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Sharif A, McGiffin D, Strong R, Trey T, Matas D, Lavee J, Hughes S, Rogers W. Response to Chen et al and the Accompanying Commentary. Transplantation 2024; 108:e81-e82. [PMID: 38809430 DOI: 10.1097/tp.0000000000005005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Doctors Against Forced Organ Harvesting, Washington, DC
| | - David McGiffin
- Department of Cardiothoracic Surgery, Monash University, Melbourne, VIC, Australia
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, VIC, Australia
| | - Russell Strong
- Department of Surgery, University of Queensland, Brisbane, QLD, Australia
| | - Torsten Trey
- Doctors Against Forced Organ Harvesting, Washington, DC
| | - David Matas
- International Coalition to End Transplant Abuse in China (ETAC), Winnipeg, MB, Canada
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Susie Hughes
- Department of Philosophy and School of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Wendy Rogers
- International Coalition to End Transplant Abuse in China (ETAC), Sydney, NSW, Australia
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Bajaj JS, Choudhury A, Kumaran V, Wong F, Seto WK, Alvares-Da-Silva MR, Desalgn H, Hayes PC, Idilman R, Topazian M, Torre A, Xie Q, George J, Kamath PS. Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm! Am J Transplant 2024; 24:733-742. [PMID: 38387623 DOI: 10.1016/j.ajt.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.
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Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
| | - Ashok Choudhury
- Department of Hepatology, Institute for Liver and Biliary Sciences, New Delhi, India
| | - Vinay Kumaran
- Division of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Florence Wong
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wai Kay Seto
- Department of Medicine, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Mario Reis Alvares-Da-Silva
- Department of Hepatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Hailemichael Desalgn
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Peter C Hayes
- Hepatology, Division of Health Sciences, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mark Topazian
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Aldo Torre
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Sade RM, Carpenter AJ, D'Amico TA, Drake DH, Entwistle JW, Ray S, Tweddell JS. Unethical Studies on Transplantation in Cardiothoracic Surgery Journals. Ann Thorac Surg 2021; 112:1746-1752. [PMID: 34654543 DOI: 10.1016/j.athoracsur.2021.07.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Robert M Sade
- Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina.
| | - Andrea J Carpenter
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel H Drake
- Department of Surgery, Munson Healthcare, Traverse City, Michigan
| | - John W Entwistle
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shuddhadeb Ray
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
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Sade RM, Carpenter AJ, D'Amico TA, Drake DH, Entwistle JW, Ray S, Tweddell JS. Unethical studies on transplantation in cardiothoracic surgery journals. J Thorac Cardiovasc Surg 2021; 162:1647-1653. [PMID: 34654563 DOI: 10.1016/j.jtcvs.2021.07.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Robert M Sade
- Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC.
| | - Andrea J Carpenter
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Tex
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Daniel H Drake
- Department of Surgery, Munson Healthcare, Traverse City, Mich
| | - John W Entwistle
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Shuddhadeb Ray
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Mo
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
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Rela M, Rammohan A. Why are there so many liver transplants from living donors in Asia and so few in Europe and the US? J Hepatol 2021; 75:975-980. [PMID: 34111504 DOI: 10.1016/j.jhep.2021.05.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
Acceptance of liver transplantation (LT) as an established treatment modality for end-stage liver disease has led to an exponential increase in the demand for organs, resulting in an ever-increasing gap between the availability of organs and the number of sick patients waiting for them. Interestingly, influenced by cultural, socio-economic and other constraints, the West and the East have attempted to address this problem of shortage in different ways. Living donor LT (LDLT) became polarised to the East with over 90% of LT in this region being LDLT. On the other hand, the West chose to concentrate their efforts on optimising the use of cadaveric livers with techniques such as split LT, or by using extended criteria donors (including donation after cardiac death donors) and machine perfusion devices etc. Consequently, LDLT did not find the widespread acceptance it did in the East and hence over 90% of all LT are DDLT in this region. We review each regions' perspective and attempt to provide a globally viable roadmap to bridge the widening gap between the demand and availability of livers for LT.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
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Management of Patients Who Receive an Organ Transplant Abroad and Return Home for Follow-up Care: Recommendations From the Declaration of Istanbul Custodian Group. Transplantation 2018; 102:e2-e9. [PMID: 29019810 DOI: 10.1097/tp.0000000000001963] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eradicating transplant tourism depends on complex solutions that include efforts to progress towards self-sufficiency in transplantation. Meanwhile, professionals and authorities are faced with medical, legal, and ethical problems raised by patients who return home after receiving an organ transplant abroad, particularly when the organ has been obtained through illegitimate means. In 2016, the Declaration of Istanbul Custodian Group convened an international, multidisciplinary workshop in Madrid, Spain, to address these challenges and provide recommendations for the management of these patients, which are presented in this paper. The core recommendations are grounded in the belief that principles of transparency, traceability, and continuity of care applied to patients who receive an organ domestically should also apply to patients who receive an organ abroad. Governments and professionals are urged to ensure that, upon return, patients are promptly referred to a transplant center for evaluation and care, not cover the costs of transplants resulting from organ or human trafficking, register standardized information at official registries on patients who travel for transplantation, promote international exchange of data for traceability, and develop a framework for the notification of identified or suspected cases of transnational transplant-related crimes by health professionals to law enforcement agencies.
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Changing Patterns of Foreigner Transplants in Korea and Overseas Organ Transplants Among Koreans. Transplantation 2018; 102:310-317. [PMID: 28863044 DOI: 10.1097/tp.0000000000001935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to estimate the numbers of foreign patients seeking organ transplantation (OT) in Korea and to examine the relationship between the trend of deceased donors in Korea and number of Korean patients seeking OT overseas since 2000. METHODS Data on foreigners who received a transplant in Korea were obtained from the Korean Network for Organ Sharing. Data on overseas transplants were obtained from 42 transplant centers surveyed through transplant coordinators. RESULTS A total of 336 foreigners underwent OT (kidney transplantation [KT], 174; liver transplantation [LT], 162) in Korea between 2006 and 2016. The Mongolians were the most common foreigners who undergo KTs (32%), followed by the Chinese (18%), Americans (9%), and Emiratis (7%). Among foreigners undergoing LTs, the most common country of origin was Mongolia (39%), followed by United Arab Emirates (23%), China (13%), and the United States (6%). A total of 2206 Korean patients underwent overseas OT (KT, 977; LT, 1229) between 2000 and 2016. In 97% of overseas KT cases (n = 942) and 98% (n = 1205) of overseas LT cases, the transplantations were performed in China. The relationship between the number of deceased donors in Korea and the number of overseas transplants after 2006 indicates a highly negative correlation. (ρ = -0.988, P < 0.001). CONCLUSIONS This analysis of trends in Korean patients seeking OT overseas demonstrates the importance of multilateral approaches to address organ trafficking. National effort to achieve self-sufficiency by increasing activities for organ donations is one of the fundamental solutions to transplant tourism.
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Abstract
Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.
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Ferraz FHRP, Rodrigues CIS, Gatto GC, Sá NMD. Diferenças e desigualdades no acesso a terapia renal substitutiva nos países do BRICS. CIENCIA & SAUDE COLETIVA 2017; 22:2175-2185. [DOI: 10.1590/1413-81232017227.00662017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/28/2016] [Indexed: 02/04/2023] Open
Abstract
Resumo A doença renal terminal (DRT) é um importante problema de saúde pública, sobretudo nos países em desenvolvimento, em vista dos altos recursos econômicos necessários para manutenção dos pacientes nas diversas formas de terapias renais substitutivas (TRS) existentes. O objetivo deste artigo é analisar as diferenças e as desigualdades que envolvem o acesso a TRS nos países que compõem o BRICS (Brasil, Rússia, Índia, China e África do Sul). Estudo aplicado, descritivo, transversal, qualitativo e quantitativo, com análise documental e pesquisa bibliográfica, tendo como fonte de dados censos nacionais e publicações científicas envolvendo o acesso a TRS em tais países. Verificou-se evidências de iniquidade no acesso a TRS em todos os países do BRICS, ausência de censos de diálise e transplante nacionais (Índia), ausência de legislações efetivas que inibam a comercialização de órgãos (Índia e África do Sul) e uso de transplantes de doador falecido de prisioneiros (China). A construção de mecanismos que promovam compartilhamento de benefícios e de solidariedade no campo da cooperação internacional na área da saúde renal passa pelo reconhecimento das questões bioéticas que envolvem o acesso a TRS nos países do BRICS.
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Human rights violations in organ procurement practice in China. BMC Med Ethics 2017; 18:11. [PMID: 28178953 PMCID: PMC5299785 DOI: 10.1186/s12910-017-0169-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 01/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 90% of the organs transplanted in China before 2010 were procured from prisoners. Although Chinese officials announced in December 2014 that the country would completely cease using organs harvested from prisoners, no regulatory adjustments or changes in China's organ donation laws followed. As a result, the use of prisoner organs remains legal in China if consent is obtained. DISCUSSION We have collected and analysed available evidence on human rights violations in the organ procurement practice in China. We demonstrate that the practice not only violates international ethics standards, it is also associated with a large scale neglect of fundamental human rights. This includes organ procurement without consent from prisoners or their families as well as procurement of organs from incompletely executed, still-living prisoners. The human rights critique of these practices will also address the specific situatedness of prisoners, often conditioned and traumatized by a cascade of human rights abuses in judicial structures. CONCLUSION To end the unethical practice and the abuse associated with it, we suggest to inextricably bind the use of human organs procured in the Chinese transplant system to enacting Chinese legislation prohibiting the use of organs from executed prisoners and making explicit rules for law enforcement. Other than that, the international community must cease to abet the continuation of the present system by demanding an authoritative ban on the use of organs from executed Chinese prisoners.
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O'Connell PJ, Ascher N, Delmonico FL. The Transplantation Society Believes a Policy of Engagement Will Facilitate Organ Donation Reform in China. Am J Transplant 2016; 16:3297-3298. [PMID: 27642171 PMCID: PMC5129567 DOI: 10.1111/ajt.14050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P. J. O'Connell
- Department of Renal MedicineUniversity of Sydney Westmead HospitalSydneyAustralia
| | - N. Ascher
- University of California San Francisco School of MedicineSan FranciscoCA
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Trey T, Sharif A, Schwarz A, Fiatarone Singh M, Lavee J. Transplant Medicine in China: Need for Transparency and International Scrutiny Remains. Am J Transplant 2016; 16:3115-3120. [PMID: 27532896 PMCID: PMC5096240 DOI: 10.1111/ajt.14014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 01/25/2023]
Abstract
Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor has the government initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes, and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals.
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Affiliation(s)
- T. Trey
- Doctors Against Forced Organ HarvestingWashingtonDC
| | - A. Sharif
- Doctors Against Forced Organ HarvestingWashingtonDC,Department of Nephrology and TransplantationQueen Elizabeth HospitalBirminghamUnited Kingdom
| | - A. Schwarz
- Independent China researcherMunichGermany
| | - M. Fiatarone Singh
- Doctors Against Forced Organ HarvestingWashingtonDC,Exercise, Health and PerformanceFaculty of Health Sciences and Sydney Medical SchoolUniversity of SydneySydneyAustralia
| | - J. Lavee
- Doctors Against Forced Organ HarvestingWashingtonDC,Heart Transplantation UnitDepartment of Cardiac SurgerySheba Medical Center and the Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Sharif A, Trey T, Schwarz A, Fiatarone Singh M, Lavee J. Truth and Transparency. Am J Transplant 2016; 16:3299-3300. [PMID: 27737501 DOI: 10.1111/ajt.14072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK. .,Doctors Against Forced Organ Harvesting, Washington, DC.
| | - T Trey
- Doctors Against Forced Organ Harvesting, Washington, DC
| | - A Schwarz
- Independent China scholar, Munich, Germany
| | - M Fiatarone Singh
- Doctors Against Forced Organ Harvesting, Washington, DC.,Exercise, Health and Rehabilitation, Faculty of Health Sciences and Sydney Medical School, University of Sydney, Sydney, Australia
| | - J Lavee
- Doctors Against Forced Organ Harvesting, Washington, DC.,Heart Transplantation Unit, Department of Cardiac Surgery, Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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