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Viewing: Blog Posts Tagged with: transplantation, Most Recent at Top [Help]
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1. Organ donor shortage versus transplant rates

By David Talbot

The article in this week’s Times with the commentary written by Chris Watson illustrates the significant changes that have happened in transplantation over the last two years. In 2008, the Organ Donor Taskforce (ODTF) came up with 14 recommendations to address the problem of donor shortage, and then UK Transplant (which then changed to Blood Transplant) acted upon these.

In addition to these changes, organ donation surgery became restricted to six zones whereas before the ODTF recommendations, all 26 transplant units in the country contributed to cadaveric organ donation. Also, the national sharing of organs (which had been voluntary, in so far as we aimed to serve our own community primarily and additional organs were shared only in certain cases) became enforced. This essentially was because there was a postcode imbalance, and some kidney failure patients waited six years for their transplant whereas in the northeast, patients generally waited only for 18 months.

The reasons for this imbalance were complex and were partly influenced by certain ethnic minority populations who didn’t support cadaveric donation while simultaneously making up a significant percentage of the number of patients who needed a transplant.

Additionally, different transplant unit structures had varying degrees of enthusiasm for donation. The work force obviously recognized these problems and tried to unify the approach and also ensure equality of access.

On a personal level, I was reluctant to throw my lot in with these national developments because our transplant population had a good deal! Indeed, with the national sharing mechanism, our local transplant rates initially fell, resulting in an increased waiting time.

The ODTF 14 point plan was, to me, an experiment which should be abandoned if it didn’t work. However, its effect was to promote donation by embedding Transplant Coordinators in most hospitals, thereby insuring that potential organ donors are not overlooked. In addition, numbers of Non-Heart-beating donors (aka donor after cardiac death), thanks to our pioneering work, have really taken off, accounting for 37% of cadaveric kidney transplants nationally. So although from a local level the national sharing scheme was a bad idea at the time, because of the promotion of donors through the enactment of the ODTF plan, the transplant numbers have now increased nationally, so my concerns for the future have proved wrong.

For example, I was on call for the week between Christmas and New Year and we did six kidneys and two liver transplants. Last week, I was again on call, and we did a liver, a kidney/pancreas, three live donor kidneys, two double kidney transplants, and an islet transplant! On the background of this our unit did 135 cadaveric donors last year.

Our next pressing problem is surgical exhaustion!

David Talbot is a Consultant Transplant Surgeon at Newcastle Hospitals NHS Trust and co-author of Organ Donation and Transplantation After Cardiac Death.

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2. Lower’s Dogs

Rom Harre is Emeritus Professor of Philosophy at Linacre College, Oxford, and Adjunct Professor of Philosophy at Georgetown University, Washington, DC. In his book, Pavlov’s Dogs and Schrodinger’s Cat: Scenes from the Living Laboratory, we get an enlightening look at the use of plants and animals–including humans–in scientific experiments. In the excerpt below we see how dogs were essential to figuring out heart transplants.

By coincidence, two men, one living in the seventeenth century and one in the twentieth, who both used dogs as models and whose work led to major breakthroughs in medicine bore the same name.  The first Richard Lower used dogs to perfect blood transfusion techniques, while the second Richard Lower used the same species of animals to perfect heart transplantation methods.

History, as presented in the media and so in popular belief, credits the beginning of heart transplantation techniques to Christiaan Barnard.  Digging a little deeper we come across the most successful practitioner of this art, Norman Shumway.  However, using dogs as experimental apparatus – as pilot plants- to perfect the surgical techniques required to carry out transplant operations on human beings.  Christiaan Barnard did forty-eight trial transplants with dogs before he undertook such an operation with a human being.  He acknowledges that what he uses ‘was a technique built on that developed by Shumway and Lower, who had experimented on more than 300 dogs… With their findings joined to mind there was little point in continuing to further sacrifice of animals.’

Richard Lower studied at the Medical School at Cornell but moved for his residency period to the University of Washington in the northwest of the United States.  One autobiographic snippet suggests that the American northwest suited his love of the outdoors.  Finding things not to his liking there he moved south to Stanford were he could qualify more quickly.  Working in very primitive conditions in the training section of the hospital he eventually met up with Norman Shumway and forged a remarkable partnership with him.

Norman Shumway (1923-2006) studied medicine at Vanderbilt University, moving on to a doctorate at the University of Minnesota in 1956.  He was appointed as a surgery instructor at Stanford University in 1958, where he remained for the rest of his career.  He seems to have been a somewhat paradoxical character.  Reticent and wary of publicity, yet he was famous for his witty and jocular conversation, particularly during the course of long and demanding surgical procedures.  The persistence with which he pursued his goal of successful himan heart transplantation suggests a dogged streak.

Lower began his experimental programme as an assistant to Shumway working on the techniques for open heart surgery, including the possibility of cooling a living heart so as to stop its beating.  Under this condition surgical repair would be greatly facilitated.  The heart could then be warmed up and restarted with a fibrillator.  Perhaps the heart could be removed completely from the patient’s body for delicate surgical work and replaced when the repair was done.  This is the procedure known as ‘auto-transplantation’.

Dogs were already in regular use at Stanford University Medical School for training surgeons.  …Lower and Shumway continued their use of dogs as experimental apparatus, pilot plants for the ultimate transfer of the techniques to the human case.  Despite his skill in surgery Lower was unable to achieve successful autotransplantation.  The reason was simple

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