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At least 19 recordsLinked to original sources
PubMed2006

Organ transplantation, organ donation and mental retardation.

We reviewed the literature on accessibility and outcomes of organ transplantation in individuals with mental retardation (MR) and on the prevalence of organ donation in this population. Six centers have published outcome data on renal transplantation in 34 individuals with MR. The one- and three-yr patient survival rates were 100% and 90%, respectively. The studies reported good compliance with post-transplant medications due to consistent support from family members or caregivers. The outcome studies for liver and heart transplantation among these individuals are limited. The literature on organ donation in individuals with MR is mostly concerned with legal issues. The courts generally permit organ donations when such is in the best interests of the donor.

Child↗
PubMedDate not supplied

[Ethical and social problems posed by organ transplantation].

Organ transplantation more than a scientific fact is now a social fact. Since the first organ transplantations in France, forty years ago, medicine demonstrated its ability to perform the operation and to obtain (what was more difficult) the tolerance of the graft but medicine so far remains unable to give the material: organs. These organs are given by the donor's relatives when the kidney is concerned and when it is a donation from a living person. But such donation remain strictly limited in our country (less than 5 p. cent of the kidney transplantations) due to the risk of moral pressure and commercialization. More often and for the other organs (liver, heart, lung) the donation is obtained after death, a special and dramatic death: the brain death. The nowadays spectacular results of organ transplantation 70 to 80 p. cent survival rate at 10 years with a complete rehabilitation gave a considerable increase on the demand. Unfortunately organ transplantation is the victim of its success, the number of donor's organ being insufficient to satisfy the needs. So in December 1990, 6,055 patients were on the waiting list and only 3,772 (56 p. cent) were transplanted. In December 1991, 6,334 patients were on the waiting list and may be only 4,000 could be transplanted. So the difference between the needs and the possibilities is increasing each year with for consequences, the death of 10 p. cent of the waiting patients and, for those who could be transplanted, a considerable increase in the waiting period responsible for slow deterioration of their status and less chances of success.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1992

[Ethical and social problems posed by organ transplantation].

Organ transplantation more than a scientific fact is now a social fact. Since the first organ transplantations in France, forty years ago, medicine demonstrated its ability to perform the operation and to obtain (what was more difficult) the tolerance of the graft but medicine so far remains unable to give the material: organs. These organs are given by the donor's relatives when the kidney is concerned and when it is a donation from a living person. But such donation remain strictly limited in our country (less then 5% of the kidney transplantations) due to the risk of moral pressure and commercialization. More often and for the other organs (liver, heart, lung) a the donation is obtained after death, a special and dramatic death: the brain death. The nowadays spectacular results of organ transplantation 70 to 80% survival rate at 10 years with a complete rehabilitation gave a considerable increase on the demand. Unfortunately organ transplantation is the victim of its success, the number of donor's organ being insufficient to satisfy the needs. So in December 1990, 6,055 patients were on the waiting list and only 3,772 (56%) were transplanted. In December 1991, 6,334 patients were on the waiting list and may be only 4,000 could be transplanted. So the difference between the needs and the possibilities is increasing each year with for consequences, the death of 10% of the waiting patients and, for those who could be transplanted, a considerable increase in the waiting period responsible for slow deterioration of their status and less chances of success. The reason of the lack of organs is not due to the lack of brain deaths which are unfortunately too numerous, but to the impossibilities of organ retrieval due to: too advanced age or the presence of a transmissible disease of the donor, lack of medical means in some intensive care units, and family refusal. This refusal is easily understood and due to the very peculiar conditions in which the donation is required: the unexpected death of a loved parent and such a death with some life appearance. To avoid the increasing number of such refusal two actions are possible. One is the modification of the law. The French law is the Caillavet law which requires for organ retrieval, the written permission of the parents for a minor, or for an adult the absence of refusal expressed during his or her life.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical↗
PubMed1994

Gift Exchange Theory: a critique in relation to organ transplantation.

Organ transplantation is becoming more important as a viable method of treatment for certain severe medical conditions. It is a complex and demanding process for all involved. Nursing as a developing science must respond to cultural and economic changes. Therefore, a need exists to develop a body of empirically based knowledge to understand and support the process of organ transplantation. This paper will argue that as trading in organs is unacceptable to the moral standards of western society and outlawed in many countries, an alternative framework must be considered for understanding the mechanisms through which organs are donated and utilized. The donating and receiving of organs may be equated with gift-giving, as there is no barter of commodities involved. Therefore, a useful framework to explore this phenomenon will be one that underpins the process of giving and receiving of gifts. Gift Exchange Theory will be evaluated and critically examined in relation to organ transplantation and the role of nurses in this process.

Anthropology, Cultural↗
PubMed2004

Beyond survival: the burden of disease in decision making in organ transplantation.

Organ transplantation has long been perceived as a life-saving intervention. However, it is now recognized that the broader objectives include reducing the patient's burden of disease. The components of the burden of disease include (i) mortality, (ii) morbidity, (iii) disability, (iv) psychological distress and (v) resource use. These components may be correlated either positively or negatively, reflecting common disease antecedents or the trade-offs in clinical decisions. Our proposed approach to modeling includes measures of each outcome and, explicitly, their correlations. Its results are the predicted independent and joint probabilities that a patient will experience any specified range of each measure and of combinations of the measures. The methods were tested with data on mortality, morbidity and resource use from patients following kidney transplantation. The predicted probabilities of the measures are consistent with their observed values and distinguish among the prognoses of patients with distinctive risks, such as diabetics. We have shown, and we believe, that it is feasible to assess the interrelated components of the burden of disease in individual patients and hope that our approach may serve as a starting point in the development of a program for inclusion of alternative measures of outcome in decision making in organ transplantation.

Cost of Illness↗
PubMed2004

Management of bone loss after organ transplantation.

Organ transplant recipients experience rapid bone loss and high fracture rates, particularly during the early post-transplant period. Early rapid bone loss occurs in the setting of uncoupled bone turnover with increased bone resorption and decreased bone formation. Because there are no clinical factors that reliably predict post-transplant bone loss and fractures in the individual patient, all transplant recipients should be considered candidates for early preventive therapy for osteoporosis. Long-term transplant recipients with densitometric osteoporosis and/or fractures should also receive treatment. Although active metabolites of vitamin D and bisphosphonates have both shown efficacy, data from clinical trials suggest that bisphosphonates are the safest and most consistently effective agents for the prevention and treatment of post-transplantation osteoporosis in adults. Kidney transplant recipients represent a special population, and more research is needed to delineate the risks and benefits of treating bone disease in these patients.

Bone Density↗
PubMed2005

Clinical pharmacogenetics of immunosuppressive drugs in organ transplantation.

Organ transplantation has become an important additional option for patients with organ failure. Immunosuppressive drugs showing a very narrow therapeutic window have to be administered. Different transporters and metabolic pathways are responsible for absorption and metabolism of these drugs; for instance, the P-glycoprotein (P-gp) pump regulates the absorption of a drug, and its metabolism is catalyzed by cytochrome P450s (CYPs). As the phenotypes of P-gp or the CYPs are predetermined by their genotypes, genetic testing prior to drug therapy may help to predict the drug doses required. This review describes polymorphisms of the genes coding for P-gp and CYPs, and focuses on the compounds cyclosporin and tacrolimus. It is hoped that this information might help to judge the value of pharmacogenetic testing prior to immunosuppressive therapy in solid organ transplantation.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2006

Orthopedic complications of solid-organ transplantation.

Organ transplantation has undeniably increased the longevity and quality of life of patients with end-stage organ failure. Its has, however, introduced the skeletal complications of (1) fragility fractures and decreased bone density due to pretransplant bone loss and immunosuppressive therapy, and (2) avascular necrosis leading to subchondral fracture and secondary osteoarthritis. This article reviews these two skeletal complications of solid-organ transplantation that lead to structural failure of bone and result in significant morbidity and reduced quality of life.

Bone Density↗
PubMed2005

The phenomenology of death, embodiment and organ transplantation.

Organ transplantation is an innovative 21st century medical therapy that offers the potential to enhance and save life. In order to do so it depends on a supply of organs, usually from cadaveric donors who have suffered brain stem death. Regardless of whether and how the deceased recorded their wishes about donation, health professionals will approach the bereaved relatives, before organs are removed. In this article, the results from 19 semi-structured interviews with Scottish donor families will be presented. These accounts will focus exclusively on the families' beliefs about death, the dead body and bonds with the deceased, and whether these affected the donation decision or the organs donated. What the families said about brain stem death (BSD); how and when they understood that death had occurred; and whether the families thought that death caused a 'disembodiment' (that the self was no longer embodied) will be explored. Finally, attention will turn to the bereaved's previous relationship with the embodied person. I conclude that the phenomenology of embodiment, death and organ transplantation offers new answers to the question of 'Who am I'? That is, in order to understand what identity is, one might look for what it is that is lost at death; the body, the self and relationships with others.

Attitude to Death↗
PubMed1999

[Cutaneous complications after organ transplantation].

Organ transplant recipients may develop cutaneous complications related to long-term immunosuppressive drug treatment (prednisolone, azathioprine, cyclosporine). These complications are either related to the immunosuppression per se, such as common warts, dermatophytosis, premalignant lesions, and skin cancer, or drug-specific effects, such as acne, rosacea, and hypertrichosis. Organ transplant recipients have a markedly increased risk of developing skin cancer, especially squamous cell carcinoma, but also basal cell carcinoma, Kaposi's sarcoma and malignant melanoma. Patients should be encouraged to avoid sun exposure, a well-known risk factor for skin cancer, and to use sun protection measures. Patients with skin lesions suspected to be malignant should be referred to a dermatologist. Close dermatological follow-up of patients diagnosed with post-transplant skin cancer is essential.

Humans↗
PubMed1994

[Cancer following organ transplantation].

Organ transplantation is followed by an increased risk of cancer. Analysis of series of transplanted, and thus immunosuppressed patients, enables the risk factors associated with this treatment to be identified, and oncogenic mechanisms in general to be investigated. In most recent cancer studies where correct epidemiological methods have been used, the incidence of cancer among transplanted patients was found to be 3-5 times that in the general population. This was the case for most types of tumours, though the distribution was uneven with an over-representation of lip, cervical, vulvar, urological and skin cancer and lympho-proliferative disorders, most of which appear early after transplantation, except for skin cancer which appears later but increases in incidence with time. The increase in the incidence of cancer appears to apply to all kinds of organ transplantation, though so too does our knowledge of possible risk factors and oncogenic mechanisms in general. For many of the tumour types there would appear to be a connexion with virus infection, which opens up avenues of research regarding prophylaxis and treatment.

Humans↗
PubMed2003

Smallpox vaccination and the patient with an organ transplant.

Organ transplant recipients are vulnerable to a variety of infections because of the immunosuppressed state required to prevent organ rejection. We review the recommendations of the Centers for Disease Control and Prevention (Atlanta, Georgia) for smallpox vaccination and the possible complications of vaccination in the population with organ transplants. The risk of these complications is presumably dependent on the extent of deficient cell-mediated immunity.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Weight gain and cardiovascular risk after organ transplantation.

Organ transplantation has become a common and effective approach to the management of patients with organ failure. The improvement in long-term survival has resulted in the emergence of cardiovascular disease as the primary cause of death in renal transplant patients and a significant complication in other organ recipients. A number of factors explain this trend, including a high incidence of hypertension, posttransplant diabetes, hyperlipidemia, and obesity-risk factors that are mediated by direct effects of immunosuppressive medications. Weight gain posttransplant affects approximately 50% of patients and represents a significant problem because of the potential synergism between obesity and immunosuppressive medication-induced effects on cardiovascular disease risk factor development. This review discusses the incidence and implications of cardiovascular disease risk factors in organ transplant recipients, strategies for clinical management, and future research directions.

Cardiovascular Diseases↗
PubMed1994

[Psychological consequences in organ transplantations].

Organ transplantations constitute therapeutic advances for some fatal diseases. Their specificity are: severe prognosis, waiting for an alive donor (kidney or marrow transplantations) or a dead one, uncertainty of results or side effects. Identity troubles, debt towards the donor characterize also transplantations. They realize a traumatic situation difficult to communicate and demand a long working through psychic procedure. We shall describe these patients' defense mechanisms and those of their family and care takers--the psychologist's role in transplantation units.

Bone Marrow Transplantation↗