Browsing by Author "Papalois, Vassilios E."

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Ethical Issues in Live Donor Kidney Transplant: Views of Medical and Nursing Staff
(Başkent Üniversitesi, 2009-03) Mazaris, Evangelos M.; Papalois, Vassilios E.; Warrens, Anthony N.
Objectives: The ongoing development of live donor kidney transplant has generated many ethical dilemmas. It is important to be aware of the attitudes of transplant professionals involved in this practice. Materials and Methods: An anonymous and confidential questionnaire was sent to 236 members of the medical and nursing staff of the West London Renal and Transplant Centre, to assess their views on the ethics of the current practice of live donor kidney transplant. Results: Of the 236 questionnaires, 108 (45.8%) were returned. Respondents considered live donor kidney transplant ethically acceptable between blood relatives (100%), nonblood relatives and friends (92.6%), and strangers (47.2%). Most respondents were willing to donate a kidney to a blood relative (92.6%) or a nonblood relative or friend (81.5%), and 12.0% were willing to donate to a stranger. Considering themselves as potential recipients if they had end-stage renal disease, most would accept a kidney from a blood relative (91.7%) or nonblood relative or friend (85.2%), while 44.5% would accept a kidney from a stranger. The highest number of respondents (43.5%) believed that the recipient should approach the potential donor. About one-third believed there should be no financial reward, not even compensation for expenses, for donors; 8% favored direct financial rewards for donors known to recipients, and 18% favored rewards for donors not known to recipients. Slightly more than half were in favor of accepting donors with mild to moderate medical problems. Conclusions: Live related and unrelated kidney donation are considered ethically acceptable procedures, and non-directed donation is gaining support among transplant professionals. A substantial minority favored direct financial rewards for donors, especially in the case of non-directed donation.
Ethical Issues in Living Donor Kidney Transplantation
(Başkent Üniversitesi, 2006-12) Mazaris, Evangelos; Papalois, Vassilios E.
The ethical issues of living donor kidney transplantation, which is the treatment of choice for patients with end-stage renal failure, are the focus of intense debate. Some of those issues are related to the safety of the operation for the donor, and others are related to the motivation of the donor, the approach to and evaluation of the donor, donation by strangers, the commercialization of donation, surrogate consent for donation, and the acceptance of minors as donors. The lack of clear consensus regarding these issues results in differences in practice, not only among countries but also among transplant centers. We believe that after an open debate, agreement on certain generally accepted principles can be achieved. Such an agreement would protect potential donors and recipients and would ensure the future of living donor kidney transplantation.
Hepatocyte Transplantation: A Review of Worldwide Clinical Developments and Experiences
(Başkent Üniversitesi, 2005-06) Mazaris, Evangelos M.; Roussos, Christos Th.; Papalois, Vassilios E.
Hepatocyte transplantation is a promising treatment for several liver diseases and can also be used as a “bridge” to liver transplantation in cases of liver failure. Although the first animal experiments with this technique began in 1967, it was first applied in humans in 1992. Clearly, the most important advantage of this treatment, compared with liver transplantation, is its simplicity, since no surgery is required for implantation of the cells. Much work has been done over the years to maximize the number of viable hepatocytes that can be isolated from a liver, to prepare the cells prior to transplantation so that the outcome will be more successful, and to identify the optimal site for implantation. We review these efforts along with the worldwide clinical experience with hepatocyte transplantation during the last 13 years.
The Effect of Machine Perfusion on the Arteries of Porcine Kidneys
(Başkent Üniversitesi, 2005-12) Peerlinck, Inge D L.; Barlas, Alexander; Karameris, Andreas; Papalois, Vassilios E.
Objectives: Machine perfusion is an excellent method of assessing the viability of a kidney graft and can also potentially improve the quality of an equivocal kidney. Several authors have expressed concerns that machine perfusion can potentially damage the vessels of the kidney but until now, no studies have been performed to clarify this issue. We aimed to examine the effect of machine perfusion on the renal arteries of porcine kidneys. Materials and Methods: Eight pairs of kidneys were removed from pigs in the abattoir. One kidney of each pair was preserved on ice for 24 hours. The other kidney from the same animal was initially stored on ice until arrival at the laboratory when it was perfused on the RM3 machine for 4 hours and then stored again on ice for the remainder of the 24 hours. After 24 hours, since the retrieval and initial storage on ice at the abattoir, tissue samples were obtained from all renal arteries at 3 different sites. These samples were sent for histologic evaluation. Results: Machine perfusion caused more damage at a statistically significant level compared with simple cold storage only for the first sample site, which was the part of the renal artery closest to the perfusion cannula. Conclusions: Our experiments suggest that machine perfusion, even when it is done lege artis, can damage the part of the renal artery closest to the adaptor, which can potentially result in a higher incidence of posttransplant arterial thrombosis. Therefore, excision of the first part of the renal artery should be considered prior to transplantation, and modifications of the perfusion technique must be developed to minimize damage to the renal arteries.