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The historical development of deceased organ donation, transplantation, and organ procurement organizations is reviewed. The concept of transplantation, taking parts from one animal or person and putting them into another animal or person, is ancient. The development of organ transplantation brought on the need for a source of organs. Although many early kidney transplants used kidneys from living donors, these donors could not satisfy the ever-growing need for organs, and extrarenal organs were recovered only from deceased donors. This need for organs to satisfy the great demand led to specialized organizations to identify deceased donors, manage them until recovery occurred, and to notify transplant centers that organs were available for their patients. The functions of these organ procurement organizations expanded to include other required functions such as education, accounting, and compliance with state and federal requirements. Because of the shortage of organs relative to the demand, lack of a unified organ allocation system, the perception that organs are a national resource and should be governed by national regulations, and to improve results of organ procurement organizations and transplant centers, the federal government has regulated virtually all phases of organ procurement and transplantation.

There are about 50,000 new leukemia patients each year in China. The Chinese government has funded the CMDP since 2001. So far, there are 1,471,212 volunteer donors registered in CMDP with HLA-A, B, DR typing. Of the donors, 25.85% were typed with high-resolution results. The typing error rate has decreased from 8.18% in 2003, to 0.4% in 2011. So far, 2,700 patients, including patients outside of China, have received stem cells from the CMDP. The overall one-year survival is about 70%. Since 2006, 42% of patients have received HLA-A, B, C, DR, DQ identical (10/10) transplants and 37.5% of patients have received 9/10 transplants. The one-year survival with 10/10 is 71% and 72% for 9/10 transplants. The efforts of the past 10 years have laid a foundation for the CMDP's further development. We expect that more patients' lives will be saved through these efforts.

Background/aims: Kidney transplantations at our center rely mainly on living donors. The purpose of this study was to suggest future donor supply directions by reviewing changing trends in donor type., Methods: During the past 40 years, 1,690 kidney transplantations were performed at our center. We divided the follow-up period into four decades and the donor population into three groups: living related, living unrelated, and deceased. We analyzed changing trends in donors from each group for each decade. Patients receiving overseas transplantation were also included., Results: The proportion of living related donors decreased from 84% (54/64) in the 1970s to 61% (281/458) in the 2000s. Living unrelated donors showed a sustained proportion of around 20% after 1990. However, among living unrelated donors, the proportion of spouse donors increased from 4.6% (17/369) in the 1980s to 8.5% (39/458) in the 2000s. Transplants from deceased donors were only 3.3% (12/369) in the 1980s. However the proportion of deceased donors increased gradually, reaching 13.2% (105/799) in the 1990s and 19.9% (91/458) after 2000. Overseas transplantations increased after 2000 and reached 20% of all cases treated in our center during the 2000s. Such transplantations peaked in 2006 and decreased markedly thereafter., Conclusions: The proportion of each donor type has continuously changed, and the changes were associated with changes in the social structure and system. We expect that this study could be an important reference for other countries to estimate future changes of donor type.

Because medical students have many different learning styles, the authors, medical students at Mayo Clinic, College of Medicine researched the history of anatomical specimen procurement, reviewing topic-related film, academic literature, and novels, to write, direct, and perform a dramatization based on Robert Louis Stevenson's The Body-Snatcher. Into this performance, they incorporated dance, painting, instrumental and vocal performance, and creative writing. In preparation for the performance, each actor researched an aspect of the history of anatomy. These micro-research projects were presented in a lecture before the play. Not intended to be a research study, this descriptive article discusses how student research and ethics discussions became a theatrical production. This addition to classroom and laboratory learning addresses the deep emotional response experienced by some students and provides an avenue to understand and express these feelings. This enhanced multimodal approach to"holistic learning" could be applied to any topic in the medical school curriculum, thoroughly adding to the didactics with history, humanities, and team dynamics.

The transplant medical community in the United States has frequently been divided over the appropriate role of the federal government and of the public in matters related to organ transplantation. Using public statements in government hearings, newspapers, and press releases, this article traces the thinking of the transplant medical community in particular during three especially politicized periods: the heart transplant and brain death controversies in the late 1960s, consideration of the National Organ Transplant Act and other legislation during the mid-1980s, and the controversy over organ allocation regulations issued by the Department of Health and Human Services in the late 1990s. Even while sometimes denouncing "politicization," over time surgeons, physicians, representatives of the United Network for Organ Sharing, and other leaders in the field became increasingly politically active and more accustomed to the notion that because of the unique nature of organ transplantation, both the public and the federal government have a legitimate and potentially beneficial oversight role.

This article is dedicated to the memory of the pioneers of solid organ transplantation 20 yr after the Iron Curtain was demolished and Eastern European countries joined the free world. Despite the special political and medical conditions that existed, the evolution of transplantation could proceed following Western trends. With the formation of Intertransplant, kidney transplantation was formalized, and a limited organ exchange could be realized. The transplantation of non-renal organs was rather sporadic until 1989. This paper summarizes the efforts in transplantation in Eastern Europe during this period of tension with the West.

This paper focuses on the infamous case of Hwang Woo Suk, the South-Korean national hero and once celebrated pioneer of stem cell research. After briefly discussing the evolution of his publication and research scandal in Science, I will attempt to outline the main reactions that emerged within scientific and bioethical discourses on the problem of research misconduct in contemporary biosciences. What were the ethical lapses in his research? What kind of research misconduct has been identified? How this kind of misconduct affects scientific integrity? How to avoid it? Focusing on these questions, the paper interprets the Hwang's case as a case study that might shed light on the worst aspects of highstakes global science. This case presents a group of problems that might endanger scientific integrity and public trust. Regulatory oversight, ethical requirements and institutional safeguards are often viewed by the scientific community as merely decelerating scientific progress and causing delays in the application of treatments. The Hwang's case represents how unimpeded progress works in contemporary science. Thus, the case might shed light on the often neglected benefits of "the social control of science".

A quarter of a century ago the commencement of liver transplantation in Australia was controversial and surrounded by medical and political intrigue. The medical opposition to its establishment was led by the Medical Journal of Australia with scathing condemnation, especially with regard to the transplantation of children. Interstate political rivalry, most prominently between the Queensland and Victorian and Federal Governments was at the forefront and was a fertile field for media attention. Despite all the obstacles, liver transplantation came to fruition and the results achieved have more than justified its introduction and continued performance. In addition, contributions from Australia have had a significant impact around the world.

Over the past 40 years, heart transplantation has become a routine treatment for end-stage heart failure. Over 3000 heart transplants are performed annually. Despite improvements in short-term outcomes, long-term survival remains limited. Current efforts remain directed at alleviating the shortage of donor organs, developing effective treatments for chronic rejection, and improving mechanical circulatory support for heart failure.

Solid organ transplantation is one of the most remarkable and dramatic therapeutic advances in medicine during the past 60 years. This field has progressed initially from what can accurately be termed a "clinical experiment" to routine and reliable practice, which has proven to be clinically effective, life-saving and cost-effective. This remarkable evolution stems from a serial confluence of: cultural acceptance; legal and political evolution to facilitate organ donation, procurement and allocation; technical and cognitive advances in organ preservation, surgery, immunology, immunosuppression; and management of infectious diseases. Some of the major milestones of this multidisciplinary clinical science are reviewed in this article.

The Brain Donation Program at Sun Health Research Institute has been in continual operation since 1987, with over 1000 brains banked. The population studied primarily resides in the retirement communities of northwest metropolitan Phoenix, Arizona. The Institute is affiliated with Sun Health, a nonprofit community-owned and operated health care provider. Subjects are enrolled prospectively to allow standardized clinical assessments during life. Funding comes primarily from competitive grants. The Program has made short postmortem brain retrieval a priority, with a 2.75-h median postmortem interval for the entire collection. This maximizes the utility of the resource for molecular studies; frozen tissue from approximately 82% of all cases is suitable for RNA studies. Studies performed in-house have shown that, even with very short postmortem intervals, increasing delays in brain retrieval adversely affect RNA integrity and that cerebrospinal fluid pH increases with postmortem interval but does not predict tissue viability.

INTRODUCTION AND SOURCES OF DATA: This paper briefly outlines the history of research on the recently dead, before critically exploring 1. In what sense can we harm the dead? 2. What are the justificatory arguments for employing family or parental consent for medical research on dead relatives? AREAS OF AGREEMENT, CONTROVERSY, GROWING POINTS OF INTEREST AND AREAS TIMELY FOR DEVELOPING RESEARCH: The controversy surrounding harm in relation to research on dead bodies largely depends on how dead people are perceived. That is, 1. As Cadavers. 2. As Ante-mortem persons. 3. By Significant others. Controversy over whether we need to have consent from significant others (bereaved relatives) depends on the weight we give to the bereaved and their experience of the dead. Understanding this is timely in developing research and is relevant to the issue of consent around organ donation for transplants.

America's medical schools have long used human cadavers to teach anatomy, but acquiring adequate numbers of bodies for dissection has always been a challenge. Physicians and medical students of the 18th and 19th centuries often resorted to robbing graves, and this history has been extensively examined. Less studied, however, is the history of body acquisition in the 20th century, and this article evaluates the factors that coalesced to transition American society from body theft to body donation. First, it describes the legislation that released the unclaimed bodies of those dying in public institutions to medical schools for dissection, thereby effectively ending grave robbery. Then it discusses midcentury journalistic exposés of excesses in the funeral industry-works that were instrumental in bringing alternatives, including the previously unpopular option of body donation, to public consciousness. Finally, it examines the rise of body transplantation, the Uniform Anatomical Gifts Act of 1968, and the subsequent state of willed-body programs at the turn of the 21st century. Body-donation programs have gradually stabilized since and currently provide most of the bodies used for dissection in American medical schools. Relying as they do on public trust, however, these programs remain potentially precarious and threatened by public scandals. Whether American medical schools will receive enough bodies to properly educate students in the future remains to be seen.

In the world, throughout history it has been difficult to obtain bodies for cadaveric dissection practice and research. In Japan, the difficulties were enhanced by the unique social culture and understanding surrounding the deceased and family responsibility. Further, from the 1970's onward, there was a large influx of new medical schools. In order to provide such a large number of medical students with anatomical study materials which are not merely obtained from unknowing deceased, but rather willfully donated by the deceased, a means by which to officially donate bodies was necessary. From the mid-1970's anatomy professors and leaders of volunteer body donation organizations realized that there was a need to formulate a procedure for the wholesome development of a body donation law. Together, they proposed this concept to senators and then on to the Ministry of Education. Their efforts bore two fruits: creation (1982) of an Official Certificate of Appreciation from the Ministry of Education (addressed to the deceased and given to the family) and also the Body Donation Law (1983). For society, such a law ensures the cultural acceptance of the concept of body donation, because it proves verification by the government. Also, such a law resolves possible later disputes between family members. Further, this law can facilitate the true wishes of the deceased, not that of the family members. In 1995, the Crown Prince and Princess participated in the Ceremony of the Centenary of the Japanese Association of Anatomists. In his address, the Prince congratulated the Association for their leadership in the development of Japanese modern medicine. He noted that body donation has been a key point to facilitate excellent medical education. As a result of the body donation law, presently there is a sufficient number of donated bodies for student dissection practice at the medical schools throughout Japan. Certainly it is pleasing to all to know that the will of the deceased has been carried out. For the family as well as the schools, this process is undertaken in an official and socially acceptable manner. In this review, we describe the process toward the development of the body donation law and the influences of this law by quoting the official journal of the Japan Union of Voluntary Body Donation, "Tokushi Kentai" (Voluntary Body Donation).

During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

The Uniform Anatomical Gift Act (UAGA) and its periodic revisions provide a template for the creation and amendment of legislation to adjust public policy and align it with developments in medical practice. It is also a model for statutory response to societal change as well as changes in regulatory and judicial precedents. Conversely, the history of the UAGA shows the limits of legislation to achieve certain social goals.

Continued progress in organ donation will help enable transplantation to alleviate the increasing incidence of end-stage organ disease. This article discusses the implementation and effect of the federally initiated Organ Donation Breakthrough Collaborative; it then reviews organ donation data, living and deceased, from 1995 to 2004. It is the first annual report of the Scientific Registry of Transplant Recipients to include national data following initiation of the collaborative in 2003. Prior to that, annual growth in deceased donation was 2%-4%; in 2004, after initiation of the collaborative, deceased donation increased 11%. Identification and dissemination of best practices for organ donation have emphasized new strategies for improved consent, including revised approaches to minority participation, timing of requests and team design. The number of organs recovered from donation after cardiac death (DCD) grew from 64 in 1995 to 391 in 2004. While efforts are ongoing to develop methodologies for identifying expanded criteria donors (ECD) for organs other than kidney, it is clear DCD and ECD raise questions regarding cost and recovery. The number of living donor organs increased from 3493 in 1995 to 7002 in 2004; data show trends toward more living unrelated donors and those providing non-directed donations.

The paper provides a short overview of key problems of medical ethics in the Russian and Soviet contexts--confidentiality, informed consent, human experimentation, abortion, euthanasia, organ and tissue transplantation, abuse of psychiatry. In Soviet ideology common interests were declared superior to private ones. Hence, medical confidentiality was viewed as a bourgeois survival. On the other hand, diagnosis was normally not disclosed to a patient in the case of an incurable disease (especially cancer). Due to the strong paternalistic traditions of Russian medicine the idea of informed consent is still disputed by many physicians. Abortions were first legalized in Soviet Russia in 1920. A brief history of this landmark event is provided. However, abortions were forbidden in 1936 and legalized again only in 1955. Active euthanasia was legalized in Soviet Russia in 1922 but for a short period. Federal law regulating human transplantation was adopted only in 1992 and based on the presumed consent model. Until then forensic autopsy and procurement of cadaver organs were viewed as equal procedures. In 1960s-1980s there was a practice of declaring political dissidents insane in their involuntary treatment.

Despite representing a small percentage of the transplant activity in our country, living donor kidney transplantation is a good alternative for the future because the needs exceed the offer of cadaver donor organs. We present the evolution of living donor kidney transplantation in Spain from the beginning in accordance to the ONT (Organización Nacional de trasplantes), and our current situation in comparison with other countries, as well as data obtained from the experience in our hospital which began in 1965.

In 1968, publication of the Harvard committee's report concerning "irreversible coma" established a paradigm for defining death by neurologic criteria (brain death [BD]). Five years earlier, Dr. Guy Alexandre, a Belgian surgeon, had not only adopted closely similar diagnostic criteria for BD but also applied those criteria in performing the first organ transplant from a brain-dead donor--a procedure many of his colleagues considered ethically unacceptable. To put those events into present-day perspective, the author reviewed the proceedings of a Ciba Symposium held in London in 1966 at which Alexandre introduced his pioneering view, obtaining information and documents from Alexandre and others who attended that meeting. Comparing Alexandre's approach with the Harvard report and later advances helps in understanding how both defining death by brain criteria and transplanting organs from a brain-dead donor have become morally tolerable today.

As the number of pre- and post-transplant solid organ recipients continues to grow, it becomes important for all physicians to have an understanding of the process of organ procurement and allocation. In the United States, the current system for allocation and transplantation of human solid organs has been heavily influenced by the experience in deceased donor liver transplantation (DDLT). This review highlights the significant changes that have occurred over the past 10 years in DDLT, with specific attention to the impact of the Model for Endstage Liver Disease (MELD) score on organ allocation and pre- and post-transplant survival. DDLT is managed by the United Network for Organ Sharing (UNOS) which oversees organ procurement and allocation across geographically defined Organ Procurement Organizations (OPOs). For many years, deceased donor livers were allocated to waiting list patients based on subjective parameters of disease severity and accrued waiting time. In addition, organs have traditionally been retained within the OPO where they are procured contributing to geographic disparities in disease severity at the time of transplantation among deceased donor recipients. In response to a perceived unfairness in organ allocation, Congress issued its "Final Rule" in 1998. The Rule called for a more objective ranking of waiting list patients and more parity in disease severity among transplant recipients across OPOs. To date, little progress has been made in eliminating geographic inequities. Patients in the smallest OPOs continue to receive liver transplants at a lower level of disease severity. However, strides have been made to standardize assessments of disease severity and better prioritize waiting list patients. The MELD score has emerged as an excellent predictor of short-term mortality in patients with advanced liver disease, and patients listed for liver transplantation are now ranked based on their respective MELD scores. This has improved organ access to the most severely ill patients without compromising waiting list mortality or post-transplant survival. The current system for DDLT remains imperfect but has improved significantly in the past decade. As the number of patients in need of DDLT grows, the system will continue to evolve to meet this increasing demand.

The Organ Transplant Law of Japan, which regulates organ transplants using brain-dead persons' organs, has a set of extremely severe intention-requirements. It has stagnated, rather than promoted, the organ transplant in Japan for the last 8 years. We believe that the Law should be reformed by making an about-face from the current "opt-in" to the "opt-out" principle.

The article explores the rules and criteria used for the allocation of donor organs in Singapore. Organs are extremely scarce, so hard decisions have to be made about who receives them. Based on an analysis of documents and interviews done with local program directors, both the admission to a waiting list for transplant and the final recipient selection are covered. The observed practices appear remarkably similar to those predominant in several Western countries until recently, when they had to be modified there following public criticism. It remains to be seen whether Singapore can sustain its much stricter standards in the future.

The 1997 Japanese organ transplantation law is the fruit of a long debate on "brain death" and organ transplantation, which involved the general public and experts in the relevant fields. The aim of this paper is to trace the history of the implementation of the law and to critique the law in terms of its consistency and fairness. The paper argues that the legislation adopts a double standard regarding the role of the family. On the one hand, the legislation over-emphasizes the family's authority by granting the family a veto on the matter of organ transplantation, while, on the other hand, not allowing the family to make surrogate decisions. In addition, the role of law in cases involving minor or incompetent patients is shown to be similarly misguided. The paper argues that accepting a decisive role for the family in current law is compatible with Japanese culture.

Lis Goulet is the Nurse Clinician for Organ and Tissue Donation at the McGill University Health Centre (MUHC). She was the first nurse in Quebec to be appointed to such a position. She is not only a pioneer in this clinical area, but also an inspiration to others and a guide for those who are following in her footsteps. As colleagues, we wish to acknowledge her many contributions which include the challenges she has met, the hurdles she has to overcome, and the inroads she has made to the Organ and Tissue Donation Program at the MUHC.

At recent presentations on the history of anatomy in the West of Scotland, our group has been asked whether we would regard the revelations of 1999-2001 about organ retention as a modern form of body-snatching. We have compared newspaper reports of the Glasgow Herald from 1823 to 1832, the decade prior to the Anatomy Act of 1832, and the Herald, Sunday Herald and Evening Times from 1999 to 2001. Clearly body-snatchers appropriated whole corpses while the recent troubles concerned individual organs. Body-snatching was illegal while the crisis over organ retention arose from differing expectations between the medical profession and the public. Both practices caused huge public concern and distress to relatives. There are, however, interesting differences between the two sets of reports. The public had been aware of body-snatching for many years prior to the Anatomy Act, which regulated the supply of cadavers, whereas revelations about organ retention came as a shock. In the organ retention crisis, the parents of the children were more organised in supporting each other and in campaigning for change than were the public in the days of the resurrectionists.

Although organ transplantation following brain death has progressed in the West, it has lagged far behind in Japan, following the first such case in 1968. As effective immunosuppressants made transplantation a better option, Japanese patients increasingly sought treatment overseas. Japanese physician groups studied issues related to transplantation but did not succeed in making brain-dead donor transplants available to patients, and the matter was referred to the government. However, transplant medicine was still marked by controversy, and as political pressure was applied the controversy deepened, splintering public opinion. At the same time, transplant groups continued working to establish structures to allow transplantation to proceed. Public awareness and knowledge of brain death grew, and acceptance widened. Eventually, legislation was passed in June 1997 that allowed organ donations from some brain-dead donors. The law is restrictive, and such organ transplants in Japan are still limited.