Transplantation for the General Surgeon: History of Transplantation, End-organ Disease, Organ Donation and Allocation, and Transplantation Regulation and Ethics

This chapter provides a glimpse of the complex regulatory, financial, ethical, and procedural aspects of transplantation. The general surgeon should appreciate the evolution of the field as seen through a brief review of its history as well as its evolving self-governance as manifested through national policies. Knowledge of the process of organ donation is important for any practitioner as is an understanding of the burden of end-organ disease. This review contains 2 figures, 1 table and references. Key Words: brain death, donation after cardiac death, epidemiology and costs of end-organ disease, history of immunosuppression, history of transplantation, living donation, organ allocation, organ donation, transplantation ethics, transplantation regulation

Transplantation Ethics and Policy

Addressing all of the ethical and policy challenges in the field of organ transplantation is a daunting task for a short review. Rather than focusing on each issue, this review starts with a discussion of the underlying ethical principles that drive transplantation ethics and proceeds to address a few of the important ethical challenges in transplantation, recognizing that it is not a comprehensive overview of every issue. Just as policy should follow the underlying ethical principles, the second part of the review addresses policy development and implementation in the United States and selected challenges worldwide. Of note, this review covers underlying ethical principles, the dead donor rule, the allocation of scarce resources, organ allocation, deceased organ donors, living organ donors, speculation for the future, and transplantation policies. This review contains 15 references.