Başkent Üniversitesi Makaleler
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Item Patients Seeking Liver Transplant Turn to China: Outcomes of 15 Egyptian Patients Who Went to China for a Deceased-Donor Liver Transplant(Başkent Üniversitesi, 2008-09) Abdeldayem, Hesham M.; Helmy, Amr; El Ella, Khaled Abo; Gabal, Ashraf Abo; Gameel, Khaled; Soliman, Sayed; Salama, IbrahimObjectives: Increasing numbers of Egyptians with end-stage liver disease seek liver transplants in China because of lower costs and shorter wait times. We evaluated outcomes of Egyptian patients who underwent liver transplants in China and address ethical concerns. Material and Methods: Fifteen Egyptian patients (11 men, 4 women; mean age, 52 years) who underwent liver transplants in China were included. Preoperative data before traveling to China, reports from China, and follow-up data upon return were reviewed. Results: Indications included hepatitis-C–related liver cirrhosis (n=9), hepatitis-C–related liver cirrhosis with hepatocellular carcinoma (n=4), and hepatitis-B–related liver cirrhosis (n=2). Nine patients were evaluated for living-related liver transplant but none of their potential donors was suitable. Three patients had advanced hepatocellular carcinoma and were not accepted for living-related liver transplant by any Egyptian center. Two patients had no living-related donor. One patient refused a living-related liver transplant in Egypt and elected to get a whole liver graft from China. Overall survival rate was 80.0% at 6 months and 73.3% at 12 months. There were 4 deaths; 2 occurred in China. Of the 11 surviving patients, 9 (82%) developed complications. Nineteen complications were seen in the 13 patients who were managed after returning from China. Major complications necessitating prolonged hospitalizations occurred in 4 patients. Two patients required further laparotomy. Conclusions: Although deceased-donor liver transplant in China could be an option for Egyptian patients with end-stage liver disease, patients and clinicians should be aware of potential outcomes and related ethical issues.Item Ethical Aspects of Organ Donation Activities(Başkent Üniversitesi, 2007-12)Renal transplant remains the treatment of choice for patients with end-stage renal disease. Human organs can be harvested from 2 main sources: living and deceased donors. Preference should be given to deceased-donor transplants since they represent the only source of organs for several nonrenal solid-organ transplants and the only modality where there is no risk to the donor. Unfortunately, even the most well-developed deceased-donor program (eg, the Spanish program) can barely cover 50% of its waiting list because the demand for deceased-donor organs far exceeds supply. The success of transplant surgery has created a waiting list dilemma. Despite all efforts, deceased-donor donation cannot meet current needs and therefore, living donation demands serious consideration. This is supported by the fact that the risk to live donors is minimal, graft survival is significantly better than that of deceased-donor kidneys regardless of HLA matching, and professional ethical philosophers have fewer difficulties with voluntary living donations than with the removal of an organ from a cadaver. This is especially true in our region. Living-related donation has always been acceptable ethically. It is, however, limited by the number of willing and qualified donors, the high incidence of familial renal diseases, and donor coercion (especially in our area). Living-unrelated donation increases the availability of donors, decreases the chances of coercion, and eliminates the problem of consanguinity. It raises, however, the ethical issues of commercialism, transplant tourism, and organ trafficking. The arguments for and against living-unrelated donation are innumerable. They have been the subject of several international forums and have raised endless discussions. We have set long ago a series of rules and regulations that are in close agreement with the recent Amsterdam and Kuwait resolutions. We have been continually modifying them over the last 15 years to try to implement our ideal, which is to protect the interest of the living donor and avoid commercialism.Item CanlI Organ Vericili Böbrek TransplantasyonlarInda Etik Sorunlar(Başkent Üniversitesi, 2004-09) F. F. ErsoyEtik sözlük anlamı olarak doğru ve yanlışların sınıflandırılmaları, savunulmaları ve tavsiye edilmeleri anlamına gelmektedir. Doğal olarak doğrular ve yanlışlar ülkeler, farklı dinler, farklı ekonomik şartlar ya da politik durumlar nedeni ile farklı algılanabilirler ve değişebilirler. Organ nakli etiğinin de bu anlamda ülkelere ve şartlara göre oluşturulması ve uygulanması gerekir. Ülkemizde mevcut organ açlığı göz önünde tutulduğunda halen kim tarafından ve nasıl oluşturulacağı çok da açık olmayan organ nakli etiğimizin daha toleranslı bir temelde ve hem verici, hem alıcının çıkarları hem de çağdaş hukuk prensiplerinin paralelinde oluşturulması uygun olacaktır. Ethics of Living-Related Organ Transplantation in Turkey Ethics refers to moral principles, a person’s sense of what is right and wrong. Ethics can differ relative to country, religion, economic conditions, and governmental policies. In general, ethics related to organ transplantation should be based on and practiced in harmony with factors and conditions that are specific to each country. There is a severe shortage of transplantable organs in Turkey, and ethics linked to organ transplantation in this country must take into account patient demands, donor rights, and the principles of modern law.