Başkent Üniversitesi Makaleler
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Item Moral and Ethical Issues in Living-Donor Liver Transplant in Egypt(Başkent Üniversitesi, 2009-03) Adawy, Nermine M.; Helmy, Amr; Abdeldayem, Hesham M.; Allam, Naglaa A.; Salah, Essam; Aziz, Amr Mostafa; Kashkoush, Samy; Gad, HishamObjectives: Since brain-death criteria are not accepted in Egypt, only organs acquired from living donors can be used for transplant. Our objective was to highlight the ethical issues raised by living-donor liver transplant. Materials and Methods: The study was conducted by reviewing publications from centers performing living-donor liver transplant in Egypt and by consulting with a group of experts in the fields of liver transplantation, clinical ethics, and religious scholarship. Results: The first successful living-donor liver transplant in Egypt was performed at the National Liver Institute in 1991; however, this program did not continue because of poor early results. In August 2002, transplants began at Dar-Al-Foaud Hospital; since then, almost 500 cases of living-donor liver transplant have been performed at 9 centers. Although the donor risk is estimated to be low, 2 donors died (0.4%). The ethical principle that best applies to living-donor liver transplant is primum non nocere (first, not to harm), as the donor derives emotional benefit from donation and the opportunity to save a life. It is important to stress that the alternative to living-donor liver transplant in Egypt is not deceased-donor liver transplant. There are no doubts that this is a beneficial procedure for the recipient with acceptable risks to the donor. Conclusions: It is ethically appropriate to perform liver transplant using living donors.Item Cytomegalovirus Disease in Renal Transplant Recipients: An Iranian Experience(Başkent Üniversitesi, 2008-06) Nemati, Eghlim; Einollahi, Behzad; Pourfarziani, Vahid; Taheri, SaeedBackground: Cytomegalovirus is considered the most important infectious cause of mortality and morbidity in organ transplant recipients. In the current study, we evaluate the potential impact of cytomegalovirus infection and cytomegalovirus disease on the outcomes of renal allograft recipients under different conditions. Materials and Methods: We retrospectively analyzed the data from 48 renal transplant recipients who had undergone a transplant at the Baqiyatallah Hospital in Tehran, Iran, between 1984 and 2007. We included all patients with valid laboratory test results for cytomegalovirus infection. Values for P less than .05 were considered statistically significant. Results: Overall, 48 patients (2.1%) were documented as developing cytomegalovirus disease. From these, 1 patient (2%) died, and 3 (6%) lost their allograft function. Compared with mycophenolic-acid–based triple immunosuppressive therapy, azathioprine was less likely to induce cytomegalovirus disease and also promised better survival (P < .0001 and P < .001). Being negative for the anti-cytomegalovirus IgG antibody and receiving an allograft from a positive donor also were associated with cytomegalovirus disease development and poorer patient survival (P = .03 and P < .0001). Conclusions: Cytomegalovirus infection induces unfavorable outcomes in renal allograft recipients, especially when the infection occurs early on in the posttransplant phase. We suggest close monitoring of cytomegalovirus-positive patients and the use of less-intensive immunosuppressive treatments. Future prospective studies seem necessary.Item Interleukin-10 Gene Polymorphism in Bone Marrow Transplant Recipients(Başkent Üniversitesi, 2008-03) Azarpira, Negar; Geramizadeh, Bita; Darai, Masumeh; Aghdaie, Mahdokht Hossein; Ramzi, ManiObjectives: Graft-versus-host disease is the main complication after hematopoietic stem cell transplant, occurring even after donor and recipient human leukocyte antigen matching, apparently because of donor/recipient minor histocompatibility antigen mismatches and cytokine polymorphisms. Interleukin-10 suppresses several activities of the immune response by inhibiting T helper 1 and T helper 2 cells. These properties suggest that interleukin-10 could act as a suppressive mediator and prevent graft-versus-host disease. This study evaluates the association between the interleukin-10 promoter gene polymorphism and transplant outcomes among 18 recipients of cytokine-mobilized peripheral blood stem cells from human leukocyte antigen-matched sibling donors. Materials and Methods: We analyzed 3 single-nucleotide polymorphisms in the proximal region of the interleukin-10 promoter gene (-1082/-819/-592) by the amplification refractory mutation system and polymerase chain reaction-restriction fragment length polymorphism methods. Eighteen donors and their recipients who had undergone an allogeneic peripheral blood stem cell transplant at the Bone Marrow Transplant Center in Nemazi Hospital (Shiraz, Southern Iran) between September 2005 and September 2006 were enrolled. Results: The GCC haplotype (1082*G/819*C/592*C) was predominant in both the donor and the recipient, but no significant correlations were present between the GCC haplotype in either the donor or the recipient and the risk of acute graft-versus-host disease (P = .56). Conclusions: The interleukin-10 promoter gene polymorphism was found not to be associated with acute graft-versus-host disease in patients after an allogeneic peripheral blood stem cell transplant from human leukocyte antigen-matched sibling donors. Additional studies with larger samples are necessary to further define the influence of interleukin-10 on the immune response after bone marrow transplant.Item Horseshoe Kidney for Transplant: Report of 3 Cases(Başkent Üniversitesi, 2007-12) Dinckan, Ayhan; Demirbas, Alper; Tuncer, Murat; Erdogan, Okan; Gurkan, Alihan; Kocak, Huseyin; Turkyilmaz, Serdar; Tekin, AhmetOwing to the limited donor pool at transplant centers, grafts may be taken from marginal donors with congenital abnormalities, one of the most common of which is a fusion abnormality. Horseshoe kidneys may be transplanted to a single recipient en bloc or to 2 recipients after division. In our clinic, 3 grafts (1 obtained from a living donor and 2 from a deceased donor) were successfully transplanted to 3 patients. In select patients, horseshoe kidneys may be used for transplant.Item Donör Hastaneleri Eğitim Programı(Başkent Üniversitesi, 2005-01) İ. Tokalak; H. Karakayalı; R. Erdal; M. HaberalTüm dünyada organ ve doku bağışını dolayısıyla da nakil sayılarını arttırabilmenin ilk yolu, toplumun her kesimini organ ve doku bağışı ve nakli hakkında bilgilendirmek ve verilen bu bilgilerin sürekliliğini ve güncelliğini de sağlayabilmektir. Tüm sağlık çalışanları organ bağışında, özellikle kadavradan yapılacak olan bağış sürecinde anahtar rol üstlenmektedir. Ancak bu sektörün profesyonellerinin bu konudaki ciddi bilgi açığı, tüm sağlık çalışanlarını ve toplumun her kesimini olumsuz yönde etkilemiştir. Tüm dünyada, oluşan bu olumsuz durumun düzeltilebilmesi ve öncelikle sağlık çalışanlarının bilgi açığının kapatılmasının tüm toplumu olumlu yönde etkileyeceği gerçeğinden yola çıkılarak uluslararası ve ulusal gereksinimlere göre eğitim programları oluşturulmaya başlanmıştır. Bu programlardan en önemlileri Avrupa Donör Hastaneleri Eğitim Programı (European Donor Hospital Education Programme-EDHEP), sağlık çalışanlarının eğitimi için ileri bir model olarak geliştirilen eğitim programı (Donor Action-DA) ve Transplant Koordinatörleri Eğitim Programı (The Transplant Procurement Management Course-TPM)’dır. Aynı gereksinim ülkemiz için de geçerlidir. Bu yüzden de ülkemizin bir modeli olabileceğini düşündüğümüz doku ve organ kaynağı ve nakli merkezlerinde çalışan tüm personelin bilgi düzeyini artırmaya yönelik Donör Hastaneleri Eğitim Programı planlanmıştır. Oluşturulan bu eğitim programı donör hastanesi ve transplantasyon merkezi bulunan tüm illere yayılmalı ve sağlık çalışanlarında konu ile ilgili bilincin oluşturulması temel amaç olmalıdır. Sağlık çalışanlarının transplantasyon ile ilgili bilgilerini artırmak, transplantasyon çalışmalarını geliştirmenin, organ bağış ve donör temini çalışmalarına büyük bir tutarlılık ve standart getirmenin bir yoludur. Bu örnek eğitim programı, gelecekte ülkemizdeki transplantasyon ile ilgilenen donör kaynağı ya da transplantasyon merkezi olan tüm sağlık kurumlarında “Türkiye Donör Hastaneleri Eğitim Programı-TÜDHEP” olarak uygulanacak eğitim programına bir model oluşturabilecektir. Donor Hospital Education Program The first step toward increasing rates of tissue and organ donation (and transplantation activities) is through public education and maintenance of this information. Healthcare professionals play a critical role in this education, especially regarding cadaveric donation. Without the sharing of their knowledge, information gaps and discontinuity in procedures and techniques among the professional community will continue that will adversely affect the attitudes and policies of other healthcare professionals as well as the lay public. To eliminate this information gap and the lack of standard procedures and techniques, many countries sought to improve their educational programs according to national and international needs. Some of the most important examples of this include the European Donor Hospital Education Programme, Donor Action, and the Transplant Procurement Management Course. A similar program is needed for Turkey. We propose a nationwide Donor Hospital Education Program to improve the knowledge base of all healthcare professionals working in donor and transplant centers in Turkey and to standardize procedures and techniques among the profession. Improving the level of knowledge among healthcare professionals is the best way to improve transplantation activities and standardize the donation process. This educational program may be the model for all donor and transplant centers in Turkey implementing the Turkish Donor Hospital Education Program (TUDHEP).Item Akraba Olmayan Canlı Vericili Böbrek Nakli(Başkent Üniversitesi, 2004-01) G. AltacaAmaç: Bu inceleme yazısında akraba olmayan canlı vericili böbrek nakillerinde medikal ve etik sorunlar araştırılmıştır. Materyal ve Metod: Ulusal ve uluslar arası yayınlar, transplantasyonla ilgili resmi Internet siteleri ve uluslar arası resmi kuruluşların Internet siteleri incelenmiştir. Sonuçlar: Organ bekleme listelerindeki alıcı sayısının sürekli artması ve belirli zamanda yeteri kadar organ bulunamaması, canlı verici havuzunun genişletilmesini gündeme getirmiştir. Bu eğilim, tüm dünyada genellikle kanunlarca yasaklanmış olmasına karşın yapılmakta olan satılık organlı nakillerden farklı olarak bir organizasyon çatısı altında akraba olmayan canlı vericilerin sayısını arttırmaya yöneliktir. Yayınlarda genellikle akraba olmayan canlı vericili nakillerde greft sağ kalımının canlı akraba vericili nakillerle ve duygusal ilişkili vericili nakillerle karşılaştırılabilir olduğu, kadavra nakillerden ise yüksek bulunduğu bildirilmiştir. Bu tür nakiller ticari olarak yapıldığında fırsatçı ve yayılım gösteren enfeksiyonlar yüksek oranlarda görülmektedir. Bağışçının otonomisi ve hayırseverliği akraba olmayan canlı vericili nakillerde en önemli etik konulardan biridir. Bazı ülkelerde akraba olmayan canlı vericilerin ameliyattan sonra hemen hiç izlenmediği ileri sürülmüştür. Bu tür nakillerde ticaretin ve sömürünün önlenmesi için verici bilgi bankaları kurulması gerekmektedir. Akraba olsun ya da olmasın tüm canlı nakillerde bağımsız bir etik komite tarafından vericinin otonomisi değerlendirilmeli ve vericilerin ameliyat sonrası takibi denetlenmelidir. Bazı ülkelerde organ bağışını arttırmak üzere vericiye ahlaki ve mali geri kazanımlar sağlanmasına ve aynı zamanda ticaretin ve sömürünün engellenmesine yönelik yasalar ve merkezi organizasyonlarla birbirini hiç tanımayan kişiler arasında organ nakli gerçekleştirilmektedir. Ayrıca iyi planlanmış ve sürekli denetlenen ticari böbrek transplantlarının tüm dezavantajlarına karşın organ bulunması için tek çözüm olduğunu savunan yazarlar da mevcuttur. Yorum: Nakil için gerekli organ kaynaklarının kıtlığı sürdükçe transplantasyon etik tartışmalara zemin hazırlayan bir alan olmaya devam edecektir. Kadavra organ nakillerinin yeterli sayıya ulaşmadığı ülkemizde ise kadavra organ sayısının arttırılması için çalışmaların hızlandırılması gerekmektedir. Bu arada, ülkemizde yasal olan akraba olmayan canlı vericili nakillerde hastaların, potansiyel vericilerin, hekim ve sağlık personelinin ticaret ve sömürüye alet edilmemesi için yeni yasal düzenlemelere gereksinim bulunmaktadır. Kidney Transplantation with Living-Unrelated Donors Objective: Medical and bioethical problems in livingunrelated kidney transplantation are discussed. Materials and Methods: Medical literature and official Internet pages of transplant organizations and international organizations were searched. Results: Increasing numbers of patients on wait lists and the low rate of deceased organ donation have sparked efforts to expand living organ donation. One way to increase the organ pool is to use living-unrelated donor organs within an organized/legislated system; that is, a person donates an organ and a patient receives that organ according to the rules of the system, similar to deceased organ sharing. This is totally different from commercial transplantation, which is widespread even though it is criminal in many countries. Rates of graft survival for living-unrelated kidney transplants are similar to those for living-related renal grafts, and are higher than the rates for cadaver-kidney grafts. Full autonomy and altruism of the donor is one of the most important issues in living-unrelated kidney transplantation. In some nations where these procedures occur, there is almost no follow-up of living-unrelated donors. When any form of live donation is practiced, an independent ethics committee should be in place to ensure the autonomy of donors and supervise the followup of these individuals. In some countries that have enacted laws to expand live organ donation, donors are offered financial benefits. Where such legislation has been approved, it has become possible to perform transplantation between persons who are completely unrelated, but also prevent commercialism and exploitation. Despite the potential and known disadvantages of commercial transplantation, some authors believe that well-organized, well-supervised programs of this type are the only way to increase organ donation and treat the large numbers of patients on waiting lists. Conclusion: The increasing demand for donor kidneys and the small number of available organs means that many aspects of transplantation will remain ethical debates. In all countries where the annual number of deceased organ transplantations is low, urgent initiatives should be taken to increase this type of donation. However, to ensure safety, new legislation is needed to prevent patients, potential donors, doctors and other health workers from being exploited by others through commercialization of this practice.