Organ Transplants

Abstract

Since the first successful organ transplants in the 1950s after over 200 years of transplant history, countless lives have been saved. Despite their success over hundreds of years, ethical, moral and social concerns remain regarding organ transplants and their impact on both donors and receivers. The question we must ask ourselves is: Are organ transplants the solution? Despite the benefits they bring to the lives of those affected by life-threatening diseases, organ transplants also have numerous downsides. The need for organ transplants continues to exceed the supply of organs and organ recipients remain at risk post-transplant. The solution seems as simple as increasing the number of organ donors, but the 3D bioprinting of tissues and organs might be a more reliable alternative.

Introduction

Researchers first began experimenting with organ transplantation on animals and humans in the 1700s. Failed transplants were common initially, but by the 1950s, scientists became more successful in performing the surgical procedure (Organ Procurement and Transplantation Network, n.d.). The first human kidney was transplanted in 1954 (Leeson and Desai, 2015). A solution had finally been discovered for those affected by life-long and life-threatening conditions. However, with this medical achievement came the start of a continuous debate about the ethical, social and medical aspects of organ transplants with scientists, policy-makers, bioethicists, religious leaders and the public getting involved (Cohen, 2006; Beyar, 2011). Some of these concerns include the “moral hazards of seeing the human body as a potential source of replacement parts, the hardship of the sick who wait for organs that sometimes never come and the criteria for determining when death has occurred and when a deceased person’s organs might be removed” (Cohen, 2006; Beyar, 2011). Whilst this medical breakthrough has saved the lives of many sufferers, people remain worried about the procedure and its drawbacks. The question is: do the advantages outweigh the negatives of organ transplants or will we be looking towards alternatives in the future?

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This essay will discuss the benefits that organ transplants bring to the lives of many people, as well as their disadvantages, including a demand for organs that exceeds the supply and post-transplant infections and diseases. Finally, solutions to these problems and alternatives to organ transplants will be considered. Data from the U.K. and U.S. Government will also be analysed and presented alongside evidence from reports by researchers and scientific experts.

Discussion

Since the first organ transplant in 1954, this field of medicine has grown and continues to grow each year. The benefits of this medical breakthrough have impacted hundreds of thousands of people worldwide. To put it simply, the introduction of organ transplants has saved lives. Life-threatening diseases, such as cystic fibrosis (Lynch et al., 2015), and life-long conditions, such as diabetes (Rangel et al., 2009) and hepatitis, can all be treated with organ transplants, saving and improving the lives of those affected.

Despite the benefits that organ transplants bring for those suffering from life-shortening diseases, the numerous problems that they generate must also be considered. The demand for organ donations continues to increase, meaning that the time spent waiting to receive organs has also grown and continues to rise at a fast rate (Grinyó, 2013). According to the Institute of Medicine, “In 1988, there were 16,000 individuals on the waiting list for an organ transplant. By 1995, the waiting list had increased almost 275% to 45,000 and it has since doubled so that by January 2006 the waiting list topped 90,000 individuals” (Cohen, 2006; Beyar, 2011). Organ donation statistics from 2017 provided by the U.S. Department of Health & Human Services show that “20 people die each day waiting for a transplant”. 114 000 men, women and children were on the national waiting list last year, however only 34 770 transplants were able to be performed (U.S. Government Information on Organ Donation and Transplantation, 2017). Despite this being a record high for transplants in the U.S., only 31% of those waiting for an organ transplant were able to receive the medical care they needed. The growing demand for transplants over the years can be seen in Figure 1. Since 1991, the number of people on the waiting list has increased from 23 193 to 115 000. The cause of this growth could be “increased public awareness, improved efficiency of the donation process, greater expectations for transplantation …” (Saidi and Kenari, 2014). Despite the success of organ transplantations, the resources needed to fulfil this demand remain significantly low. The number of organ donors increased from 6 953 to 16 473 from 1991 to 2017 (U.S. Government Information on Organ Donation and Transplantation, 2017).

Figure 1: The number of people on the waiting list for an organ transplant, receiving transplants and donating organs between 1991 and 2017 (U.S. Government Information on Organ Donation and Transplantation, 2017). The number of patients waiting for a transplant remains larger than the number of organ donors.

The reason for this is that simply not enough people are donating organs. Whilst many are in favour of organ transplants, only of small percentage have signed up to become organ donors. The U.S. Department of Health & Human Services states that only 54% of U.S. adults, out of the 95% in favour of organ donation, are actually enlisted as donors (U.S. Government Information on Organ Donation and Transplantation, 2017). A single person is able to donate 8 life-saving organs, as well as other tissue that could improve and save the lives of around 75 people. Organs such as the heart, kidney and liver, as well as corneas and other tissue including skin and bones can all be donated by a single person and will then be used to improve numerous lives.

Due to the low supply of organs, patients are forced to wait longer for a transplant, meaning their medical condition deteriorates and those who receive organs are in a much worse condition. Recipients of organ donations nowadays are more often sicker than people who got organs years ago, which also risks diminishing the advantages of receiving an organ (Cohen, 2006). In the case of sufferers of cystic fibrosis, the timing of a lung transplant is critical. This is because in the past “up to 25 to 41% of [cystic fibrosis] patients have died while awaiting LT” (Lynch et al., 2015). In countless cases, patients suffer and go through pain whilst they wait for organs that never come.

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Not only are patients in a more critical condition after receiving a transplant, they are also at risk of developing infections. Immuno-suppressant drugs given to transplant recipients help prevent the rejection of organs, by reducing the efficiency of their immune system. Unfortunately, this also reduces their resistance to infections. In most cases, this is only minor, but the risk can be more severe if the patient has another medical condition such as diabetes or kidney disease (NKF Kidney Patients UK, 2016). Infections may include influenza, pneumonia or chicken pox. Despite successful transplants, recipients could be at asked of developing tuberculosis, with signs sometimes appearing months or even years after the transplantation. Tuberculosis can prove difficult to treat in transplant receivers due to the response of drugs and their harmful reactions (Epstein and Subramanian, 2018).

Non-infectious complications can also arise post-transplant in patients. One example is the increased risk of malignancies in cystic fibrosis patients post-lung transplant. A study involving over 40 000 cystic fibrosis sufferers in the United States between 1990 and 2009 observed an increased risk of specific cancers at particular sites: the digestive tract, testicular cancer and lymphoid leukaemia. A similar study involving 24 500 patients from 17 different European countries discovered a greater risk of cancers in the digestive tract (Lynch et al., 2015). 40% of organ transplant recipients are also at risk of developing problems with their central nervous system. One example of a neuropsychiatric clinical syndrome called catatonia. The frequency of catatonia is currently unknown due to the difficulty of its diagnosis in patients (Tatreau et al., 2018).

Since the first organ transplant was performed, the quality of medical care for sufferers of organ failure is extraordinary. Diseases that once meant the end of someone’s life, or that left patients fearing the possibility of never regaining normal function, are now routinely treated. When it comes to organ failure, more people can be assisted than ever before, both extending and improving life for the afflicted.  Organ transplantation is not the only form of medical progress benefiting those suffering from organ disease, however in certain circumstances it is the only treatment available for sufferers of certain types of organ disease (Cohen, 2006).

Despite the growing number of lives that continue to be saved by organ transplants, the increase in demand for organs over the past years can simply not be met. Whilst research into alternatives continues to be made, no other options are available now for those on organ transplant waiting lists. One possibility for increasing the number of organ donations could be through a system of benefits. This concept would mean that the families of patients who donate their organs will receive some form of benefit because of the donation. This benefit could include funeral expenses, a donation to a charity in memory of the donor or higher priority on the waiting list if any family member ever needs an organ transplant. Whilst laws may restrict this concept from becoming reality, it would bring many advantages, notably an increase in organ donations which would make more organ transplants possible and financial assistance to those who may need it (Cutler, 2002). Another option to increase the number of organ donations is a presumed consent model where people decide they don’t want to be an organ donor. The opt-in model currently used in the U.S. means that people must voluntarily opt-in to the system if they wish to donate organs. The opt-out system is already used in a number of countries including Spain, Belgium, France, Austria and Greece (Caplan, 2016). The opt-in approach was operated in the UK for many years. However, in December 2015, the Welsh government legalised deemed consent, with Scotland following in their footsteps in 2017. England has also announced its intention to do the same in 2020 (Neuberger et al., 2017).

One country where the sale of organs has been legalized is Iran. Since the late 20th century, cases of end stage renal failure increased and the government recognized a need for increased resources. As a result of the Iranians’ system, cases of renal failure have decreased, whilst they continue to increase in other countries (Major, 2008). Should other countries continue in Iran’s footsteps?

Alternatives for patients suffering from life-threatening disease are limited at present. However, the field of medicine continues to advance every day. Therapies and technologies that can regenerate tissues as well as create new tissues entirely are being improved and could be a possible alternative and solution to the growing need for organ transplants. Major advances in regenerative medicine are leading to the possibility of utilising three-dimensional bioprinting in creating artificial tissue and organs. While this field continues to improve, there are several challenges that come with it and have slowed its progress (Dzobo et al., 2018).

Conclusion

Organ transplants sparked a growth in medical development and research. Medical technology continued to progress, and more donors became available over time. As a result, more people were able to live longer and healthier lives each year than was ever thought possible before the 1700s. Millions of lives continue to be changed every day. However, the supply of organs remains significantly below the growing need for organ transplants. In the journal articles and review papers discussed above, notable progress has been made with regards to trying to implement new concepts to increase the number of organs available for transplants. More people require organ transplants, showing a shift in a positive direction for this industry. However, concerns will always remain: whether the benefits of organ transplants outweigh the negatives.

The fact that researchers continue to remind us about the possibility of failed transplants in their reports despite the great successes over many years shows a global concern that the ever-growing demand of organs will never be met. Unless the number of organ donors increases drastically in the coming years, it will be impossible to become dependable on organ transplants for treating life-threating conditions in the future. With constant advancements in regenerative medicine, the 3D production of tissues and organs could be the required solution to the world’s growing need for organs. Perhaps it is time for an increase in research into other areas of medicine in hopes of developing an alternative for sufferers.

References

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