How to Reverse the Organ Shortage

Abstract Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

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Production of Human Pluripotent Stem Cell-Derived Hepatic Cell Lineages and Liver Organoids: Current Status and Potential Applications

Bioengineering ◽

10.3390/bioengineering7020036 ◽

2020 ◽

Vol 7 (2) ◽

pp. 36 ◽

Cited By ~ 5

Author(s):

João P. Cotovio ◽

Tiago G. Fernandes

Keyword(s):

Cell Types ◽

In Vitro Models ◽

Hepatic Cell ◽

Current Status ◽

Organ Shortage ◽

Cell Lineages ◽

Potential Applications ◽

Liver Organoids

Liver disease is one of the leading causes of death worldwide, leading to the death of approximately 2 million people per year. Current therapies include orthotopic liver transplantation, however, donor organ shortage remains a great challenge. In addition, the development of novel therapeutics has been limited due to the lack of in vitro models that mimic in vivo liver physiology. Accordingly, hepatic cell lineages derived from human pluripotent stem cells (hPSCs) represent a promising cell source for liver cell therapy, disease modelling, and drug discovery. Moreover, the development of new culture systems bringing together the multiple liver-specific hepatic cell types triggered the development of hPSC-derived liver organoids. Therefore, these human liver-based platforms hold great potential for clinical applications. In this review, the production of the different hepatic cell lineages from hPSCs, including hepatocytes, as well as the emerging strategies to generate hPSC-derived liver organoids will be assessed, while current biomedical applications will be highlighted.

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Heart and Heart-Lung Transplantation: An Update

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239600400102 ◽

1996 ◽

Vol 4 (1) ◽

pp. 4-13

Author(s):

David D Yuh ◽

Robert C Robbins ◽

Bruce A Reitz

Keyword(s):

Lung Transplantation ◽

Postoperative Care ◽

Organ Preservation ◽

Surgical Techniques ◽

Organ Shortage ◽

Transplant Recipients ◽

Donor Organ ◽

The West ◽

Thoracic Transplantation ◽

End Stage

Heart and heart-lung transplantation have been established as effective treatments for a wide variety of end-stage cardiopulmonary diseases. Recent years have seen refinements in surgical techniques for cardiopulmonary replacement as well as the selection and postoperative care of thoracic transplant recipients. Despite substantial clinical progress, however, significant problems remain, particularly donor organ shortage, graft rejection, opportunistic infection, and limited organ preservation techniques. Basic and clinical research are currently addressing these problems. In this brief review, we provide an update of our experiences with heart and heart-lung transplantation in the West (particularly at Stanford University), an outline of the active issues in the field, and some thoughts about the development of thoracic transplantation in Asia.

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Addressing organ shortage in the European Union: getting the balance right

Organ Shortage ◽

10.1017/cbo9780511973536.015 ◽

2011 ◽

pp. 227-244

Author(s):

Anne-Maree Farrell

Keyword(s):

European Union ◽

Organ Shortage ◽

The European Union

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Cell-Based Regeneration and Treatment of Liver Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms221910276 ◽

2021 ◽

Vol 22 (19) ◽

pp. 10276

Author(s):

Julia Hofmann ◽

Verena Hackl ◽

Hannah Esser ◽

Andras T. Meszaros ◽

Margot Fodor ◽

...

Keyword(s):

Liver Diseases ◽

Ex Vivo ◽

Organ Shortage ◽

Clinical Implementation ◽

Organ Function ◽

Novel Technologies ◽

Recent Developments ◽

Underlying Mechanisms ◽

The Moment ◽

End Stage

The liver, in combination with a functional biliary system, is responsible for maintaining a great number of vital body functions. However, acute and chronic liver diseases may lead to irreversible liver damage and, ultimately, liver failure. At the moment, the best curative option for patients suffering from end-stage liver disease is liver transplantation. However, the number of donor livers required by far surpasses the supply, leading to a significant organ shortage. Cellular therapies play an increasing role in the restoration of organ function and can be integrated into organ transplantation protocols. Different types and sources of stem cells are considered for this purpose, but highly specific immune cells are also the focus of attention when developing individualized therapies. In-depth knowledge of the underlying mechanisms governing cell differentiation and engraftment is crucial for clinical implementation. Additionally, novel technologies such as ex vivo machine perfusion and recent developments in tissue engineering may hold promising potential for the implementation of cell-based therapies to restore proper organ function.

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Organ Shortage, Will People's Knowledge be a Path to the Solution?

Nursing and Health Care ◽

10.33805/2573.3877.137 ◽

2019 ◽

pp. 44-49

Author(s):

Cantarovich Félix

Keyword(s):

Organ Donation ◽

Economic Incentives ◽

University Education ◽

Basic Knowledge ◽

Organ Shortage ◽

Loved One ◽

Social Risks ◽

The Social ◽

Medical Teams ◽

Main Protagonist

Organ shortage transforming death into life, which is what organ transplants symbolize, needs the end of somebody life, a scientific miracle of our times, but as well a social problem. Prejudices or ignorance inhibits to offering life to another human being. The consequence of this conflicting situation is that patients waiting for transplantation, “unfairly” die every day. States and Social Security should be involved in this problem. Programming efficient education will be important for change social conduct towards organ donation. As well, several studies emphasize the persistence of an insufficient university medical teams training in transplantation. Organ shortage and waiting lists patient’s mortality is a failure of social communication on organ donation and transplantation. Proposals to review social and university education in current organ shortage crisis might be an ethical duty for states health and education officials. Solidarity is a positive people’s feeling, nevertheless faced with death of a loved one; it does not seem to be an enough reason to justify authorization to donate. For many people, organ donation represents a perverse and unjustified action of mutilation. Considering the negative reactions that often can occur in the moment in which the alternative of deciding the donation of organs of a loved one is presented; we have proposed the inclusion in the social education plans the following concepts: • Organ shortage is a health emergency. • Throughout our lives, we might need organ or tissue transplantation. • Our body after death is a unique source of health to be shared. • Organ donation meant to” share life” more than “to gift life”. • Organ donation should be a social agreement. • People should know the social risks involved in establishing economic incentives for donation. This analysis is made to provide a basic knowledge of a vital medical crisis, and to suggest to decision makers of educational programs useful suggestions for this serious problem. In addition, and very particularly this work is directed to the Society, the main protagonist of this problem, requiring to receiving a correct and detailed information on the dilemma of the lack of organs, in quest that the donation decision will be an act of full awareness. A french philosopher, Jean Rostand has said "To dream you have to know".

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Liver transplantation: a 10-year single center experience in Pernambuco- northeastern Brazil

Brazilian Journal of Transplantation ◽

10.53855/bjt.v13i2.227 ◽

2010 ◽

Vol 13 (2) ◽

pp. 1288-1292

Author(s):

Luiz Eduardo C. Miranda ◽

Paulo Sérgio Vieira de Melo ◽

Diego Laurentino Lima ◽

Bernardo Sabat ◽

Américo Gusmão Amorim ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Curve ◽

Deceased Donor ◽

Conventional Technique ◽

University Hospital ◽

Northeastern Brazil ◽

Organ Shortage ◽

Single Center ◽

Liver Donor ◽

Single Center Experience

Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year rata was 76.4%. Conclusion: It is possible to provide a high-quality public medical assistance in an efficient and continuous manner in less developed areas of Brazil.

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BioMEMS Technologies for Regenerative Medicine

MRS Proceedings ◽

10.1557/proc-1139-gg02-01 ◽

2008 ◽

Vol 1139 ◽

Cited By ~ 3

Author(s):

Jeffrey T. Borenstein

Keyword(s):

Drug Delivery ◽

Regenerative Medicine ◽

Drug Delivery Systems ◽

Ex Vivo ◽

Delivery Systems ◽

Organ Shortage ◽

Engineered Tissues ◽

Drug Concentrations

AbstractThe emergence of BioMEMS fabrication technologies such as soft lithography, micromolding and assembly of 3D structures, and biodegradable microfluidics, are already making significant contributions to the field of regenerative medicine. Over the past decade, BioMEMS have evolved from early silicon laboratory devices to polymer-based structures and even biodegradable constructs suitable for a range of ex vivo and in vivo applications. These systems are still in the early stages of development, but the long-term potential of the technology promises to enable breakthroughs in health care challenges ranging from the systemic toxicity of drugs to the organ shortage. Ex vivo systems for organ assist applications are emerging for the liver, kidney and lung, and the precision and scalability of BioMEMS fabrication techniques offer the promise of dramatic improvements in device performance and patient outcomes.Ultimately, the greatest benefit from BioMEMS technologies will be realized in applications for implantable devices and systems. Principal advantages include the extreme levels of achievable miniaturization, integration of multiple functions such as delivery, sensing and closed loop control, and the ability of precision microscale and nanoscale features to reproduce the cellular microenvironment to sustain long-term functionality of engineered tissues. Drug delivery systems based on BioMEMS technologies are enabling local, programmable control over drug concentrations and pharmacokinetics for a broad spectrum of conditions and target organs. BioMEMS fabrication methods are also being applied to the development of engineered tissues for applications such as wound healing, microvascular networks and bioartificial organs. Here we review recent progress in BioMEMS-based drug delivery systems, engineered tissue constructs and organ assist devices for a range of ex vivo and in vivo applications in regenerative medicine.

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