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The gift of life. Ethical problems and policies in obtaining and distributing organs for transplantation
173 Supply and distribution of hearts for transplantation: Legal, ethical and policy issues Robertson, J.A. School of Law, University of Texas at Austin, Austin, TX 78705, U.S.A. Circulation 75/l (1987) 77-87 Once considered experimental, transplantation for end-stage cardiac disease has now achieved accepted status. Survival rates of 70% to 80% for one year and 50% for five years are routine. Medicare has announced that it will cover heart transplants at selected centers. Many public and private insurers already extend this coverage. As heart transplantation matures medically, a second generation of ethical and policy issues demands attention. The concerns about safety and efficacy, which led to a moratorium of the procedure in the 1970s. have given way to questions about increasing organ supply and developing fair systems for allocating and distributing the hearts that become available. While these questions are typical of later stages of biotechnological development, they present a new challenge to further progress in cardiac transplantation.
The gift of life. Ethical problems and policies in obtaining and distributing organs for transplantation Childress, J.F. Department of Religious Studies, Cocke Hall, University of Virginia, Charlottesville, VA 22903, U.S.A. Crit. Cure Clin. 2/l (1986) 133-148 Several transplanted organs and tissues can increase a recipient’s changes of survival or improve a recipient’s quality of life, yet the supply of organs and tissues is inadequate to meet the need and demand for transplantation. Enough cadaveric organs exist, but society has not yet found an effective, efficient and morally acceptable way to obtain them.
Why are cadaveric renal transplants so hard to find in Japan? An analysis of economic and attitudinal aspects Ohi, G., Hasegawa, T., Kumano, H. et al. Department of Environmental and Community Medicine, Teikyo University School of Medicine, Kaga. Itabashi-ku, Tokyo 173, Japan. Health Policy, Educ. Health Serv. Deliv. Regal. 6/3 (1986) 269-278 In view of the fact that in Japan treatment of end-stage renal disease depends disproportionately heavily on hemodialysis and almost negligibly on transplants from cadaveric donors (hemodialysis 44.4/100000 per year; renal transplants 0-31/100009 per year; cadaveric renal transplants 0.11/100000 per year (1983 data)), we analysed the cost-effectiveness of hemodialysis and renal transplantation, predicted economic gains under expected changes in variables and described attitudes of the Japanese hampering cadaveric renal transplantation. Adjusted life expectancy of transplant recipients (live and cadaveric combined) under the current technical conditions is longer than that of those on hemodialysis (18.3 vs. 14.7 years) and the cost per year for maintaining the transplant is approximately one third of hemodialysis ($12,000 vs. $32,000). If the proportion of cadaveric transplant recipients would increase to the levels of the USA (hemodialysis 30.8/100000; transplants 2.6/100 000 per year; cadaveric transplant 1.9/100 000 per year (1983 data)) along with improvement in graft survival rate, the life expectancy for transplant recipients in Japan could increase by two years, thus reducing the annual cost even further. The current number of patients starting hemodialysis (11500 cases per year) coupled with their life expectancy predicts the number of patients on hemodialysis to reach equilibrium at around 174000 in a decade (Japanese population 110 million). Based on current price, their annual cost will be about 5.3 billion dollars. Medical expenditure of this magnitude for such a small fraction of people is expected to become an increasingly strong economic incentive for cadaveric renal transplantation.
The gift of life. Ethical problems and policies in obtaining and distributing organs for transplantation Childress, J.F. Department of Religious Studies, Cocke Hall, University of Virginia, Charlottesville, VA 22903, U.S.A. Crit. Cure Clin. 2/l (1986) 133-148 Several transplanted organs and tissues can increase a recipient’s changes of survival or improve a recipient’s quality of life, yet the supply of organs and tissues is inadequate to meet the need and demand for transplantation. Enough cadaveric organs exist, but society has not yet found an effective, efficient and morally acceptable way to obtain them.
Why are cadaveric renal transplants so hard to find in Japan? An analysis of economic and attitudinal aspects Ohi, G., Hasegawa, T., Kumano, H. et al. Department of Environmental and Community Medicine, Teikyo University School of Medicine, Kaga. Itabashi-ku, Tokyo 173, Japan. Health Policy, Educ. Health Serv. Deliv. Regal. 6/3 (1986) 269-278 In view of the fact that in Japan treatment of end-stage renal disease depends disproportionately heavily on hemodialysis and almost negligibly on transplants from cadaveric donors (hemodialysis 44.4/100000 per year; renal transplants 0-31/100009 per year; cadaveric renal transplants 0.11/100000 per year (1983 data)), we analysed the cost-effectiveness of hemodialysis and renal transplantation, predicted economic gains under expected changes in variables and described attitudes of the Japanese hampering cadaveric renal transplantation. Adjusted life expectancy of transplant recipients (live and cadaveric combined) under the current technical conditions is longer than that of those on hemodialysis (18.3 vs. 14.7 years) and the cost per year for maintaining the transplant is approximately one third of hemodialysis ($12,000 vs. $32,000). If the proportion of cadaveric transplant recipients would increase to the levels of the USA (hemodialysis 30.8/100000; transplants 2.6/100 000 per year; cadaveric transplant 1.9/100 000 per year (1983 data)) along with improvement in graft survival rate, the life expectancy for transplant recipients in Japan could increase by two years, thus reducing the annual cost even further. The current number of patients starting hemodialysis (11500 cases per year) coupled with their life expectancy predicts the number of patients on hemodialysis to reach equilibrium at around 174000 in a decade (Japanese population 110 million). Based on current price, their annual cost will be about 5.3 billion dollars. Medical expenditure of this magnitude for such a small fraction of people is expected to become an increasingly strong economic incentive for cadaveric renal transplantation.