scholarly journals Ethical issues in living-related corneal tissue transplantation

2019 ◽  
Vol 45 (7) ◽  
pp. 430-434 ◽  
Author(s):  
Joséphine Behaegel ◽  
Sorcha Ní Dhubhghaill ◽  
Heather Draper
Keyword(s):  
Stem Cell ◽  
Ethical Issues ◽  
Ex Vivo ◽  
Tissue Donation ◽  
Ocular Tissue ◽  
Surgical Approaches ◽  
Corneal Tissue ◽  
Ethical Challenges ◽  
Limbal Stem Cell ◽  
Living Related

The cornea was the first human solid tissue to be transplanted successfully, and is now a common procedure in ophthalmic surgery. The grafts come from deceased donors. Corneal therapies are now being developed that rely on tissue from living-related donors. This presents new ethical challenges for ophthalmic surgeons, who have hitherto been somewhat insulated from debates in transplantation and donation ethics. This paper provides the first overview of the ethical considerations generated by ocular tissue donation from living donors and suggests how these might be addressed in practice. These are discussed in the context of a novel treatment for corneal limbal stem cell deficiency. This involves limbal cell grafts which are transplanted, either directly or after ex vivo expansion, onto recipient stem cell-deficient eyes. Where only one eye is diseased, the unaffected eye can be used as a source of graft tissue. Bilateral disease requires an allogenic donation, preferably from a genetically related living donor. While numerous papers have dealt with the theory, surgical approaches and clinical outcomes of limbal stem cell therapies, none has addressed the ethical dimensions of this form of tissue donation.

scholarly journals Safety of Cultivated Limbal Epithelial Stem Cell Transplantation for Human Corneal Regeneration

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
J. Behaegel ◽  
S. Ní Dhubhghaill ◽  
C. Koppen ◽  
N. Zakaria
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Health Risks ◽  
Ex Vivo ◽  
Good Manufacturing Practice ◽  
Surgical Approaches ◽  
Potential Health ◽  
Limbal Stem Cell Transplantation ◽  
Limbal Stem Cell

Ex vivo cultivated limbal stem cell transplantation is a promising technique for the treatment of limbal stem cell deficiency. While the results of the clinical trials have been extensively reported since the introduction of the technique in 1997, little has been reported regarding the potential health risks associated with production processes and transplantation techniques. Culture procedures require the use of animal and/or human-derived products, which carry the potential of introducing toxic or infectious agents through contamination with known or unknown additives. Protocols vary widely, and the risks depend on the local institutional methods. Good manufacturing practice and xeno-free culture protocols could reduce potential health risks but are not yet a common practice worldwide. In this review, we focus on the safety of both autologous- and allogeneic-cultivated limbal stem cell transplantation, with respect to culture processes, surgical approaches, and postoperative strategies.

Arguments for ‘ocular donation’ as standardised terminology to reduce the ‘ick factor’ of ‘eye donation’

2022 ◽  
pp. medethics-2021-108003
Author(s):  
Katrina A Bramstedt
Keyword(s):  
Life Support ◽  
Deceased Donor ◽  
Informed Consent Process ◽  
Tissue Donation ◽  
Ocular Tissue ◽  
Corneal Tissue ◽  
Root Cause ◽  
Eye Donation ◽  
Over Time

This brief report presents the global problem of the shortfall of donor corneal tissue for transplantation, a potential root cause (‘ick factor’ language), and a potential solution (modification of ‘ick factor’ language). Specifically, use of the term ‘eye donation’ is a potential hurdle to ocular tissue donation as it can stimulate the ‘ick factor.’ Verbiage such as ‘ocular (eye tissue)’ could be a method of providing terminology that is less emotive than ‘eye donor’ or ‘eye donation.’ The field of transplantation has experienced terminology shifts over time; for example, ‘cadaver’ has been replaced with ‘deceased donor,’ ‘harvest’ has been replaced with ‘recover,’ and ‘life support’ has been replaced with ‘ventilated.’ Notably, only a small number of regions worldwide are using ‘ocular’ terminology, yet it could be an important step to enhancing the informed consent process and improving donation rates, potentially increasing transplant and optimising patient quality of life for those with treatable blindness.

Long-term Outcomes of Living-Related Conjunctival Limbal Allograft Compared With Keratolimbal Allograft in Patients With Limbal Stem Cell Deficiency

Cornea ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Albert Y. Cheung ◽  
Medi Eslani ◽  
Khaliq H. Kurji ◽  
Elizabeth Wright ◽  
Enrica Sarnicola ◽  
...  
Keyword(s):  
Stem Cell ◽  
Limbal Stem Cell Deficiency ◽  
Long Term Outcomes ◽  
Keratolimbal Allograft ◽  
Limbal Stem Cell ◽  
Living Related

Limbal stem cell and oral mucosal epithelial transplantation from ex vivo cultivation in LSCD-induced rabbits: histology and immunologic study of the transplant epithelial sheet

2016 ◽  
Vol 37 (6) ◽  
pp. 1289-1298 ◽  
Author(s):  
Napaporn Tananuvat ◽  
Kanokkan Bumroongkit ◽  
Chainarong Tocharusa ◽  
Umnat Mevatee ◽  
Aphisek Kongkaew ◽  
...  
Keyword(s):  
Stem Cell ◽  
Ex Vivo ◽  
Epithelial Sheet ◽  
Limbal Stem Cell

Transplantation of Conjunctival Epithelial Cells Cultivated Ex Vivo in Patients With Total Limbal Stem Cell Deficiency

Cornea ◽  
2013 ◽  
Vol 32 (3) ◽  
pp. 221-228 ◽  
Author(s):  
José Reinaldo S. Ricardo ◽  
Priscila C. Cristovam ◽  
Pedro A. N. Filho ◽  
Charles C. Farias ◽  
Aline L. de Araujo ◽  
...  
Keyword(s):  
Stem Cell ◽  
Epithelial Cells ◽  
Ex Vivo ◽  
Limbal Stem Cell Deficiency ◽  
Limbal Stem Cell ◽  
Conjunctival Epithelial Cells

Stem Cell and Related Therapies: Nurses and midwives representing all parties

2006 ◽  
Vol 13 (3) ◽  
pp. 292-303 ◽  
Author(s):  
S H Cedar
Keyword(s):  
Stem Cell ◽  
Ethical Issues ◽  
Best Interests ◽  
Ethical Challenges ◽  
New Techniques ◽  
Paediatric Primary Care ◽  
Moral Frameworks ◽  
Stem Cell Isolation ◽  
Benefits And Costs ◽  
Nurses And Midwives

Nurses and midwives are part of health care in all the stages of our lives from preconception to death. Recent scientific advances have introduced new techniques of screening and diagnosis linked to stem cell isolation and therapies. These could affect us at any age and therefore nurses will be involved as carers and patients advocates for these techniques. In this article stem cell techniques and therapies are outlined, as well as some of the ethical challenges faced by various nursing groups, whether in adult, learning difficulties, mental health, paediatric, primary care, public health or health visiting areas. Nurses have to understand the ethical issues and the rights of all parties (donor, recipient and families), which may conflict with each other, to be able to weigh up the benefits and costs to each group involved. Answers have to be found on a case-by-case basis within local moral frameworks and law. Nurses represent all parties in these therapies and act as advocates for every patient group. They need to act in an interprofessional environment to promote the best interests of all their clients, both clinically and ethically.

scholarly journals Modulation of corneal tissue mechanics influences epithelial cell phenotype

2018 ◽  
Author(s):  
Ricardo M. Gouveia ◽  
Guillaume Lepert ◽  
Suneel Gupta ◽  
Rajiv R. Mohan ◽  
Carl Paterson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Epithelial Cell ◽  
Ex Vivo ◽  
Stem Cell Differentiation ◽  
Tissue Mechanics ◽  
Cell Phenotype ◽  
Corneal Tissue ◽  
Physiological Level ◽  
Epithelial Stem Cell

SummaryWhilst the control of stem cell differentiation using substrates of differing compliance has been extensively explored in vitro, the significance of this mechanism at a physiological level is not known. Here we set to explore the role of corneal surface biomechanics in controlling epithelial cell proliferation and differentiation. Using non-contact high-resolution Brillouin spectro-microscopy we showed that the corneal outer edge (limbus) has significantly lower bulk modulus compared to the central cornea, and that this difference is precisely delimited in the organ. Furthermore, the areas of the limbus with distinctly softer properties were shown to be associated with limbal epithelial stem cell (LESC) residence. Based on these findings, we then provided the first demonstration of the capacity to modulate LESC phenotype, both in vivo and ex vivo, solely through the recreation/restoration of suitable biomechanical niches. These results thus confirm the fundamental role of corneal biomechanics in directing epithelial stem cell behavior.

scholarly journals Limbal stem cell deficiency: etiology, pathogenesis, priniciples and prospects of surgical treatment

2019 ◽  
Vol 12 (1) ◽  
pp. 103-111
Author(s):  
A. S. Dubovikov ◽  
I. O. Gavrilyuk ◽  
A. N. Kulikov ◽  
S. V. Churashov ◽  
V. F. Chernysh ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Surgical Treatment ◽  
Ex Vivo ◽  
Epithelial Stem Cells ◽  
Limbal Stem Cells ◽  
History Of Development ◽  
History Of ◽  
Limbal Epithelial Stem Cells ◽  
Limbal Stem Cell

The review is focused on the modern view of the etiology and pathogenesis of limbal stem cells deficiency. The history of development of tissue and ex-vivo transplantation of limbal epithelial stem cells is presented. Certain promising directions of the treatment of patients with limbal stem cells deficiency are presented.

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