Translating cancer genomics into clinical oncology.
نویسنده
چکیده
The medical directors of the organ-procurement organizations can determine the ABO compatibility of the exchange pairs and the proximity of their centers and note the date of the listings. Equipoise should be achieved in terms of the medical characteristics of the donors and recipients; therefore, donors and recipients should be aware of the medical characteristics of their exchange partners, even if anonymity is preserved. This revelation should allay any understandable apprehension about whether the two kidney transplantations have similar prospects of success. Nevertheless, each transplantation center should reevaluate the medical information of the other donor and recipient in keeping with its own standards. As with any kidney transplantation from a living donor, both the donor and the recipient must realize that there is no guarantee that the exchange will yield a successful outcome. Finally, these exchange procedures must comply with the National Organ Transplant Act of 1984, which prohibits monetary transfers or transfers of valuable property among donors, recipients, and brokers in sales transactions. In New England, the two transplantation procedures take place simultaneously by design, even when they are performed in different centers that may be at distant locations. Each donor travels to the recipient's center. When these elements of the procedure are maintained, the risk that one donor will withdraw his or her commitment after the other donor has undergone nephrectomy can be avoided. Exchange transplants in instances in which there was cross-match incompatibility between recipients and their intended donors have been particularly gratifying. For example, a brother with blood type A who was incompatible with his sibling because of an A-to-B blood-type disparity donated his kidney to a man with blood type A who was sensitized to the HLA antigens of his wife, who had blood type O. The wife simultaneously donated her kidney to the exchange donor's brother (see Figure). A father with blood type A who could not donate his kidney to his daughter, who had blood type B, gave his kidney to a teenager with blood type A, and the teenager's sister provided a kidney for the exchange donor's daughter. Clearly, we have come a long way since the first living-donor transplantation between twins, which was performed after skin grafts had been exchanged between the prospective donor and the recipient in order to verify their genetic identity. Half a century later, irrespective of genetic relationships, we are no longer impeded by either blood-type or …
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ورودعنوان ژورنال:
- The New England journal of medicine
دوره 350 18 شماره
صفحات -
تاریخ انتشار 2004