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Around the World. Yu, Shuangjin; Luo, Xunrong. Yu, Shuangjin; Luo, Xunrong Less. Morelli, Adrian E. Bernat, James L. Niemann, Claus U. Sometimes donor leukocytes traveling along with a transplanted organ attack recipient tissues, such that graft-versus-host disease GvHD is said to have occurred. The epithelial cells of the skin, liver and intestine of the transplant recipient are the prime targets of GvHD.
Onset can be acute and sometimes fatal or chronic. Although GvHD rarely occurs in solid organ transplants, it is a huge problem for patients undergoing HSCT since, by definition, the transplant is of donated immunocompetent cells that disperse throughout the body. Read full chapter. Tak W. Mak, Mary E. Saunders, in The Immune Response , Transplantation is slowly becoming an accepted means of saving lives in most parts of the world.
A transplant registry was started in Asia in to keep track of the numbers of centers performing transplants, numbers of patients on waiting lists, numbers of patients going abroad for transplants, the specific organ types undergoing transplant, and ethical and social issues associated with transplantation.
Member countries of this registry now reply to regular surveys to contribute data. Transplantation rates vary widely by country: for example, only 85 kidney transplants were carried out in Bangladesh from to , whereas China performed 14, in the same period. While all member countries carried out kidney transplants and several countries did liver transplants, only China and Thailand performed a very few pancreas transplants in — Issues surrounding definitions of brain death are being debated in many member countries. For example, a brain death law was implemented in Japan only in In several countries, the donor must conform to very strict criteria, the donor's family must approve, and the donor must have signed a written living will indicating an intention to donate organs.
Partly because of a lack of cadaveric donors, a relatively modest total of heart transplants and 71 lung transplants were carried out in 11 member countries between and Interestingly, the annual number of heart transplants in Asia actually dropped between and due to a decrease in donors following the introduction of mandatory motorcycle helmet use in Taiwan. Acceptable sources of donated organs vary in member Asian countries, with living, related kidney donors being much more common in India than in China.
Numbers of living liver donors were also increasing in the late s.
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Waiting lists are an issue in Asia as they are in Western countries. Prospective recipients wait almost 5 years for a kidney transplant in the most advanced of member countries. Curt R. Robert E. Breeze, in Handbook of Clinical Neurology , Where shall human transplant research go from here?click
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To evaluate fully the effectiveness of dopamine cell transplants for PD, a uniform source of dopamine neurons must be developed. Differentiation of embryonic stem cells from dopamine neurons may produce an unlimited number of dopamine neurons for transplant.
Unlike most somatic tissue transplants, allografts of human fetal neural tissue are not rejected. Although less likely, some of the other cell sources described in this chapter may prove useful. Because of immunologic barriers, successful xenografts are improbable. On the other hand, clinical benefits have been incomplete in most patients. Many PD patients have cognitive deterioration either early or late in their disease.
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In an effort to improve the outcome of neurotransplantation, we are obliged to consider new targets for transplantation. Because the region of dopamine cell loss, the substantia nigra pars compacta, has important regional connections with the pars reticulata, the subthalamic nucleus and the pallidum, dual tranplants into putamen and substantia nigra should be considered. Because the caudate nucleus has a role in cognitive function and eye movements, comparison of dual transplants into caudate and putamen could be compared to putamen alone.
Although restoring uniform anatomic integrity of the nigrostriatal dopamine system is a daunting challenge, transplantation has already demonstrated successful repair of the human PD brain.