“…For this reason, research has focused on strategies to achieve immune tolerance in an immunosuppression‐free status (IFS) whereby the recipient accepts an allograft without immunosuppressants. In more recent years, the field has been transitioning into the regenerative era in tandem with other developments, such as big data, exchanged pair donation chains, and transplants across blood groups or among incompatible donors 8–11 . Recent achievements in organ bioengineering and regeneration technologies to manufacture organs from the patient's own cells may offer the genesis of organ‐on‐demand and IFS.…”
Section: State‐of‐the‐art Regenerative Medicine Technologiesmentioning
Organ transplantation is predicted to increase as life expectancy and the incidence of chronic diseases rises. Regenerative medicine‐inspired technologies challenge the efficacy of the current allograft transplantation model.
A literature review was conducted using the PubMed interface of MEDLINE from the National Library of Medicine. Results were examined for relevance to innovations of organ bioengineering to inform analysis of advances in regenerative medicine affecting organ transplantation. Data reports from the Scientific Registry of Transplant Recipient and Organ Procurement Transplantation Network from 2008 to 2019 of kidney, pancreas, liver, heart, lung and intestine transplants performed, and patients currently on waiting lists for respective organs, were reviewed to demonstrate the shortage and need for transplantable organs.
Regenerative medicine technologies aim to repair and regenerate poorly functioning organs. One goal is to achieve an immunosuppression‐free state to improve quality of life, reduce complications and toxicities, and eliminate the cost of lifelong antirejection therapy. Innovative strategies include decellularization to fabricate acellular scaffolds that will be used as a template for organ manufacturing, three‐dimensional printing and interspecies blastocyst complementation. Induced pluripotent stem cells are an innovation in stem cell technology which mitigate both the ethical concerns associated with embryonic stem cells and the limitation of other progenitor cells, which lack pluripotency. Regenerative medicine technologies hold promise in a wide array of fields and applications, such as promoting regeneration of native cell lines, growth of new tissue or organs, modelling of disease states, and augmenting the viability of existing ex vivo transplanted organs.
The future of organ bioengineering relies on furthering understanding of organogenesis, in vivo regeneration, regenerative immunology and long‐term monitoring of implanted bioengineered organs.
“…One obstacle is that there will often be financial barriers that prevent the health insurance system of those countries from paying the costs incurred by their citizens in the United States. However, this needn't be an insuperable obstacle, because transplantation is much cheaper than dialysis, and so substantial savings accrue to American healthcare payers whenever an American patient is transplanted; these savings are sufficient to pay the costs of the foreign pair in the United States and after they return home (Krawiec and Rees 2014, Rees et al 2017b, Bozek et al 2018). These pilot KE programs, still in their infancy as practical alternatives, offer the prospect of enabling patient-donor pairs from around the world to assist each other in receiving transplants.…”
Many patients in need of a kidney transplant have a willing but incompatible (or poorly matched) living donor. Kidney exchange programs arrange exchanges among such patient-donor pairs, in cycles and chains of exchange, so that each patient receives a compatible kidney. Kidney exchange has become a standard form of transplantation in the United States and a few other countries, in large part because of continued attention to the operational details that arose as obstacles were overcome and new obstacles became relevant. We review some of the key operational issues in the design of successful kidney exchange programs. Kidney exchange has yet to reach its full potential, and the paper further describes some open questions that we hope will continue to attract attention from researchers interested in the operational aspects of dynamic exchange. This paper was accepted by David Simchi Levi, Special Section of Management Science: 65th Anniversary.
“…The Global Kidney Exchange (GKE) proposed by Rees et al raises a novel possibility of enrolling the combination of an ESKD patient from a developing country along with their willing living donor candidate to exchange with an incompatible pair in the United States, and deploying the funds saved by the expedited transplant of a US ESKD patient to create the opportunity to transplant the economically disadvantaged international pair by paying for their travel, transplantation, immunosuppression, and follow‐up . Limitations and concerns related to this strategy include the legality of GKE given each nation's unique transplantation laws, as well as concern for exploitation risk .…”
End‐stage kidney disease patients in the United States may have family members or friends who are not US citizens or residents but are willing to serve as their living kidney donor in the United States (“international donors”). In July 2017, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) convened a multidisciplinary workgroup of experts in living donation care, including coordinators, social workers, donor advocates, administrators, and physicians, to evaluate educational gaps related to the evaluation and care of international donors. The evaluation of international living donor candidates is a resource‐intensive process that raises key considerations for assessing risk of exploitation/inducement and addressing communication barriers, logistics barriers, and access to care in their home country. Through consensus‐building discussions, we developed recommendations related to: (a) establishing program guidelines for international donor candidate evaluation and selection; (b) initial screening; (c) logistics planning; (d) comprehensive evaluation; and (e) postdonation care and follow‐up. These recommendations are not intended to direct formal policy, but rather as guidance to help programs more efficiently and effectively structure and execute evaluations and care coordination. We also offer recommendations for research and advocacy to optimize the care of this unique group of living donors.
“…In the Philippines, laws forbid prostitution (but there is nevertheless an active black market, including for foreign sex tourism). Philippine laws do not forbid surrogacy or kidney exchange, and Philippine citizens have benefited from legally participating in global kidney exchange (GKE) transactions in the United States (6,7). Fig.…”
We study popular attitudes in Germany, Spain, the Philippines, and the United States toward three controversial markets—prostitution, surrogacy, and global kidney exchange (GKE). Of those markets, only prostitution is banned in the United States and the Philippines, and only prostitution is allowed in Germany and Spain. Unlike prostitution, majorities support legalization of surrogacy and GKE in all four countries. So, there is not a simple relation between public support for markets, or bans, and their legal and regulatory status. Because both markets and bans on markets require social support to work well, this sheds light on the prospects for effective regulation of controversial markets.
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