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Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of 'designated donation' and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B's consent. Second, if B offers to give back the organ to A, then B's act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B's right to bodily integrity. But B's refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.

Dynamics of virus-specific T cell immunity in pediatric liver transplant recipients

Immunosuppression following solid organ transplantation (SOT) has a deleterious effect on cellular immunity leading to frequent and prolonged viral infections. To better understand the relationship between posttransplant immunosuppression and circulating virus-specific T cells, we prospectively monitored the frequency and function of T cells directed to a range of latent (CMV, EBV, HHV6, BK) and lytic (AdV) viruses in 16 children undergoing liver transplantation for up to 1 year posttransplant. Following transplant, there was an immediate decline in circulating virus-specific T cells, which recovered posttransplant, coincident with the introduction and subsequent routine tapering of immunosuppression. Furthermore, 12 of 14 infections/reactivations that occurred posttransplant were successfully controlled with immunosuppression reduction (and/or antiviral use) and in all cases we detected a temporal increase in the circulating frequency of virus-specific T cells directed against the infecting virus, which was absent in 2 cases where infections remained uncontrolled by the end of follow-up. Our study illustrates the dynamic changes in virus-specific T cells that occur in children following liver transplantation, driven both by active viral replication and modulation of immunosuppression.

Fire in the belly and the professionalization of nurses: a historical analysis of Crohn disease care

Today, professional nurses around the world are stepping up to meet the needs of individuals with Crohn disease, using their specialized knowledge and skills that demonstrate areas of expertise that have not always existed. The gastrointestinal-specific knowledge being used by these 21st-century nurses exists today because progressive efforts of nurses in previous decades moved the profession of nursing forward. The purpose of this article was to describe and analyze the development of the role of nurses in responding to new challenges patients with Crohn disease face since the emergence of the disease in the early 20th century. The authors used traditional historic research methods to conduct the study. Primary sources include nursing journals and textbooks published in the 20th and 21st centuries and documents archived at The Mount Sinai Hospital in New York City, where Burrill B. Crohn conducted his seminal work. The significance of the findings is that the changing role of nurses in caring for patients with Crohn disease mirrors the professionalization of nursing during the 20th and early 21st centuries.

Nobel Laureate Surgeons

Eminent surgeons who received the Nobel Prize in Physiology or Medicine for their work and accomplishments are considered Nobel Laureate surgeons. There are nine such distinguished individuals who achieved this award. In chronological order, from earliest to latest, we encounter: 1. Theodor Kocher, 1909, thyroid gland pathology; 2. Allvar Gullstrand, 1911, dioptrics of the eye; 3. Alexis Carrel, 1912, vascular suture and organ transplant; 4. Robert Barany, 1914, vestibular system; 5. Frederick Banting, 1923, discovery of insulin; 6. Walter Hess, 1949, midbrain function; 7. Werner Forssmannn, 1956, cardiac catheterization; 8. Charles Huggins, 1966, hormones and cancer; 9. Joseph Murray, 1990, organ transplantation. These extraordinary Nobel Laureate surgeons had in common four significant qualities expressed by four letters, CDFI, representing commitment, determination, focus, and innovation. The examples of a sustained path of accomplishment and success set by these unique personalities serve as a vivid guide for future generations of surgeons.