Editing Organ transplantation (section)

==Society and culture==

=== Success rates ===

Since 2000, there have been approximately 2,200 lung transplants performed each year worldwide.  From 2000 to 2006, the [[median]] survival period for lung transplant patients has been 5.5 years.<ref name="History of Lung Transplantation, Dabak, Şenbaklavacı, April 2016">{{cite journal| pmc=5792120 | pmid=29404127 | doi=10.5578/ttj.17.2.014 | volume=17 | title=History of Lung Transplantation | year=2016 | author=Dabak G, Şenbaklavacı Ö | journal=Turk Thorac J | issue=2 | pages=71–75}}</ref>

=== Comparative costs ===

[[Organ transplantation in China|In China]], a kidney transplant operation runs for around $70,000, liver for $160,000, and heart for $120,000.<ref name="orgharv" />

=== Safety ===
In the United States, tissue transplants are regulated by the US Food and Drug Administration (FDA) which sets strict regulations on the safety of the transplants, primarily aimed at the prevention of the spread of communicable disease. Regulations include criteria for donor screening and testing as well as strict regulations on the processing and distribution of tissue grafts. Organ transplants are not regulated by the FDA.<ref>{{Cite web|url=https://www.fda.gov/BiologicsBloodVaccines/TissueTissueProducts/QuestionsaboutTissues/ucm101559.htm|title=Questions about Tissues – Tissue and Tissue Product Questions and Answers|author=Center for Biologics Evaluation and Research|website=www.fda.gov|access-date=2017-01-22}}</ref> It is essential that the HLA complexes of both the donor and recipient be as closely matched as possible to prevent graft rejection.

In November 2007, the [[Centers for Disease Control and Prevention|CDC]] reported the first-ever case of [[HIV]] and [[Hepatitis C]] being simultaneously transferred through an organ transplant. The donor was a 38-year-old male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients. Experts say that the reason the diseases did not show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies would not have existed in high enough numbers to detect. The crisis has caused many to call for more sensitive screening tests, which could pick up antibodies sooner. Currently, the screens cannot detect the small number of antibodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18–21 days before a donation is made.

[[Nucleic acid test]]ing is now being done by many organ procurement organizations and is able to detect HIV and hepatitis C directly within seven to ten days of exposure to the virus.<ref>{{cite journal | journal =Clin Microbiol Infect | date=29 January 2014 |  title= Recommendations for Screening of Donor and Recipient Prior to Solid Organ Transplantation and to Minimize Transmission of Donor-Derived Infections |author1=Len, O.|author2=Garzoni, C.|author3=Lumbreras, C.|author4=Molina, I.|author5=Meije, Y.|author6=Pahissa, A.|author7=Grossi, P.|author8=The ESCMID Study Group of Infection in Compromised Hosts (ESGICH)|  pmid=24476053 | doi=10.1111/1469-0691.12557 | volume=20 | pages=10–18| doi-access=free }}</ref>

=== Transplant laws ===
Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens. However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not. The [[Indian government]] has had difficulty tracking the flourishing organ black market in their country, but in recent times it has amended its organ transplant law to make punishment more stringent for commercial dealings in organs. It has also included new clauses in the law to support deceased organ donation, such as making it mandatory to request for organ donation in case of brain death. Other countries victimized by illegal organ trade have also implemented legislative reactions.  Moldova has made international [[adoption in Moldova|adoption illegal]] in fear of organ traffickers. China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent. However, doctors in other countries, such as the United Kingdom, have accused China of abusing its [[Capital punishment in China|high capital punishment rate]]. Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China and Ukraine, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking. Some organs are also shipped to Uganda and the Netherlands. This was a main product in the [[triangular trade]] in 1934.{{citation needed|date=April 2013}}

Starting on 1 May 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime.<ref>{{cite news |url=http://news.bbc.co.uk/2/hi/asia-pacific/6534363.stm |title=China issues new rules on organs |publisher=BBC |date=7 April 2007 |access-date=25 December 2013}}</ref>

On 27 June 2008, Indonesian, [[Sulaiman Damanik]], 26, pleaded guilty in [[Singapore]] court for sale of his kidney to [[CK Tang]]'s executive chair, [[Tang Wee Sung]], 55, for 150&nbsp;million [[rupiah]] (S$22,200). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks." Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (US$20,200). Upon sentence, both would suffer each, 12 months in jail or 10,000 [[Singapore dollar]]s (US$7,600) fine.<ref>{{cite news|author=<!--Staff writer(s); no by-line.-->|date=28 June 2008|title=Two Indonesians plead guilty in Singapore midorgan trading case|publisher=Abs-Cbn Interactive|agency=Agence France-Presse|url=http://www.abs-cbnnews.com/world/06/28/08/two-indonesians-plead-guilty-singapore-organ-trading-case|access-date=26 July 2021}}</ref><ref>{{cite news|author1=Lee Hui Chieh|author2=Sujin Thomas|date=28 June 2008|title=CK Tang boss quizzed by police|newspaper=The Straits Times|url=http://www.straitstimes.com/Free/Story/STIStory_252526.html|url-status=dead|archive-url=https://web.archive.org/web/20080704203125/http://www.straitstimes.com/Free/Story/STIStory_252526.html|archive-date=4 July 2008}}</ref>

In an article appearing in the April 2004 issue of [[Econ Journal Watch]],<ref name="econjournalwatch.org" /> economist [[Alex Tabarrok]] examined the impact of direct consent laws on transplant organ availability. Tabarrok found that social pressures resisting the use of transplant organs decreased over time as the opportunity of individual decisions increased. Tabarrok concluded his study suggesting that gradual elimination of organ donation restrictions and move to a free market in organ sales will increase supply of organs and encourage broader social acceptance of organ donation as a practice.

In the [[United States]] 24 states have no law preventing discrimination against potential organ recipients based on cognitive ability, including children. A 2008 study found that of the transplant centers surveyed in those states 85 percent considered disability when deciding transplant list and forty four percent would deny an organ transplant to a child with a neurodevelopmental disability.<ref>{{Cite web|last=Stetler|first=Pepper|date=2021-06-14|title=It's Perfectly Legal in Many States to Deny People With Down Syndrome Organ Transplants|url=https://slate.com/technology/2021/06/organ-transplants-down-syndrome-iq.html|access-date=2021-06-14|website=Slate Magazine|language=en}}</ref><ref>{{cite journal |last1=Richards |first1=Christopher T. |last2=Crawley |first2=LaVera M. |last3=Magnus |first3=David |title=Use of neurodevelopmental delay in pediatric solid organ transplant listing decisions: Inconsistencies in standards across major pediatric transplant centers |journal=Pediatric Transplantation |date=November 2009 |volume=13 |issue=7 |pages=843–850 |doi=10.1111/j.1399-3046.2008.01072.x |pmid=19067911 |s2cid=19868624 }}</ref>

=== Ethical concerns ===
{{Main|Ethics of organ transplantation|Declaration of Istanbul}}

The existence and distribution of organ transplantation procedures in [[developing countries]], while almost always beneficial to those receiving them, raise many [[ethical]] concerns. Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of [[distributive justice]]. The [[World Health Organization]] argues that transplantations promote health, but the notion of "transplantation tourism" has the potential to violate [[human rights]] or exploit the poor, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. Regardless of the "gift of life", in the context of developing countries, this might be coercive. The practice of coercion could be considered exploitative of the poor population, violating basic human rights according to Articles 3 and 4 of the [[Universal Declaration of Human Rights]]. There is also a powerful opposing view, that trade in organs, if properly and effectively regulated to ensure that the seller is fully informed of all the consequences of donation, is a mutually beneficial transaction between two consenting adults, and that prohibiting it would itself be a violation of Articles 3 and 29 of the [[Universal Declaration of Human Rights]].

Even within developed countries there is concern that enthusiasm for increasing the supply of organs may trample on respect for the right to life. The question is made even more complicated by the fact that the "irreversibility" criterion for [[legal death]] cannot be [[Medical definition of death|adequately defined]] and can easily change with changing technology.<ref>{{cite journal |vauthors=Whetstine L, Streat S, Darwin M, Crippen D |title=Pro/con ethics debate: When is dead really dead? |journal=Critical Care |volume=9 |issue=6 |year=2005 |pages=538–42 |pmid=16356234 |pmc=1414041 |doi=10.1186/cc3894 |doi-access=free }}</ref>

=== Artificial organ transplantation ===
Surgeons, notably [[Paolo Macchiarini]], in Sweden performed the first implantation of a synthetic trachea in July 2011, for a 36-year-old patient who had cancer. Stem cells taken from the patient's hip were treated with growth factors and incubated on a plastic replica of his natural trachea.<ref>{{cite web |url=https://www.npr.org/templates/transcript/transcript.php?storyId=137701848 |title=Cancer Patient Gets First Totally Artificial Windpipe |publisher=NPR |date=8 July 2011 |access-date=7 August 2011}}</ref>

According to information uncovered by the Swedish documentary "Dokument Inifrån: Experimenten" (Swedish: "Documents from the Inside: The Experiments") the patient, Andemariam went on to develop an increasingly terrible and eventually bloody cough to dying, incubated, in the hospital. At that point, determined by autopsy, 90% of the synthetic windpipe had come loose. He allegedly made several trips to see Macchiarini for his complications, and at one point had surgery again to have his synthetic windpipe replaced, but Macchiarini was notoriously difficult to get an appointment with. According to the autopsy, the old synthetic windpipe did not appear to have been replaced.<ref>{{cite web |url=http://www.svtplay.se/video/5990228/dokument-inifran-experimenten/dokument-inifran-experimenten-avsnitt-2 |title=Dokument inifrån: Experimenten – Avsnitt 2: Varje kirurg har sin kyrkogård |access-date=2016-01-29 |url-status=dead |archive-url=https://web.archive.org/web/20160909083052/http://www.svtplay.se/video/5990228/dokument-inifran-experimenten/dokument-inifran-experimenten-avsnitt-2 |archive-date=9 September 2016}}</ref>

Macchiarini's academic credentials have been called into question<ref name="vanityfair">{{cite magazine|title=The Celebrity Surgeon Who Used Love, Money, and the Pope to Scam an NBC News Producer|url=https://www.vanityfair.com/news/2016/01/celebrity-surgeon-nbc-news-producer-scam|magazine=Vanity Fair|first=Adam|last=Ciralsky|date=31 January 2016|access-date=7 January 2016}}</ref> and he has recently been accused of alleged research misconduct.<ref name="expressen.se">{{cite web|url=http://www.expressen.se/nyheter/tekniken-skulle-radda-liv--sex-av-atta-dog/ |title=Karolinskas "superkirurg" utreds och granskas |date=13 January 2016 |access-date=2016-02-10 |url-status=live |archive-url=https://web.archive.org/web/20161009040221/http://www.expressen.se/nyheter/tekniken-skulle-radda-liv--sex-av-atta-dog/ |archive-date=9 October 2016}}</ref>

Left ventricular assist devices are often used as a "bridge" to provide additional time while a patient waits for a transplant.  For example, former US vice-president Dick Cheney had such a device implanted in 2010 and then 20 months later received a heart transplant in 2012.  In year 2012, about 3,000 ventricular assist devices were inserted in the United States, as compared to approximately 2,500 heart transplants. The use of airbags in cars as well as greater use of helmets by bicyclists and skiers has reduced the number of persons with fatal head injuries, which is a common source of donors hearts.<ref>[https://www.washingtonpost.com/national/health-science/cheney-helped-for-many-months-by-a-mechanical-heart-is-terrific-after-transplant/2012/03/25/gIQAfy1eaS_story.html Cheney, helped for many months by a mechanical heart, is "terrific" after transplant], ''Washington Post'', David Brown and Lena H. Sun, 25 March 2012.</ref>