Since the 1970s, we have witnessed astonishing scientific and technical progress in the field of organ transplantation. Patients who suffer organ failure can now often have their lives greatly improved both in terms of quality and quantity of years. The success of transplantation techniques has created an enormous demand for donor organs. Unfortunately, donor organs are in short supply, relative to the number of patients who could greatly benefit from them. Therefore, donor organs are a scarce and valuable resource that must be thoughtfully and fairly allocated among waiting patients. Not surprisingly, this situation raises many pressing ethical questions, each requiring careful consideration. This volume presents a systematic and balanced treatment of some of the most pressing ethical questions including: what is our ethical obligation to become organ donors and who should be allowed to donate?; to what extent can markets facilitate the fair allocation of organs and how should we most fairly determine who should be recipients?; how do we determine death when the donor is not brain dead?; should non-human donor organs be used to save human lives and should we use organs from anencephalic infants and tissue from embryos? ; and what is the role of the news media in covering stories about organ transplantation? Many of the leading authorities in medical ethics come together in this volume to develop extensive analyses and arguments. The reader is provided with a sound understanding of the ethical, as well as many of the broader issues in organ donation and transplantation.

Post-transplant lymphoproliferative disorders are a group of conditions that straddle the borders between infection and malignancy. They were very rare prior to the mid-1980s but now can be expected to develop in 1-10% of transplant recipients. While some cases are reversible with reduction in immunosuppression, more severe forms are indistinguishable from frank lymphomas. This book sets out to cover in depth every aspect of these disorders, including both basic science and clinical topics. The epidemiology is reviewed, and careful attention is paid to the role of Epstein-Barr virus in their development. Clinical features are documented and clear guidance is provided on diagnosis, with thorough description of pathologic and imaging findings. Further chapters are devoted to treatment, prognosis, preventive and pre-emptive strategies, and organ-specific considerations. The state-of-the-art information contained in this book will aid researchers as well as the many different professionals involved in caring for patients with post-transplant lymphoproliferative disorders. The comprehensive and detailed coverage will appeal to those who already have some expertise in the field, yet the book will also serve as an invaluable resource for beginners in transplantation.

The book encompasses Dr Baranski's 20 year experience in the field of abdominal organ donation. It is a step-by-step guide with photographs and drawings with clear explanations highlighting pitfalls. The book quickly and easily guides the reader through the difficult steps during organ procurement. It is mainly illustration-based, without much text, and covers surgical technical mistakes and organ damage.

The book gives an account of results obtained from experiments where grafts of neuronal, glial and other tissues as well as artificial materials were placed into the spinal cord. It attempts to evaluate the contributions made by these studies to our understanding of basic neurobiologies questions. These include factors that regulate neuronal growth during development as well as regenera tion following injury to the nervous system. The model of neural transplanta tion is also useful for the study of cell-to-cell interactions, and this applies to interactions between glial cells and neurones, between various populations of neuronal cells and finally between axons and skeletal muscle fibres. The mecha nisms involved in the establishment of specific synaptic connections between neurones can also be investigated in this experimental paradigm. Important in formation regarding this issue was also obtained on systems other than the spinal cord, i. e. the cerebellum, hippocampus and striatum. Although such in formation of precise connections between the host and the grafted embryonic tissue is still lacking in the spinal cord, there is much information on the re sponse of the host nervous system to the grafted embryonic tissue, and that of the graft to its new host environment. It appears that embryonic grafts are able to induce repair processes follow ing injury to the nervous system.

The aim of this book is to present a unique compilation of lectures given by international speakers at the Hammersmith Hospital during the recent Meetings in Hepato-Pancreato-Biliary and Transplantation. New therapeutical approaches, advances in oncology and in diagnostic imaging, which reduce the need for invasive techniques and reach an improvement in survival and quality of life in cancer, are considered in this book. Modern literature has been reviewed with special reference to articles of general interest. In the clinical management of patients with liver, bile duct and pancreas diseases, it is important to assess the degree of disturbance and to diagnose the causative insult, and therefore clinical and laboratory methods of assessing each of these pathologies are of high interest. This version is an up-to-date account of diseases of the liver, biliary tract and pancreas, including transplantation, which we trust will be of value for surgeons, physicians and pathologists and also a reference book for medical students.

Stem Cell Biology in Health and Disease presents an up-to-date overview about the dual role of stem cells in health and disease. The Editors have drawn together an international team of experts providing chapters which, in this fully-illustrated volume, discuss: - the controversial debate on the great expectations concerning stem cell based regeneration therapies raised by the pluripotency of various stem cells. - the advantages and concerns about embryonic stem cells (ES cells), induced pluripotent stem cells (iPS cells) and adult stem cells, such as bone marrow-derived stem cells (BMDCs). - the type of stem cells, which has become of interest in the past decade, namely so-called cancer stem cells (CSCs). CSCs are now in the focus of cancer research since the eradication of tumour initiating cells would raise the changes of definitely cure cancer. Professor Dittmar and Professor Zanker have edited a must-read book for researchers and professionals working in the field of regenerative medicine and/or cancer.

Though kidney transplantation is considered a routine procedure, there are still significant challenges in post-transplant management. Core Concepts in Renal Transplantation is a clinically focused authoritative guide to the management of kidney transplantation. This comprehensive, state-of-the-art reference summarizes the recent changes in the field of transplantation, offering the complete range of up-to-date information on all the various aspects of basic immunobiology and the medical care of the transplant recipient. Written by a team of renowned authorities in renal transplantation, this concise resource is intended for both the nephrologist and the non-specialist with an interest in kidney transplantation.

Laryngotracheal Reconstruction: From Lab to Clinic lines for using the technique of tracheal autotra- presents the experimental and clinical aspects of plantation in conservation laryngectomy. The tissue reconstruction of the larynx and trachea. shortcomings and complications of tracheal auto- The book reflects the development and implemen- transplantation encountered in the initial patient tation of a research-based clinical program. The series led to a modification of the technique. The experimental work was started in 1989 with the modified autotransplantation technique proved to aim of improving the reconstructive possibilities be reliable from a reconstructive, functional and in the following two clinical situations: (1) extend- oncological viewpoint. ed hemilaryngectomy defects after tumour In a second part (Chap. VI), healing aspects after removal and (2) tracheal stenoses that are impos- repair of laryngotracheal defects are highlighted. sible to repair by segmental tracheal resection. The The healing mechanisms of the cartilage support, two problems differ in localization (larynx, tra- the mucosal lining and the blood supply were chea), etiology (oncology, traumatic), and treat- studied for each tissue component individually.

The use of cells for the treatment of a variety of diseases is no longer a dream. Today, blood transfusion, bone marrow transplantation, the use of ex vivo cultured skin in wound healing, and peripheral stern cell transplantation, including the ex vivo expansion of hematopoietic stern cells after high-dose chemo/radiation therapy, are routine. This high standard of knowledge and skills in cell transplantation might also re sult in tackling hitherto untreatable diseases. Organ transplantation is presently the only life-saving treatment for a variety of conditions. Important findings in cell and molecular biol ogy, the identification of hematopoietic, mesenchymal and neuronal stern cells, together with breakthroughs in the methodology for isolat ing, purifying, expanding, and storing human cells could make cellular therapy an alternative to organ transplantation in certain diseases within the next decade. Placental blood may be the source of choice in isolating naive progenitor cells for allogeneic transplantation. Immunotherapy is the most hopeful strategy to date for the treat ment of tumors resistant to chemotherapy, radiation therapy, or hor mone therapy. It includes the use of tumor-infiltrating lymphocytes, ex vivo activated memory T lymphocytes, and cell-based vaccines."

Progress in the development of surgical implant materials has been hindered by the lack of basic information on the nature of the tissues, organs and systems being repaired or replaced. Materials' properties of living systems, whose study has been conducted largely under the rubric of tissue mechanics, has tended to be more descriptive than quantitative. In the early days of the modern surgical implant era, this deficiency was not critical. However, as implants continue to improve and both longer service life and higher reliability are sought, the inability to predict the behavior of implanted manufactured materials has revealed the relative lack of knowledge of the materials properties of the supporting or host system, either in health or disease. Such a situation is unacceptable in more conventional engineering practice: the success of new designs for aeronautical and marine applications depends exquisitely upon a detailed, disciplined and quantitative knowledge of service environments, including the properties of materials which will be encountered and interacted with. Thus the knowledge of the myriad physical properties of ocean ice makes possible the design and development of icebreakers without the need for trial and error. In contrast, the development period for a new surgical implant, incorporating new materials, may well exceed a decade and even then only short term performance predictions can be made.

The book includes recommendations for COPD from published guidelines (eg, the GOLD, ATS, and NICE guidelines) and presents them in the context of relevant clinical treatment issues. This is an in-depth guide on the management of COPD, concentrating on the impact of COPD on a patient as well as how healthcare professionals can intervene and educate the patient at an early stage and thereby slow the onset of severe symptoms.

The inadequate supply of organs in the United States and other countries continues to drive the reliance on living donor transplantation. In 2000, representatives of the transplant community convened for a meeting on living donation in an effort to provide guidelines to promote the welfare of living donors. The consensus statement that resulted from this meeting recommended that transplant centers retain an Independent Living Donor Advocate (ILDA) to focus on the best interest of the donor. A decade later, nearly every transplant center in the United States, performing living donor surgeries, has incorporated an ILDA into their living donor screening and/or evaluation process Living Donor Advocate provides an overview of living donation and its risks, ethical challenges and future developments , as well as details about the role a Living Donor Advocate plays in the transplantation process. This book will interest health professionals across various disciplines and patients undergoing transplantation or living donor surgery.

The research field of biobanks and tissue research is highly promising. Many projects around the globe are involved in the collection of human tissue and health data for research purposes. These initiatives are driven by the perspective of decisive breakthroughs in the knowledge of the genetic pathways involved in widespread diseases. However, there are considerable ethical and legal challenges to be considered as well. These challenges encompass the use of body material for research purposes, the misuse of genetic and other health data by third parties, trust in science and medicine, concerns regarding privacy, use of genetic data for forensic applications by the state and the police, and regulatory issues. This volume is divided into three parts: the inclusion of the public, the rights of donors and patients, examples and recommendations for the future of tissue research. It presents a comprehensive overview of the most important topics in the field by renowned scholars in medical ethics and biolaw.

This book - the first multicenter book on orthotopic liver transplantatio- reflects the progress in this field. The first 'experience in hepatic transplantation' was documented in 1969 by Starzl and his group in Denver in the classic of the same name. It was followed in 1983 by 'Liver transplantation', edited by Caine, in which the experience of the Cambridge-King's College Hospital team was laid down. Apart from these the book of Lie and Giitgemann appeared in 1974. These books are fundamental for all who want to become involved with experimental and clinical liver transplantation. Developments in liver transplantation are fast (faster than the production of this book) and new knowledge now not only is coming from the pioneer centers but also from their off-spring, scattered over the world. In only a few years there has been an enormous increase in the number of liver transplantations and certainly there have been performed at least as many transplants since 1980 as between 1963 -the start of clinical liver transplantation- and 1980. Even if our understanding is better, many problems are the same as twenty years ago and for some there may be a long way to go before they are solved.

In Japan, cadaveric donor liver transplantation is not common even though cadaveric organ transplantation was legally established in 1998. In contrast, the number of living donor liver transplantations is increasing, with more than 1700 cases at 43 Japanese institutes by November 2001. Indications for and have become living donor liver transplantation are widening in Japan similar to those for cadaveric donor liver transplantation in the United States and Europe. At the same time, split liver transplantation from cadaveric donors shares some technical aspects with living donor liver transplantation. Remarkable progress has been reported recently, and thus it was an auspicious time to hold a symposium on "Current issues in liver/small bowel transplantation" in Japan. We were honored to hold a very fruitful symposium sponsored by the Keio University Medical Science Fund and to bring together top-rank transplant surgeons from Japan and other countries. It was a productive and rewarding time for all participants. We were able to share our experience through excellent presentations followed by active discussions and insightful com ments. At the symposium, we focused on current issues in liver transplanta tion such as widening indications for viral hepatitis and malignant tumors. We also discussed technical aspects and physiological problems in split/iiving donor liver transplant, novel strategies in immunosuppression, and the current status and future prospects in small bowel transplantation. This book contains the papers from all the distinguished guest speakers, focusing on the topics discussed at the symposium."

For the first time a complete review of the research work done over the past 30 years by leading investigators around the world in targeting immunosuppressants to both solid-organ and cellular transplants is available in a single volume. One section consists of studies conducted in rat allograft models using osmotic minipumps for delivery of a variety of immunosuppressants. The book will be of great benefit to researchers in the fields of transplant immunology, pharmacology and drug delivery and targeting, particularly those involved in drug development.

M. BENcovA Slovak Foundation Education in Immunogenetics Kopanice 25, 821 04 Bratislava Slovak Republic Short History of Slovakia After the end of the 5th century, the major part of Central Europe was dominated by Slavs (Slovaks). They had already in the 7th century settle ments in the vicinity of towns Bratislava, Devin, Nitra to create the Slovak's state formation with the name "The Empire of Sam", territory of which corresponded to that of Slovakia of present. The Empire of Sam was also the first state formation in the Central Europe (as present states Czech Republic, Poland, Hungary, Slovakia etc. ) Very important town of this state was Nitra, with the biggest Castle in the Central Europe with his Duke Pribina. The first Church of the Central Europe was built here in the year 830, and it is now considered to be the "Slovak Bethlehem". In the year 880, Nitra also became the first Office of Bishops. Later, the Slovak Duke Pribina and Moravian Duke Mojmir (Moravia corresponded to eastern part of the present Czech Republic) joined their formations to common state "Greate Moravian Empire". The strongest King of the Great Moravian Empire was Svatopluk (864 A. D. ), who spread his empire over Czech Republic, Hungary and part of Poland, Ukraine and eastern Germany of present, which at that time still did not exist as state formations.

Rejection and Tolerance is the latest subject in the Continuing Education series, organized by Fondation Marcel Merieux and Universite Claude Bernard in Lyon. The annual subject is chosen to reflect the status of the topical issues of the year, as taught by leading international experts. The contribution of transplantation and clinical immunology to advanced medicine is considerable and promising. The annual volumes in this series keep the reader abreast of these developments. "

With a long practice of organ transplantation, retransplantation has become a major goal in patients with long-term failure of their first transplant (chronic rejection, exhaustion of the transplant, recurrence of the initial disease, etc. ). In addition, retransplantation can be necessary in the initial period, due to severe acute rejection, a non-functioning organ, or surgical complication. Immunological and non-immunological factors affecting the success of a second transplant are described in this volume, together with alternatives to retransplantation. It is hoped that in the future retransplants will be less frequent, as a result of improved prevention of transplant failure. J. L. Torrroine et a/. (ens. ), Retra isplantation, xvii. Q 1997 Kluwer Academic Pirblislters. P . iilted in Great Britain. List of contributors R. ARNOLD Y. W. CHO University of Pittsburgh UCLA School of Medicine Center for Medical Ethics Tissue Typing Laboratory Division of General Internal Medicine 950 Veteran Avenue 200 Lothrop Street - MUH, Suite W-919 Los Angeles, CA 90095-1652 Pittsburgh, PA 15213-2582 USA USA P. COCHAT M. A. BELGER Hopital Edouard Herriot UKTSSA Pavillon S Fox Den Road 5, Place d'Arsonva1 Stoke Gifford F-69437 Lyon Cedex 3 Bristol BS12 5RR France UK B. CUZIN F. BERTHOUX Hopital Edouard Herriot Service de Nephrologie et Pavillon V Transplantation Renale 5, Place d3Arsonval Hopital Nord F-69437 Lyon Cedex 3 F-42055 Saint Etienne Cedex 2 France France J. H. DAUBER C.

Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.

Clinical lung transplantation has seen an early start within the history of solid organ trans plantation, marked by the 1963 first lung transplant by James D. Hardy. This was prompted by the seemingly easy way of joining the transplanted organ to the recipient by me ans of a few well-defined anastomoses, i.e. bronchus, pulmonary artery and pulmonary vein carry ing left atrial cuff. The following decade thus witnessed a number of such mostly unilateral lung transplants in several centres, in Germany represented by the two only lung transplants performed by E. S. Bucherl, then at the Neukolln City Hospital in Berlin in 1969. As with most other such attempts these two patients suffered early and lethai graft failure. There was only one single lung transplant patient who lived up to ten months after the transplant at Gent, Belgium, having been operated on by Derom in 1969. The alm ost universal failure during this initial phase was attributed to bronchial anasto motic insufficiency, pulmonary infection of either the transplanted lung or the left-in-place contralateral lung and a far-reaching lack of knowledge how to cope with transplant rejec tion. In the early 1970s it had become gene rally accepted that lung transplantation could not be performed successfully."

Hepatitis C Virus and Liver Transplantation is designed to provide a comprehensive and state-of-the-art overview of the major issues specific to the field of liver transplantation and hepatitis C virus infection. The sections of the book have been structured to review the overall scope of issues of recurrent hepatitis C in different complex settings, including retransplantation, HIV-coinfected patients or in the setting of suboptimal graft donors. This book provides up-to-date information on the application of new therapies to the field of liver transplantation. It provides the most recent data on their efficacy, the management of side effects, as well as the potential interactions and specific problems associated with their use in the transplant setting. Finally, an appraisal of the risks and benefits of using organs from anti-HCV positive donors is presented. This book provides concise and actual materials for several important topics that are simply not adequately covered by current available literature. Hepatitis C Virus and Liver Transplantation will provide a unique and valuable resource in the field of liver transplantation and will be of great value to Hepatologists, Transplant and Abdominal Surgeons, Oncologists, as well as Fellows and Residents training in these fields.

Bronchiolitis Obliterans Syndrome in Lung Transplantation presents the most current and up-to-date evidence regarding the diagnosis and management of BOS. In-depth chapters provide readers with a comprehensive understanding of the definition and changing perceptions of the nature of BOS as a clinical and pathologic entity, immune and non-immune mechanisms that have been identified as risk factors for the development of BOS, and interventions that may prove to be clinically useful for the prevention or treatment of BOS. In addition to outlining the current state of knowledge, each chapter provides the reader with the most current and ongoing research in the field as well as identifies areas where future research is needed. Written by an international group of expert authors, Bronchiolitis Obliterans Syndrome in Lung Transplantation is an important new text, that is essential reading for pulmonologists, primary care practitioners, respiratory care practitioners and clinical researchers.