Name: Amber Cameron
Class: ENG 102-11192
Merrill Goldin
Rough Draft
Fighting Against the Organ Shortage
Have you ever wondered what happens to the human body when a(n) organ system begins to fail and ultimately breakdown. The human body is interconnected by systems of complicated organs with specific jobs in order to allow us to go throughout our daily life. On average there are more than 100,00 people waiting for a transplant, every 9 minutes someone is added to the list, but 6,000 people die each year waiting for a transplant, and everyday 17 people die waiting for an organ (DonateLife America). Without transplantation humans wouldn't be able to survive failing organ systems. The sad fact is, the country is in an organ shortage where the supply of organs decreases while the demand of organ donations never stops. Bioprinting viable human organs became a solution in a field desperate for answers. With developments in bioprinting, transplantations have the ability to limit the time patients spend on the transplant list, reduce black-market organ trafficking, and reduce rates of infection and rejection after transplantation. In order to understand more about bioprinting organs a short description will be provided.
Organ transplants have been a backbone to the medical field by using donations from living or dead donors to replace the failing organ(s) of a patient in order to extend their life and be given a second chance. With the lack of organ donations the development of bioprinting became a solution. Bioprinting tissues and organs is possible with the use of patient DNA and tissue samples. The process can be simplified into three generic steps pre-brioprinting, bioprinting, and post-bioprinting. Creating a digital file for the printer to read generally comes from a patients CT or MRI scan allowing the provider to create an image to use as a base model for the tissue to be printed from (Wallmanderco). Bioprinting is a new and experimental procedure that an help patients not only with needed organs but can help reduce the need for human testing on drug developments during clinical trials. Bioprinting has a vast range of uses once it becomes more developed and discussed procedure. Medicine is constantly advancing and evolving, bioprinting is one example in how today's technology is advancing with and keeping up with the medical field. It is no surprise that in today's environment the supply of qualified human organs for donation are becoming scarce and limited.
Bioprinting human organs can reduce the time spent in hospitals waiting for an organ donation to become available regardless of where they are located in the United States. In order to be considered by UNOS (United Network of Organ Sharing) and medical providers to qualify for an organ donation, patients must meet strict standards and guidelines to be placed on the transplant list. Not all hospitals have the same criteria for patients to meet before determining if the patient is a candidate for transplant. Each Organ Procurement Organization (OPO) establishes the criteria acceptable for donation and transplant programs working within the Donation Service Area (DSA). Having a variety of different criteria available in a region makes sure that, "if a host OPO rejects a donor, the OPO can offer organs to other established OPO's in the area" (United Network of Organ Sharing). Once the patient has been established to meet the criteria, next the medical providers and UNOS determine the urgency in which a patient requires an organ donation. Using a grading system A-D (A is the highest rank and D is the lowest) and in categories I or II. Before a label is decided, "... a discussion between the transplant candidate, or medical decision maker, and the listing clinician should start before placed on the wait list" (Seem). Working simultaneously, UNOS looks at the condition of the patient and will determine their status and place them on the appropriate waiting list.
Once the patient receives a status and is placed on a list, next comes the long and dreaded waiting game. Unfortunately not all geographical locations have the same rate of available organs for transplants. Dependent on where the patient is located in the United States can determine how quickly they are able to receive an organ donation and transplantation surgery. Organ Procurement Organizations (OPO) and transplant hospitals desperately want equal distribution and representation for patients across the country. Donation policies within the network help eliminate the differences throughout the regions but, " ... each region varies tremendously in terms of donor availability, number of recipients and number centers that compete" (Baran). If a patient is lucky enough to live in a region with high donations, they have the possibility of getting lucky and receiving an organ quickly. Those who live in a less dense area population with fewer donations they are more than likely to be placed on a waitlist and either become death statistic while waiting or luckily receive an organ transplant. This dreadful waitlist is where the development of bioprinting relieves patients and families.
Using bioprinted organs can help alleviate the pain of patients while waiting on the transplant list and their families while waiting for a donor to become available. It would allow patients to minimize time spent waiting on a list and dying before an organ become available for them. The transplant list is hard enough to get on due to the strict criteria, but once one it a donation isn't guaranteed. For example,, "most patients who need a transplant, the first step is to get on the national transplant waiting list. Most transplant candidates usually wait for some length of time because there are not enough organs for all who need them" (United Network o Organ Sharing). Bioprinting organs can give the time back to patients and their families that they would be spent waiting in a hospital bed sick or weakened due to the failing organ system. Using the latest data from the Organ Procurement and Transplantation Network, "there are more than 100,000 people in the United States waiting for life-saving organ transplants..." (Zeek). By utilizing bioprinting in the medical field the number of patients on the waiting list can drop drastically. Not only is the potential of eliminating the need for the transplant waiting list, the long time periods spent in turmoil and anxiety while waiting can be slashed to meat hours while an organ is printed.
While time better spent with loved ones than in a hospital room waiting for an organ donation, bioprinting has other benefits in the medical community. Receiving a diagnosis of an organ failure is already devastating news for patients to be able to process and understand. Some patients believe they deserve a transplant more than others and will resort to the black market for human organs where they procure and transplant organs illegally. Yes, that's right the black market is used in illegal organ procurement and senseless modifications and murders of others. In order to understand the importance of stopping illegal organ procurement throughout the black market, the process of harvesting illegally will be provided.
Understandably hearing a provider explain the patients process of being placed on the transplant list can give patients and their families the feeling of despair. Some patients go as far as using the black market to skip the legal and ethical processes of organ donation. Patients will enter into a deal with a black market provider to receive an organ. The way that the organs are procured is astounding and violates basic human rights. After a transaction is agreed upon between patient and dealer, "a black market broker will enter into a financial arrangement with a criminally minded medical director and carve bodies before cremation" (Scheve). Most of the bodies used in these illegal transactions are located at funeral homes and hospitals where the deceased patients families choose cremation as an option. Along with funeral homes and hospital, when desperate enough deal brokers will arrange murders of homeless/forgotten members of the community. If a broker can use a living donor (bone marrow or kidney transplants) they generally recruit from third-world countries and rundown cities. The black market broker will, "recruit donor from the slums of Brazil, flown to South Africa where the operation is being performed, the patient will be compensated between $6,000 to $10,000, then they will be returned home" (Scheve). While the promise of compensation is attractive to those who need money, the complications of infections and surgeries often result in donor death. Black Market organ procurement undermines the whole system built to protect patients and those waiting for organ transplants. It increases the risks of rejection, infection, and surgical complications for the donor and the recipient of the transplant.
Black market organ transactions don't only impact the availability of organs for those on the transplant waiting list but run the risk of receiving donations that haven't gone through rigorous inspections to make sure they are viable for donation. Surprisingly, not all everyone is determined fit to become a donor, donors have to meet requirements to avoid spreading infection. In once case of a black market study, "illegally obtained tissue from one cadaver has been known to reach 90 tissue recipients" (Scheve). The use of black market organs and tissues poses a direct threat to those who receive the transplant and those whose are performing the procedure. Imagine the cadaver has HIV, and since the procured tissue didn't receive the proper testing the patients who received the donation also received and unexpected viral transmission of the HIV/AIDS virus. Like mentioned previously, the black market directly undercuts the protection created by years of discussions between multiple organizations to provide patient safety. To keep patients safe;
"The level of safety, efficacy, and quality of human cells, tissue, and organs for transplantation, as health products of an exceptional nature must be maintained and optimized on an on going basis. This requires implementation of quality systems including traceability and vigilance" (White et al.)
The use of bioprinted organs eliminates the hidden use of the black market and will help eliminate the cases of botched surgeries from brokers. Not only does it eliminate the "need" for the black market but can help patients feel as their needs are being handled and with sense of urgency. Reducing and eliminating the use of the black market with bioprinted organs also ensures that the patients safety is never compromised and a top priority for all those involved in the transplant process.
The process of bioprinting organs recently entered the clinical trial phase and once approved for use, it has tremendous opportunities to limit postoperative infection/rejection rates and be able to replace failing organ parts before organ dysfunction and failure. Undergoing any major medical operation or procedure puts the patient at risk for developing a postoperative infection, but organ transplantation runs a higher risk of accidental infection which can lead further illness or rejection. Once the patient finally receives word they have been selected from the list for a transplant the recipient goes to the hospital and undergoes even more tests to limit the risk of infection and complication. Transplant recipients need to have a superior bill of health because, " recipients get infections more easily because their immune systems are suppressed. It is also more difficult for a transplant recipient to recover..." (United Network of Organ Sharing). If the recipient of the donation isn't in prime health it can complicate the procedure and the patient can become septic from infections. Not only is there an increased risk of infection the rate of recovery could be extended which means more time in the hospital, expensive medical bills, and complicated medication schedules to keep track of. Bioprinted tissue and organs use the patients DNA and tissue samples to build a one in a kind donation that can reduce the dangers of surgery like infection to a reduced or eliminated risk (Sunny). Since the printed sample is produced using the patients own DNA the body is more inclined to accept the sample without rejection. The sample would already share the bodies blood, antibodies, and cells eliminating the complications of waiting for acceptance/rejection in surgery. The quicker that a surgery is completed reduces the risk of postoperative infection demo being on the surgical table. While the focus has been on organ transplantation in patients, the possibilities of bioprinted tissues and organs has endless advancements for the medical community.
There is more to bioprinting organs than just for whole organ transplantation, it's a tool that can help with pathogenic research development, tissue repair, and of course whole organ replacement ultimately leading to better medical knowledge and practice. In the future there is a possibility that humans will no longer have to sign up for experimental clinical trials thanks to bioprinted organs or complicated diseases (i.e cancer) can be cured by studying the pathogenic processes of the disease. Using the technological advancements of bioprinting can advance the knowledge of all medical providers and streamline the treatment processes of patients. Using bioprinted samples, "scientist would be able to study the disease pathogenesis, progression, and its effect in an actual organ, without having to sacrifice many animals or experimentations on humans" (Sunny). Using bioprinted samples in clinical trials virtually eliminate the need for human testing and complications for experiment. Along with internal treatments (organ transplants) the use of bioprinting can come in handy when patients require large amounts of external repairs (skin grafts.) When a patient receives partial thickness or full thickness burns on their body they require skin grafts to restore looks and functions of body parts. Dependent on the degree of which a patient is burned determines how many skin grafts are required and if skin grafts are a viable option. The technology of bioprinting can easily use patient skin tissue to print and develop viable skin grafts (Sunny). This development would allow any patient of any thickness and coverage the chance to undergo advanced treatments and returned functions of body parts. While bioprinting is still in clinical trials, it already shows advancements in the protection of patients in surgical procedures by limiting postoperative infections and organ rejection. As well as being used in advanced treatments and procedures to quickly return normal function in internal and external injuries.
In conclusion, bioprinting viable human organs and tissue is a more effective and safe surgical procedure for patients that are in need of care. Just like any procedure or new experimental drug it comes with it's inherent risks each patient must consider. Bioprinting human organs seems like a technology of the future, it's a technology of today that can lead to advancements in medicine. Bioprinting not only is a beacon of hope for those waiting for transplants, it is a step in integrating technology into medical practices and using the technology to improve society. The hope is that bioprinting is not only the end to the organ shortage in this country, but to help end the disparities of those around the world. This is the beginning of a bright developmental future for the face of medicine not only in the United States, but for all countries, and all human life's on Earth.
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