Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients.

IF 1.8 4区 医学 Q3 TRANSPLANTATION
Rick Selby, Taylor Selby-Medical, Michael Richman
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引用次数: 0

Abstract

Purpose of review: Jehovah's Witnesses do not accept transfusion of major allogeneic blood fractions. Successful solid organ transplantation is challenging for Jehovah's Witnesses when anemia, coagulation disturbances, and difficult technical aspects co-exist, and key blood bank resources cannot be utilized. Organ availability for transplantation is limited and demand exceeds supply for all organ types. Historically, the likelihood of poor outcomes in Jehovah's Witnesses patients placed ethical limitations on transplant candidacy for this population violating the precept of maximal utilization of a limited resource. The review's purpose is to describe advancements and strategies that make Jehovah's Witnesses transplant outcomes comparable to transfusion-eligible patients and allay the ethical concerns of their candidacy.

Recent findings: Immunomodulation from allogeneic transfusion is a cause of significant postop morbidity. Blood conservation strategies have led to improved outcomes across different medical and surgical cohorts and set the stage for expanded utility in Jehovah's Witnesses with organ insufficiency.Published single-center series with descriptions of specific peri-operative strategies describe the path to major blood product avoidance.

Summary: Comparable outcomes in solid organ transplantation for Jehovah's Witnesses without allogeneic transfusion are possible when inclusion-exclusion criteria are respected, and blood conservation strategies employed.

实体器官移植的伦理问题:耶和华见证人患者的无输血移植。
审查目的:耶和华见证会不接受输注主要的异体血液成分。当贫血、凝血障碍和困难的技术问题同时存在,且无法利用关键的血库资源时,成功进行实体器官移植对耶和华见证会来说是一项挑战。可供移植的器官有限,所有类型的器官都供不应求。从历史上看,耶和华见证会患者可能出现不良预后,这就从伦理上限制了这一人群的移植候选资格,违反了最大限度利用有限资源的原则。这篇综述的目的是介绍使耶和华见证会患者的移植结果与符合输血条件的患者相媲美的先进技术和策略,并消除对他们作为移植候选者的伦理顾虑:最新研究结果:异体输血引起的免疫调节是导致术后严重发病的原因之一。最近的研究结果:异体输血引起的免疫调节是导致术后严重发病的原因之一。血液保存策略改善了不同内科和外科组群的治疗效果,并为在器官功能不全的耶和华见证会患者中推广使用奠定了基础。已发表的单中心系列研究描述了避免使用主要血液制品的具体围手术期策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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