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Transcript of Organ Donation and Transplantation - Universidade … Dr. Joseph E. Murray made an implant of the...
Organ Donation and Transplantation
ANA MENDONÇA LOPES
N.º 1224
• The first transplant assumed as such is immortalized in a
painting of Fra Angelico, of 1438‐1440, where we can see the
Saint Cosme and Saint Damião transplantating an ethiopian’s
leg.
• The first successful trasplant of human organs was in 1954,
when Dr. Joseph E. Murray made an implant of the kidneys of
a twin in the other twin, in the Brigham and Women Hospital.
• Murray thought that there was no danger of rejection,
because that was being made between twins, with the same
genome.
• However, after some days, the patient died.
• In Portugal, Linhares Furtado was responsible for the first
transplant, in 20th July 1969, in Coimbra.
• In 1980, he made the first kidney transplant taken from a
corpse.
• The organs and tissues donation is the removal of organs and
tissues of a body of a person who recently died (deceased
donor) or a volunteer donor (living donor) with the purpose
of transplantating it or to graft it to another person.
• It’s more important the state of the donated organ than the
age of the donor.
• There are absolute counter indications for donation patients, such as: an uncontrolled infection; the HIV virus, the virus HTLV ½, a malignant neoplasm (except if it’s a primary tumor of the CNS), a basal cell carcinoma (skin cancer) and carcinoma of the uterus.
• The best donors are those whose death is in the brain and that have no history of heart disease.
• Advances in immunosuppressive therapy and in
techniques for preserving and transporting organs
emphasize the contribution that dead people can
give to living people.
• However, there is a big problem...
The demand for organs is far greater than its supply!!
• A transplant (or transplantation) is the transfer of
cells, tissues or organs alive, from a person (the
donor) to another (the receiver), or from a part of
the body to another part of it, with the purpose of
restoring a lost function.
There are three types of transplantation:
Autoplastic transplantation occurs when tissues are transplanted in the same body, from one place to another;
Heteroplastic transplantation is the transplantation of organs or tissues from one body to another. It can be homologous if it occurs between individuals of the same species;
Heterologous transplantation or xenotransplantation, is the transplantation of organs or tissues between individuals of different species.
In Portugal, there are transplantation of these organs and tissues:
o lung; o pancreas;o blood vessels;o intestines;o ossicles of the ear;o skin;o heart;o heart valves;o corneas;o bone marrow;o liver;o kidneys;o tendons;o meninges.
Scientific advances and their practical applicability to humans, raises legal issues that are important to consider because the progress is always made to serve Men, not to be against Him.
José de Oliveira Ascensão
There is a lot of international and national lawwithin the Organ Donation and the Transplantation areas.
Additional Protocol to the Convention of Human Rights and Biomedicine concerning transplantation of organs and tissues of human origin
• Since 1st May 2006.
• Has resulted in very important innovations from a legal standpoint.
• Densified concrete provisions of the Convention of Human Rights and Biomedicine, 1997.
• Applies the Principles of the Convention to the field of
organ and tissue transplants, respecting its main
objectives: protecting the dignity and integrity of the
human being and protecting the rights and fundamental
freedoms, with regard to advances in Medicine and
Science.
The Principles:
• Equality of access to patients in the transplant services;
• Transparency of rules for allocation of organs and tissues;
• Setting safety standards;
• Gratuity of donations;
• Good information for all involved;
• Confidentiality;
• Punishments in case of violation.
CONSTITUIÇÃO DA REPÚBLICA PORTUGUESA
• Part I: Contains provisions which supervise fundamental values of bioethics
Principle of Equality (13º)
Right to Life (24º)
Right to Humane Treatment (25º)
Right to Health (64º)
Lei 12/93, de 22 de Abril
• Rules the harvesting and transplantation of organs and tissues of
human origin;
• It was amended by Lei 22/2007, de 29 de Junho and Lei 12/2009,
de 26 de Março.
• The donation of organs after death is considered a pre‐
acquired (or suspected) ‐ any national or foreign citizen who
lives in the portuguese territory, is considered a donor since
birth. It is not necessary to perform any application,
registration or authorization for the donation.
• Those who do not wish to donate their organs after death,
must register in Registo Nacional de Não Dadores (REENDA).
The Decreto‐Lei 244/94, de 22 de Abril, rules REENDA.
• The main standard is to check the ability of regenaration after
a partial harvest.
• In case of removing a not regenerable organ, the
admissibility depends on the assent of the Entidade de
Verificação da Admissibilidade da Colheita para Transplante
(EVA). Minors and unabled people are completly forbidden of
donating non‐regerative organs.
The general requirements that donation of organs and tissues
must attend are:
• It doens’t matter a big risk to the donor;
• His/her consent must be informed, enlightened, free and clear.
MINORS and UNABLED PEOPLE have their own requirements
to donate organs and tissues:
• There isn’t a suitable donor
AND
• The receiver must be brother or sister of the donor.
Besides...
UNABLED PEOPLE need a court authorization
MINORS need parental consent or, in case of this absence, court authorization
The RECEIVER
• His/her consent has to be personal and free;
• He/she must be informed of all risks of the procedure;
• The transplant must come to a good end, improving the duration and conditions of life of the beneficiary;
Principle of Confidentiality
• There is a prohibition against revealing the identity
of the donor or receiver, unless the consent of the
eligible;
• It is important to safeguard the identity of the
receiver and of the donor, since these phenomena
involves issues and emotions that can lead to
unpredictable consequences
Principle of Gratuity
• It is not allowed the sale of organs and tissues.
Other legislation:
• Lei 12/2009, de 26 de Março rules legal framework of quality and safety for the donation, collection, processing, preservation, storage, distribution and application of tissues and cells of human origin;
• Despacho 26 951/2007 rules about the Entidade de Verificação da Admissibilidade da Colheita para Transplante (EVA);
• Decreto‐Lei n.º 38/2010, de 20 de Abril about the exemption from payment of user fees;
• Portaria n.º 367/2008, de 9 de Maio rules about the Gabinetes de Coordenação de Colheita de Órgãos e Transplantação (GCCOT).
Three ethical principles, related with transplantation
The principle of inviolability of the body
The principle of solidarity
The principle of totality
Always connected with organ donation and transplantation is
Principle of human dignity
• There are no brain transplants;
• There are no sexual organ transplants.
Non‐Discrimination Principle
• The receivers selection is made exclusively from the medical criteria.
The Right of Refusal and the Right of Acception
• It’s based on the right to self‐determination.
The majority of Religions advocates the practice of
organ transplantation
Catholic Church;
Protestantism;
Judaism;
Islamism;
Buddhism;
Hinduism;
Jehovah's Witnesses.
• They see it as an act of giving and loving the others;
• In all cases, the donation is an individual choice,
• Almost all of them condemn the organs trade, because this
practice promotes the trivialization of the body and its
transformation into an object, which according to them, is
wrong because the body is the haven of the soul, and also
represents something sacred.
The Agnostics accept organ donation and transplantation, as
well. For them the most important thing about the issue is
that all progress in Medicine should be done in a clear, and
respectable, dignifying way towards human life.
When a person needs a transplant, due to
the advanced technology, there are
numerous factors to consider, according to
medical jugdements, juridical judgements,
ethical, social, religious, etc..
Its up to us, the general public, to promote organ donation and the consented harvest.
Organ donation is not just a personal action.
It is citizen action!