart." Stephen Paget, 1896 Alexis Carrel • published his technique for the vascular anastomosis in 1902 • 1905 reported heterotopic kidney and heart transplantation in dogs • Nobel Prize in Physiology 1912 History of Cardiac History Evolution of CPB Early Challenges in Cardiac Surgery 1920s - 1950s • Multiple failed attempts at operative treatment of rheumatic mitral stenosis • Poor visualization during ASD repairs Tubbs dilator Heart Lung Machine John Gibbon 1953 Cecilia Brevolek: May 6th as the first successful truly open-heart operation performed with the use of a heart-lung machine. Norman Shumway Surg Forum 1960;11:18. James Hardy • First human cardiac transplant was a chimpanzee xenograft performed at the University of Mississippi in 1964. Operative Permit Public ridicule “…not only immoral, but amoral”. Richard Lower • 1966 Lower performed “a reverse Hardy” • Passed up an opportunity to perform a human to human transplant in 1966 due to over cautious concern about secondary incompatibility Christiaan Barnard Louis Washkansky (December 3, 1967) “My moment of truth – the moment when the enormity of it all really hit me – was just after I had taken out Washkansky’s heart.
    [Show full text]
  • A Tale of Two Kidneys Overcoming the Immunological Barrier in Organ Transplantation by Roxanna Haghighat
    375Focus: Illuminating Science Years of Science at Harvard A Tale of Two Kidneys Overcoming the Immunological Barrier in Organ Transplantation By Roxanna Haghighat rgan transplantation becomes from one person and implant it into Harvard Medical School (now known Oa pesonal rather than scien- a separate human being at the outset as Brigham and Women’s Hospital), WLÀFPDWWHUDWWKH'09·VRIÀFHZKHUH seemed overwhelmingly complicated 'U0XUUD\SHUIRUPHGWKHÀUVWVXF- newly-licensed drivers are faced with DQGDOPRVWOLNHVFLHQFHÀFWLRQ³DPRUH cessful transplant of a major organ, for the crucial choice of whether or not humanistic Frankenstein, perhaps. Yet, which he received the Nobel Prize in to be an organ donor. Organ dona- decades of research later and count- Physiology in Medicine in 1990. More tion carries two seemingly polarized less obstacles overcome, organ trans- VSHFLÀFDOO\LQKHSHUIRUPHGWKH LPDJHV³RQHRI DJULHYLQJIDPLO\ plantation stands as the gold standard ÀUVWUHQDOWUDQVSODQWEHWZHHQLGHQWLFDO choosing to give life to sick patients therapeutic approach for patients with twins without organ rejection result- sitting at the top of the transplant list failing organs. ing in recipient mortality. Beyond this with no other treatment options and the While transplantation remains con- successful demonstration, Dr. Murray other of the global organ black market troversial in some cultures, as it is seen sought further to link his medical ac- by which scarce tissue resources are DVFRPPRGLÀFDWLRQRI KXPDQEHLQJV FRPSOLVKPHQWWRWKHEDVLFVFLHQWLÀF smuggled across borders. Perceptions the ability to perform organ transplants principles underlying it, investigating DVLGHWUDQVSODQWDWLRQ³ZKLOHWRGD\D LVDUHPDUNDEOHVFLHQWLÀFDFKLHYHPHQW genetics, the immune system, and organ VHWRI URXWLQHVXUJLFDOSURFHGXUHV³ that is due largely to the efforts of Dr. rejection. His discoveries, both in the UHPDLQVDQLQFUHGLEOHVFLHQWLÀFIHDW Joseph E.
    [Show full text]
  • Xeno Shark Tank Session “We're Close but There Are a Few Issues to Work Out”
    Xeno Shark Tank Session “We’re Close but there are a few Issues to Work Out” Andrew Adams, MD, PhD Emory University Disclosure I have no relevant disclosures. CEOT 2018- Xeno Shark Tank “Are We Ready to Take the Plunge?” Xenotransplantation • Organ Shortage is the #1 Issue in Transplantation • Optimization of Donation will never fully answer the problem • Xenotransplantation has the potential to answer the organ shortage dilemma • Genetic Engineering- New Technologies have opened new possibilities • Recent Outcomes in Preclinical Models are Promising but are we ready to try it in patients? In order to see where we’re going, it is important to remember where we’ve been Early Attempts at Clinical Xenotransplantation . Early 1960’s limited options for pts with ESRD . Deceased donor kidney transplantation infancy . 23 y/o school teacher with renal failure . chimpanzee to human kidney transplant . functioned for 9 months . 5 additional xenotransplants (8-63 days) . All died of infections . Additional heart and liver xenografts Early Attempts at Clinical Xenotransplantation Reemtsma Liver Xenotransplantation Leonard Bailey Xeno Donors . Non-human primates – ethical concerns – infectious risks – limited numbers/endangered status – concordant . Pigs – ethically acceptable, food source – easier to breed large litters – similar organ size for adults The Emory – Discordant immunologic barrier Transplant Center Challenges with Xenotransplantation . Concordant vs Discordant – distinct carbohydrate expression- a-Gal Carbohydrate xenoantigens are major
    [Show full text]
  • The Saga of Liver Replacement, with Particular Reference to the Reciprocal Influel1ce of Liver and Kidney Transplantation (1955-1967)
    ---- ---11CHARLES G DRAKE HISTORY OF SURGERY LECTURE ~I- ---- The Saga of Liver Replacement, with Particular Reference to the Reciprocal Influel1ce of Liver and Kidney Transplantation (1955-1967) Thomas E Srarzi, MO, PhD, FACS Between 1955 and the end of 1967, the framework of plantation was not mentioned in the literature until clinical organ transplantation that exists today was es­ 1955. The first report was in a journal called Transplan­ tablished in a small number of centers in continental tation Bulletin, the forerunner of the current Europe, Great Britain, and the North America. Here, I Transplantation. will describe the events during this period that led to human liver replacement. These efforrs were influenced by, and in turn contributed to, the development of other kinds of organ transplantation, and especially that of the kidney. The geneSis of liver transplantation As described by the immunologist, Leslie Brent, I and the Glasgow surgeon-historian David Hamilton/ trans­ plantation of all the major organs except the liver can be traced back to the early 1900s. In contrast, liver trans- Figure 1. C Stuart Welch (1909-1980), the author of the first article in the literature on liver transplantation, Information about Welch's tragic personal life can be found in: Starzl TE: The Puzzle People: Memoirs of a Transplant Surgeon. PittSburgh, PA: University of Pittsburgh Press; 1992. Figure 2. Auxiliary liver homotransplantation in dogs (the Welch Presented at rhe Amnican College of Surgeons, 88'h AnnuaJ Clinical Con­ procedure). Note that the reconstituted portal venous inflow is from gress, San Francisco , CA, Ocrober 2002, the inferior vena caval bed rather than from the splanchnic organs.
    [Show full text]
  • The Point System for Organ Distribution
    The Point System for Organ Distribution T.E. Starzl, R. Shapiro, and L. Teperman HEN congressional hearings on transplantation were The 1984 Gore bill was passed, but the key issues so W held by Congressmen Gore and Waxman in the important to transplant surgeons were not resolved. Extra­ autumn of 1983, the full implications were not obvious to renal transplant procedures remained classified as experi­ many who testitied. Support for the proposed legislation was mental. The key provision to fund medications was removed organized by Dr Oscar Salvatierra of San Francisco. Those from the original bill, although it was restored subsequently who contributed to the Washington support of the legislation in other legislation. The organ procurement and distribution included officers of the American Society of Transplant network that already had developed unofficially to the point Surgeons, Norman Shumway on behalf of the thoracic that it was an international model found itself under siege. A surgeons, many of the procurement coordinators, and myself task force was called for to make recommendations in (TES). There were three definable objectives. One was to transplantation, including how to distribute organs equita­ increase the supply of organs with a small grants program bly. Data collection was called for by a separate contract. that could strengthen procurement agencies already in exis­ tence or stimulate the development of new programs in THE JONASSON COMMITTEE underserved areas. An almost unnoticed proviso was the Implementation of the law was forestalled temporarily by establishment of a national network for organ distribution. ddiberations of the task force, which was instructed to The second proposal was to pay for expensive medicines, such complete its work in 6 months.
    [Show full text]
  • Success for Cross-Species Heart Transplants
    RESEARCH NEWS & VIEWS MEDICAL RESEARCH (perfusing) a blood-based, oxygenated solution containing nutrients and hormones through the hearts at 8 oC during the procedure (Fig. 1). This change improved short-term survival Success for cross-species in four recipient baboons, but the animals died within 40 days owing to rapid, detrimental growth of the transplanted hearts. Längin and heart transplants colleagues therefore modified the pro cedure to decrease this hypertrophy, and tested the A modified protocol has enabled baboons that received transplanted pig hearts to optimized protocol in five more baboons. First, survive for more than six months. This improvement on previous efforts brings they reduced the baboons’ blood pressure pig-to-human heart transplants a step closer. See Letter p.430 to match that of pigs. Second, they gave the baboons temsirolimus — a drug that combats heart overgrowth by stifling cell proliferation8. CHRISTOPH KNOSALLA pig-to-baboon transplants have so far lasted Third, they modified the standard hormone- only 57 days7. treatment regimen. The steroid cortisone is eart failure, in which the heart cannot Längin et al. set out to extend the survival typically given to transplant recipients to aid pump blood around the body effi- of baboons receiving life-supporting heart immunosuppression, but can cause heart over- ciently, is a problem of epic propor- transplants. They based their procedure on growth in newborn babies that receive stem- Htions. The number of adults living with heart a previously described immunosuppression cell transplants9. The authors therefore tapered failure in the United States is expected1 to reach protocol6 that prevents the baboon immune cortisone treatment much more quickly than more than 8 million by 2030, and many of system from rejecting the pig hearts, and used they had for their first group of baboons, these people will die while waiting for a donor pigs that had been genetically modified to minimizing levels of the drug by three weeks organ2,3.
    [Show full text]