Alternative Solutions To Lack Of Organ Donors

Every 24 hours, almost 200 people die because suitable organs are not available. Last year more than 7,000 Americans died while awaiting an organ transplant; two times the amount of American troops killed in Iraq. The need for donated organs is far greater than the supply. The biggest problem faced by organ donation agencies is the lack of donors. Scientists are looking for less conventional methods than finding more organ donors to solve this problem. This coursework will look into alternative methods that are being considered. There are various medical problems which could result in the loss of functioning of a particular organ in the body. Since the first organ transplant was carried out in 1905, the science has become more and more technologically advanced to the point that full limb transplants are now possible. However in today's day and age, finding an organ donor is becoming increasingly difficult due to the high demand and low supply. Organ donation is indeed a highly debated issue. In essence, it is a charitable act of an organ to someone who needs a transplant; but the system has been exploited in recent years. Socially deprived communities have been known to sell their organs for money and gangs in the Far East are known for 'organ farming' where they will kill people for the sole purpose of harvesting their organs to sell. Data obtained from the Guardian Newspaper has been put into a graph below which shows the difference between the demand for organs and the supply. As you can tell from the graph, in all countries surveyed in 2007, the demand is at least twice as high as the supply.

According to the World Health Organisation, only 1 in 10 people in need of a kidney (the body part most in demand) manage to get one. In the poorest places, of course, a complex transplant (which in the American health system costs $500,000) is unthinkable for most people anyway. Therefore, alternative solutions are readily being researched all around the world every day. One of the main methods to solve the problem is stem cell research which will be the main focus of this coursework. Biological solutions to the problem of a lack of organ donors Research on human embryonic stem cells is furthering our understanding about how an organism evolves from a single cell and how healthy cells replace damaged cells in adult organisms. This branch of biology is leading scientists to explore the option of stem cells to treat disease. Stem cell research is an emerging technology that aims to be able to develop a type of cell called a stem cell into almost any of the 220 types of cell in the human body. In essence, it is possible to grow the organ instead of getting it donated. There is immense optimism for stem cell research and its potential to discover treatments for some of the worst diseases. All stem cells - regardless of their source have three common features. They are able to perform cell division (mitosis) for long durations of time, they are unspecialised and they can develop into specialised cell types under specific conditions. The capability of stem cells to produce specialised cells is a crucial one. Unspecialised stem cells create specialised cells. This happens by the cells genes regulating the internal signals that trigger which specialised cell it will turn into. Scientists do not fully understand its mechanism yet however. This is the key to being able to prepare organs which are suitable for transplant. Once the mechanism of differentiation of stem cells has been understood, the most significant prospective use of human stem cells can be made use of. The synthesis of cells, organs and tissues that could be used for transplantation therapies. Stem cells instructed to differentiate into particular cell types open up possibilities of a renewable source of replacement cells and tissues to treat malfunctioning organs and countless other diseases. Problems such as rejection by the recipient's immune system also need to be overcome. Currently, the option of a stem cell transplant is offered to patients with certain types of cancer. For instance types of leukemia or myeloma. Stem cell transplants are not the first in line in terms of therapy. Chemotherapy and other such treatments have a tendency to be used first. The graph on the right shows the success rate from one particular stem cell transplant test. Transplanting organs grown from stem cells is still very much in its early stages; however in 2008 British doctors became the first in the world to successfully grow an organ from patients' stem cells and then transplant it in successfully. `I reckon in 20 years' time it will be the commonest operation surgeons will be doing. It will completely transform the way we think about surgery, health and disease.' Once scientists overstep the barrier of how to choose how stem cells differentiate stem cell organ transplants will almost single handedly solve the problem of lack of organ donors.

How the methods are appropriate to addressing the problem Figure 4 on the right shows an overview of a specific stem cell transplant procedure. Windpipe transplants are notoriously difficult to carry out for surgeons and therefore, any methods to reduce complications are made use of. One of the ways in which the method is appropriate is that the stem cells used to grow into cartilage are taken from the patient herself, from the same area of the body that is being transplanted. Furthermore, in step 3 the scaffold windpipe is washed thoroughly. All of these precautions are taken in order to reduce the likelihood of transplant rejection occurring. Transplant rejection is a problem that arises when an organ that has been transplanted is not recognised by the body of the transplant recipient. In most scenarios this trait of the immune system is useful, because the immune system`s purpose is to tell apart foreign matter within the body and attempt to destroy it, just as it attempts to destroy infecting organisms such as bacteria and viruses.

Monitoring success is also an important part to determining how to use appropriate methods. If it is shown recipients of stem cell transplants have a significantly shorter life expectancy than recipients of conventional donors then it would not be viable to introduce stem cell transplants. The table to the left shows data in tabulated form comparing the survival rate after stem cell transplants and conventional transplants.

As the graph shows, stem cell transplants are generally more reliable than conventional transplants over a long period of time. Ethical Implications Stem cell research causes a storm of disagreement due to its ethical implications. Although few qu estion the medical advancement that can be made by understanding stem cells, many object to the procedures occurring to reach that goal. Research on adult stem cells is not disputed, since obtaining them causes no harm. However, embryonic stem cells are a different issue as it necessitates the use of embryos (blastocycts). One side of the argument is that a blastocyst is only a cluster of 150 cells, and does not possess even the nervous system required to biologically qualify as a human being. Furthermore, the blastocysts that research is carried out on are surplus ones left over from in vitro fertilization so technically no life is being lost as the blastocyst would not be allowed to develop anyway. Opponents of embryonic stem cell research however state that human life begins at the moment of conception making this process unacceptable as it essentially destroys a human life. Economic Implications The amount of stem cell transplants being carried out is rising. The graph below shows this clearly. If every single person that needed it were to get a stem cell organ transplant, the cost would be extremely high putting a lot of pressure on the already slim NHS budget. Of course, many people would argue that you cannot put a cost on life; however it must be taken into consideration where the money would come from. Possible sources are by increasing taxation, decreasing doctors pay, cutting spending on questionable expenditure of the NHS such as treating smokers. all of these possibilities will cause protest by a certain minority of people. In America, a heart transplant can cost in excess of half a million dollars. Needless to say, many cannot afford such a procedure. Millions of extra pounds of the government's budget would have to be allocated to healthcare.

Alternative Solutions Another alternative to organ transplantation would be creating artificial organs which could be used instead. An artificial organ is a synthetic man made device that is implanted into a human to replace an organ so that it can perform its job without needing constant maintenance such as recharging. Significant progress has already been made in this field. Heart transplants can currently be given to those who urgently need it; however life cannot be reliably sustained after a period of about 18 months with this particular example. As well as artificial hearts; hands, eyes, lungs and livers and many more organs have been produced to varying degrees of success. Current research is going into making these transplants more efficient and less expensive. This is a high risk operation however, and the mortality rate for operations tends to be quite high. This leads to very difficult decisions having to be made by all those involved in the procedure including the patient. Clinical testing of new artificial organs is very difficult to carry out. It is only carried out on patients who have exhausted all over possible forms of therapy, some patients who are terminal and rarely, on violent convicts facing execution. There is also the more obvious, less scientific approach to address the problem of lack of organ donors. The current system of organ donation is an opt in one where individuals must register their willingness to be a donor after death. If Britain adopted a system of presumed consent where it is assumed that one wishes to be a donor unless they have "opted out", the demand for organs will almost certainly be met. They also argue that the relatives or those close to a person who has not expressed a wish to donate would be relieved of the burden of making that decision at such a traumatic time. One fear with presumed consent is that people won't get round to registering an objection and the subsequent expectation that organ donation should take place could lead to unnecessary distress to their relatives. Many transplant recipients add that a donated organ is more easily accepted because they know it has been positively given by the deceased whereas presuming consent would turn donation into an action by default. Other concerns surround the potential medical risks involved in removing organs without full discussion with relatives. If an individual does not register an objection, it is possible that their silence may indicate a lack of understanding rather than agreement with the policy. It is because of these concerns that in the majority of countries operating an opt-out system, health care professionals still consult the family to establish consent.