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 field of transplantation has grown exponentially over the last few decades, and leaders in the field may argue that we have seen only the tip of the iceberg. Perhaps in no other discipline is there a need for multidisciplinary dialogue, debate, and approaches to patient care. In preparing this book, we have attempted to introduce readers to a few of the key clinical and ethical issues confronting the field of transplantation today. In so doing, we recognize that the face of transplantation may change dramatically in the years to come. Nevertheless, the issues raised throughout this book will serve as a useful introduction to important clinical issues and as a catalyst for clinicians and researchers to expand the horizons of transplantation. Health professionals involved in evaluating and treating transplant patients must be knowledgeable of the indications for transplantation and patient outcomes and the process of evaluation and management. Chapters 1 and 2, focusing on solid organ transplantation and blood/marrow transplantation, provide this important contextual information. The next two chapters address what is often considered the most significant issue facing the field of transplantation - organ donation. While the number of patients needing transplantation has risen dramatically in recent years, the rate of organ donation has remained relatively stable. Chapter 3 highlights the many ethical issues surrounding the more general concept of organ donation, while Chapter 4 focuses specifically on the burgeoning interest in living organ donation.

This book is the first to provide a thorough overview of the experience of pancreas transplantation in Asian countries, including in particular Korea, Taiwan, and Japan. Recent trends are identified and attention drawn to differences in comparison with the United States and Europe. Such differences relate, for example, to the history of pancreas transplantation, the operative procedure, and the organ-sharing system. In addition, the insulin-secreting ability of pancreatic islet cells is thought to vary depending on race. Beyond these aspects, the coverage also encompasses ABO-incompatible living donor pancreas transplantation, which is very rarely performed elsewhere in the world. By introducing the number, technique, and outcomes of pancreas transplantation in Asian countries, the book will hopefully further stimulate the pancreas transplantation program in this region and beyond. It will be of value for all medical professionals in the field and will be informative for diabetic patients receiving insulin treatment in Asia.

Diagnosis of death by neurological criteria (DNC) is a construct which has been part of the British medico-legal landscape for nearly half a century. This book examines the factors behind its emergence, and discusses the various changes that took place in the last few decades that culminated in the current definition and clinical criteria for determining brain-based death. It highlights the continuities and discontinuities in practice, and the impact they have on the issue of withdrawal of mechanical ventilation in intensive care units and on the field of organ transplantation. The book also explores the law's response to the introduction and development of DNC in clinical practice. It demonstrates how the legitimacy of the definition and criteria used by the medical profession were forged in the courtroom rather than in Parliament. It documents why case law were introduced in court, and assesses whether organ donation was a consideration in the deliberations. It will be emphasised that courts have given insufficient consideration to requests made in recent cases to consider a broader range of methods to determine death. Those pleas were made on the grounds that the definition and criteria used in the UK are dissimilar to those used in other jurisdictions that also adopt DNC; and that faith communities have a different understanding of death. By taking a close look at those other approaches before highlighting the inherent limitations of the courtroom as the forum that confers DNC its legitimacy, the book puts forward the argument that the democratic process should be engaged.

‘Jauhar weaves his own personal and family story into his history of the heart…very effectively… This gives a certain dramatic tension to the book, as it tells the fascinating and rather wonderful history of cardiology.’ –Henry Marsh, New Statesman

A Mail on Sunday Book of the Year

The heart lies at the centre of life. For cardiologist Sandeep Jauhar it is an obsession.

In this fascinating history he interweaves gripping scenes from the operating theatre with the moving tale of his family’s history of heart problems – from the death of his grandfather to the ominous signs of how he himself might die.

Jauhar looks at the pioneers who risked patients’ lives and their own careers, and confronts the limits of medical technology, arguing that how we live is more important than any device or drug we may invent. Heart is the all-encompassing story of the engine of life.

This volume features up-to-date protocols for the isolation, preservation, and validation of various cell sources comprising large and small animal models, examining the impact of cell transplantation on acute and chronic liver diseases. Hepatocyte Transplantation: Methods and Protocols guides readers through laboratory protocols for the generation of humanized livers for the assessment of biological actions in vivo and techniques to monitor cell engraftment after cell transplantation in vivo are described and procedures for computational analyses of hepatocyte transplantation. Written in the highly successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls. Comprehensive and practical, Hepatocyte Transplantation: Methods and Protocols is an essential resource for researchers and clinicians to assess the biological as well as the therapeutic potential of hepatocyte transplantation.

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.

Transplantation is a medically successful and cost-effective way to treat people whose organs have failed-but not enough organs are available to meet demand. Ethics and the Acquisition of Organs is concerned with the major ethical problems raised by policies for acquiring organs. The main topics are the rights of the dead, the role of the family, opt in and opt out systems, the conscription of organs, living organ donation from adults and children, directed donation and priority for donors, and the sale of organs. In this ground-breaking work, T. M. Wilkinson uses concepts from moral and political theory such as autonomy, rights, posthumous interests, justice, and well-being, in a context informed by the clinical, legal, and policy aspects of transplantation. The result is a rigorous philosophical exploration of real problems and options. He argues that the ethics of acquiring organs for transplantation is not only of great intellectual interest, but also of practical importance. As such, this book will be of profit not only to students and academics who work in applied ethics and bioethics, but also to the lawyers, policy-makers, clinicians, and lobby groups interested in transplantation.

Xenotransplantation could have an impact on at least three aspects of medicine. The first is as a means of overcoming a severe shortage of human donor organs for the treatment of organ failure. The second aspect relates to the possibility that a xenogeneic organ would not be susceptible to infection by a "human" virus and thus the xenograft might resist injury caused by such viruses. The third and, as of yet, unexplored aspect relates to a means of delivering genes for therapeutic purposes thus overcoming some of the limitations of "conventional" gene therapy.     

This text for students and researchers, takes an interdisciplinary approach to describing the chemistry and physics of materials, their biocompatibility, and the consequences of implantation of devices made of these materials into the human body. The reader is introduced to the principles of polymer science and the study of metals, ceramics and composites, and also to the basic biology required to understand the nature of the host-transplant interface. Topics covered in this book include the macromolecular components of cells and tissues, self-assembly processes, biological cascade systems, microscopic structure of cells and tissues, immunology, transplantation biology, and the pathobiology of wound healing. Topics covered in the materials science chapters include the structures and properties of polymers, metals, ceramics and composites, and the processes for forming materials as well as the pathobiology of devices. The final two chapters deal with tissue engineering and the relations between the biology of cells and tissue transplantation, and the engineering of tissue replacements using passaged cells.

If most Americans accept the notion that the market is the most efficient means to distribute resources, why should body parts be excluded? Each year thousands of people die waiting for organ transplants. Many of these deaths could have been prevented were it not for the almost universal moral hand-wringing over the concept of selling human organs. Kidney for Sale by Owner, now with a new preface, boldly deconstructs the roadblocks that are standing in the way of restoring health to thousands of people. Author and bioethicist Mark Cherry reasserts the case that health care could be improved and lives saved by introducing a regulated transplant organs market rather than by well-meant, but misguided, prohibitions.

Mathematical Approaches to Liver Transplantation provides mathematical approaches to the optimization of liver graft distribution. Through mathematical and computational methods, several aspects related to organ allocation are tackled, with possible solutions presented. The book discusses topics such as patient selection for liver transplantation, transplantation procedures, dynamics of organs waiting list, improvement on grafts allocation, live donors and MELD scale. The content focuses on liver transplantation, however the mathematical approaches presented can be successfully replicated to different organs. This book is a valuable source for mathematical biologists, bioinformaticians, and several members of biomedical field who are involved in decision-making related to organs transplantation.

This book provides a comprehensive review of ethical issues in clinical nephrology. With the advent of dialysis and kidney transplantation midway through the 20 Century, clinical nephrology was one of the first areas of medicine to deal with complex ethical issues such as rationing of health care and discontinuation of life-sustaining therapy. In the first section of the book this historical perspective is reviewed, followed by a consideration of legal issues. Specific ethical issues in nephrology are discussed in detail in the next section. These include problems in the allocation of chronic dialysis and in termination of that treatment. Also reviewed are issues in kidney transplantation, such as proposals for enhanced acquisition of kidneys, including a number of controversial proposals such as payment to donors and xenotransplantation; and equity in allocation of the supply of kidneys. Other chapters consider ethical issues in genetics; special problems in the care of children with kidney disease; and broad societal issues such as allocation of national resources for expensive therapies and economic issues in clinical practice. In the final part of the book ethical issues in the care of patients with kidney disease are discussed from an Asian and African perspective.

Addressing all aspects of brain death and thoroughly detailing how a potential organ donor should be maintained to ensure maximum use of the organs and cells, The Brain-Dead Organ Donor: Pathophysiology and Management is a landmark addition to the literature. This first-of-its-kind, multidisciplinary volume will be of interest to a large section of the medical community. The first section of the book reviews the historical, medical, legal, and ethical aspects of brain death. That is followed by two chapters on the pathophysiology of brain death as investigated in small and large animal models. This includes a review of the many hormonal changes, including the neuroendocrine- adrenergic 'storm', that takes place during and following the induction of brain death, and how they impact metabolism. The next section of the book reviews various effects of brain death, namely its impact on thyroid function, the inflammatory response that develops, and those relating to innate immunity. The chapters relating to assessment and management of potential organ donors will be of interest to a very large group of transplant surgeons and physicians as well as critical care and neurocritical care physicians and nurses. Neurologists, endocrinologists, neurosurgeons, and pathologists will also be interested, especially in the more basic science sections on various aspects of brain-death and hormonal therapy. Organ procurement organizations and transplant coordinators worldwide will also be interested in this title. Other chapters will be of interest to medical historians, medico-legal experts, and ethicists.

This text serves as a convenient one-stop resource on the pathogenesis, diagnosis and treatment of kidney diseases in context of advanced heart failure and presence of ventricular assist devices. Advances in managing heart failure, evidence-based practices and therapies are covered, along with the management of this unique and complex subset of patients. The book also provides insights into combined heart and kidney transplantation. Authored by leaders in nephrology, cardiology and transplantation, this book fills a critical knowledge gap in understanding and treating patients with acute or chronic dysfunction of the heart and kidneys and how one induces dysfunction in the other organ.

In response to persistent donor organ shortages, organs from marginal donors, such as expanded criteria donors (ECD) and donation after cardiac death (DCD) donors, are now accepted and have been successfully transplanted, reducing the waiting times for transplantation. Especially in Japan, transplantation of DCD kidneys has a relatively long history because of the difficulty or lack of national consensus in accepting brain death, which has made it possible to accumulate considerable clinical experience. Thus, the current organ shortage has stimulated interest in the use of marginal donors for transplantation. On the other hand, however, it is known that these organs have a high rate of delayed graft function and a more complicated postoperative course. These drawbacks have created the greatest clinical challenge in transplantation to date because of the current shortage and limitations of donors using ECD and DCD.

This book, prepared by distinguished authorities in their fields, is intended for clinicians and researchers. It highlights the use of marginal donors as a comparatively novel source of transplantation organs and provides a thorough overview of marginal donors from their historical origins to recent clinical applications, including the state-of-the-art science of organ/donor management, procurement, and preservation. Also provided is valuable information on ABO-incompatible donors which extend the availability of donor sources. Each chapter offers an individual analysis of the optimal requirements for the safe management and preservation of organs, including the heart, lung, liver, kidney, pancreas, and pancreatic islets.

The skin is the largest human organ system. Loss of skin integrity due to injury or illness results in a substantial physiologic imbalance and ultimately in severe disability or death. The most common cause of significant skin loss is thermal injury, followed by trauma and chronic ulcerations.

Over the past decades extraordinary advances have been made in the understanding of cellular and molecular processes of wound healing and the pathobiology of chronic wounds. This knowledge has led to wound care innovations that facilitate more rapid closure of wounds with better functional and aesthetic outcome. A sensible and resource-saving utilization of these innovative technologies requires a broad knowledge of these processes and innovations.

This book intends to give an overview about today's wound care developments in tissue engineering and skin replacement. It presents a variety of indications and diversities of clinical applications to help the surgeon select a specific procedure for each clinical situation.

This book summarizes rapid progress and innovation in transplantation and regenerative medicine - the merger of reconstructive plastic surgery and transplantation - called Vascularized Composite Allotransplantation. This merger includes face, hand, uteri, larynx, tongue, penis and trachea translplantations as well as other body part transplants using grafts derived from organ donors. These sorts of transplants are now performed more commonly. Cell therapies for immunomodulation are surrogates for immune responses after transplantation to non-invasive imaging of neuroregeneration for improving functional outcomes after transplant.

This volume presents a comprehensive overview of the latest advances in basic and translational research in the field of reconstructive transplantation and its potential therapeutic implications. Dr. Thomas E. Starzl and Dr. Raimund Margreiter, both pioneers in the field of transplantation, have written the foreword for the book. The volume spans such topics as skin rejection, immune monitoring, stem cell-based immunomodulatory strategies, costimulatory blockade, tolerance induction, chronic rejection, ischemia reperfusion injury, nerve regeneration, cortical reintegration, and small and large animal models for reconstructive transplantation. The book is intended for biomedical researchers and basic scientists in the field of reconstructive transplantation, transplant immunology and regenerative medicine, as well as clinicians, surgeons and multidisciplinary specialists, who are practicing or interested in this novel and exciting field. Postgraduate fellows and students will also find it a valuable reference.

This book examines the position of children who provide tissue to potentially save the life of another. It questions whether child donors of all ages have been treated appropriately and whether they are sufficiently protected in acting as tissue donors, and ultimately considers whether a new regulatory response is needed to benefit donor children. The book couples a legal exposition of the donor child's position with the medico-ethical reality of clinical practice. In recent years, a growing body of literature concerning the clinical experiences and outcomes for child donors has emerged. This book adds to this by examining another dimension - the regulatory frameworks at play. It examines the ethical arguments for and against children acting as tissue donors and provides an original analysis of the legal and non-legal regulatory frameworks governing children's participation in the United Kingdom, United States and Australia. It combines these doctrinal and theoretical approaches with insights into clinical practice gained from the results of qualitative research conducted with health professionals. The analysis inevitably explores the more general issues of children's right to make medical decisions, the role of parents in decision-making, the value of the best interests test and alternative (legal and ethical) standards, rights of participation of children before the courts, and the role of law and other forms of regulation in a clinical context.

This volume is a compendium of cutting-edge molecular methods for the successful transplantation of hematopoietic stem cells. The availability of genetic profiles for committed and uncommitted stem cells combined with the determination of molecular steps involved in hematopoietic stem cell activation and self-renewal hold tremendous promise for future success in the clinic. Currently, stem cells can be quantified and sorted successfully, but transduction, labeling, and in vivo tracking of stem cells are difficult techniques with traditionally low efficiency levels. The contributors to this volume describe promising tools for stem cell transplant research models, such as in vivo bioluminescence imaging.

Topics included in this volume are molecular profiling of hematopoietic stell cells, methods for imaging cell fates in hematopoiesis, PCR-SSP typing of HLA Class I and Class II alleles, sequence-based HLA typing, and typing minor HLA antigens. Also discussed in this volume are the roles of natural killer cells and killer inhibitor receptor polymorphisms, polymorphisms within epithelial receptors, molecular methods used for the detection of autologous graft contamination in lymphoid disorders, and the application of proteomics to posttransplantation follow-up. With the recent trend moving from gene expression to the protein expression profiles, the application of proteomics to the posttransplant follow-up of patients is becoming routine. As a result, this volume will become an invaluable source for biochemists, molecular biologists, and clinicians.

Pancreas transplantation has rapidly moved from an experimental procedure associated with high rates of morbidity and mortality to a mainstream technique with excellent patient and graft survival. Over 30,000 pancreas transplants have already been performed. The value of pancreas transplantation however must be balanced against the risk of the operative procedure and the innovative long-term immunosuppressive therapy. The indications for this procedure and the selection of the patients are critical to ensure low mortality and any improvements in quality of life.
This second edition reflects recent advances in the field, especially the increasing number of islet transplantations and the growing interest in stem cell research applicable to this condition. It provides an authoritative account on the current status of the whole organ pancreas transplantation and islet and pancreatic stem cell transplantation.

Cirrhosis from hepatitis C (HCV) is now the most common indication for liver transplant (LT) in the U.S., but between 2004 and 2013, new LT listings for NASH increased by 170%. Unfortunately, fibrosis progression leading to cirrhosis, liver cancer, and liver decompensation continues to occur after transplantation. Once cirrhosis and decompensation are evident, patient survival is poor and repeat LT is considered to improve outcomes. Therefore, the never-ending thirst for new approaches in the management of patients pre- and post-transplant has led to a very promising future in transplantation, thought there is much to learn to achieve better patient outcomes. This issue of Clinics in Liver Disease addresses the core areas to achieve better patient outcomes, with articles devoted to coagulopathy before liver transplant, challenges in renal failure before LT, LT for acute alcoholic hepatitis, LT in the pregnant patient, bariatric surgery and LT,and MELD Scores in prioritization of LT, to name a few. Readers will place a high value on the current state of liver transplantation in this issue.