,ORGAN,TRANSPLANT,The first successful living-related kidney transplant at Brigham Hospital in Boston: A kidney was transplanted from Ronald Herrick into his identical twin, Richard.,Uniform Anatomical Gift Act establishes the Uniform Donor Card as a legal document for anyone 18 years of age or older to legally donate his or her organs upon death.,UNOS was incorporated as an independent, non-profit organization, committed to saving lives through uniting and supporting the efforts of donation and transplantation professionals,UNOS launches UNetsm, a secure, Internet-based transplant information database system for all organ matching and management of transplant data.,UNOS launches DonorNetsm, a secure, Internet-based system in which organ procurement coordinators send out offers of newly donated organs to transplant hospitals with compatible candidates.,1954,1968,1984,1999,2006,How organs are matched,The first step,Geography plays a part,The right-sized organ,Before an organ is allocated, all transplant candidates on the waiting list that are incompatible with the donor because of blood type, height, weight and other medical factors are automatically screened from any potential matches. Then, UNOS computer system determines the order that the other candidates will receive offers.,There are 58 local donor service areas and 11 UNOS regions that are used for U.S. organ allocation. Hearts and lungs have less time to be transplanted, so we use a radius from the donor hospital instead of regions when allocating those organs.,Proper organ size is critical to a successful transplant, which means that children often respond better to child-sized organs. Although pediatric candidates have their own unique scoring system, children essentially are first in line for other childrens organs.,General nephrologyAllocation of resources: individual versus populationAcute renal failure- when is it futile to continueClinical and molecular diagnosis of inherited disorders DialysisESDR treatment in an unequal world TransplantationSource of donor organsAnencephalic babiesLiving donors-paid-unpaid-coercion-minorsExecuted prisonersPatients in a persistent vegetative stateEquitable distribution of organs,Cadavers Donations,Dead role,2,Executed Prisoner,1,Living Donations,nondirected donation,2,directed donation to a stranger,3,directed donation to a loved one or friend,1,race, religion, and ethnic group,4,CASE,Both parents of a child who was dying of respiratory failure insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life.,With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced.,directed donation to a loved one or friend,Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves.,Physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large.,CASE,A man who seemed pathologically obsessed with giving away everything, from his money to his organs, saying that doing so was “as much a necessity as food, water, and air.” After donating one kidney to a stranger, he wondered how he might give away all his other organs in a dramatic suicide.,The radical altruism that motivates a person to make a potentially life-threatening sacrifice for a stranger calls for careful scrutiny.,nondirected donation,Other psychologically suspect motivations need to be ruled out as well. Is the person trying to compensate for depression or low self-esteem, seeking media attention.,CASE,1.the family of a brain-dead Florida man agreed to donate his organs but insisted that because of the mans racist beliefs, the recipients must be white.2. A Jewish man in New York learned of a Jewish child in Los Angeles who needed a kidney transplant. The man wanted to help someone of his own faith and decided he was willing to donate a kidney to help this particular child.,1.Although the organs were allocated accordingly, Florida subsequently passed a law prohibiting patients or families from placing such restrictions on donation.,race, religion, and ethnic group,2.One might view the donation as permissible, since at least some patients would benefit (the child would receive a kidney, and those below her on the waiting list would move up one notch) and no one would be harmed,those above the girl on the waiting list would not receive the kidney under any circumstances, because the man would not give it to them.,Whether directed donation to strangers violates standards of fairness is thus controversial. But if it is permitted, it will be very difficult to prohibit discriminatory preferences, since donors can simply specify that the organ must go to a particular person, without saying why,Some argue that just as we have a right to donate to the political parties and charities of our choice, so should we be able to choose to whom to give our organs. In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs rather than those most in need.,