2009). The susceptibility is highest is the first month of the transplantation and decreases afterwards. it, however, remains high even after 12 following. Susceptibility is highest among kidney recipients who are more likely to develop the infection 12 months after the transplantation. They have a lower mortality rate than liver transplant recipients. The study also reflected a trend in increasing antimicrobial resistance among these susceptible recipients. The E-coli strain was shown to be the most common organism, which caused the gram-negative bloodstream infection after an organ transplant. The organism was also shown to be found most frequently in the urinary tract, which is the main source of bacteremia (Al_Hasan et al.).
Developing Tolerance to Transplants
Progress in transplant immunology in the past half of a century has been slower than expected (Lechler et al. 2005). Tolerance towards a foreign organ has been intentionally induced through non-myeloablative mixed chimerism induction in a few patients. There have been much information on immunology and new available tools to understand human allograft responses. But a single drug for tolerance is unlikely. A multifaceted approach, instead, will be a better approach in studying mechanisms in rat models, non-human primates and humans. Tolerance may develop in response to disease and treatment. The complex issue requires large studies and systems-based approach to information. Therapies must focus on the interaction between genetic and environmental factors in every individual (Lechler et al.).
Large studies combined with a systems-based approach to data interpretation may be needed to address this complex issue, with an ultimate goal to match therapies with the intricate interplay of genetic and environmental factors unique to each individual.
Opt-Out System "Abhorrent"
The Church of Scotland's Life and Work Magazine commented against too much interference by the government and the disrespect shown to the human body (Duffy 2008). Its editor, Muriel Armstrong, deplored the "Orwellian undertones" by which organ donation has been treated. She viewed the principle as abhorrent and that the crisis should be handled much better by the generosity of spirit than by government interference. Cardinal Keith O'Brien, a donor card holder for 14 years, described organ donation as a "noble and meritorious act." But he felt it morally wrong to presume that a deceased person would have wanted any of his organs removed from his body if he was unable to explicitly declare so. Cardinal O'Brien stressed that organ transplant must be performed promptly after death, as its success depends on the freshness of the organ. But the person should not be declared dead or his death hastened for the purpose of using or removing his organ. While the Church of Scotland has no express view on the issue, it saw organ donation as something praiseworthy (Duffy).
The Church and the magazine shared the view that organ donation was an individual choice (Duffy 2008). That choice exists under the current system. It does not confer ownership of the body to the state but makes it easier for people to indicate their choice or decision. Scotland has the lowest organ donation in Europe. In addressing the situation, a campaign was launched, urging the people to sign up as donors. Health Secretary Nicola Sturgeon said the Scottish government would pursue the recommendations of the task force in increasing the rate of organ donations by 50%. The Members of Parliament failed to replace the current law in 2006 but support for a change had been gathering force since then.
No to a Change in the Current System
British Health Minister Rosie Winterton rejected the call to replace the current opting-in system in organ donation with opting out (Transplant News 2004). The British Medical Association made the call and urged to incorporate the change into the Human Tissue Bill. The Minister said that no evidence existed that presumed consent would increase the number of organs for transplantation. Drawing from the experience of Spain, which enjoys the highest number of donations in the world, she pointed to assigning someone to identify possible donors as the most effective approach to increase donations. Furthermore, she stressed the premise of the Human Tissue Bill of obtaining consent from the living or after death. Audit reports of British hospital intensive care units the previous year revealed that 49% of the relatives of deceased patients, whose organs could have been used, denied permission (Transplant News).
Public Reaction to Ruling
Records say there are more than 8,000 patients waiting for a transplant in the UK
(Doughty 2008). Of this number, 1,000 will die every year unless a suitable donor is found. This will remain with the recent rejection of a call for a system of presumed consent. The UK Organ Donation Taskforce did not find sufficient evidence that it would increase the number of available organs for transplantation. This decision angered some patients in Tyneside whose lives were extended by organ donations. Under presumed consent, the person is presumed to have willed to offer his body organs for donation after his death if he did not opt out. Those who register as organ donors have a donor card (Doughty).
One apprehension about presumed consent was that it might erode public trust in healthcare professionals who could deliberately reduce organ donation rates (Doughty 2008). Some might think that the care of their loved ones would be affected by the pressing need for a transplant. About 16 million patients are listed in the organ donor register. The majority of people feel that despite a diversity of opinions, one should save or change another person's life when he can (Doughty). #
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