This article appears in the August 1998 edition of the Catholic Medical Quarterly

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Symposium Summary

Sheffield 1998 - Transplantation

Professor Sir Roy Calne opened the symposium with a talk going back over the history of transplantation, and the crucial work of Peter Medawar in 1960 which began to explain the immune response. He gave figures on the current survival of transplanted solid organs.


Survival of renal transplants

1 year

5 years

10 years

Cadaveric transplant




One haplotype match




Two haplotype match




He explained how Cyclosporin had revolutionised the transplant world with markedly reduced opisodes of acute rejection. However the problem of long term chronic rejection still remains. He described concepts of classical tolerance, operational tolerance and "almost" tolerance. He gave some research data on the use of new anti-CD3 (anti T-cell ) antibodies linked with diptheria toxin which dramatically reduced the number of episodes of acute rejection. This talk was fully illustrated with many personal anecdotal stories of patients he had treated. He completed his talk with brief mention of the ethical problems of Xenografting, testicular transplantation and cloning.


The second talk was from Mr Franco Cuilli, a transplant surgeon, describing details of heart and lung transplantation. He surprised many in the audience by saying that the techniques had advanced so much that the operation was regarded as the ‘registrars operation’.

He told us that most heart transplants were for cardiomyopathy or coronary artery disease. He described the early complications of rejection and infection, with late complications of accelerated coronary atheroma, renal impairment, hypertension, malignancy, infection and chronic rejection.

The first human lung transplantation was in 1963, which was before the first heart transplant. The recipient survived 18 days. Between 1963 and 1969 20 single lung transplants took place with survival of no more than several weeks. Later combined Heart and lung transplantation were introduced which improved matters. In 1981 Cyclosporin revolutionised the situation. As control of rejection improves they are now moving away from heart and lung transplantation and using either single or double lungs transplants. Currently there is a 70% 1 year survival for lung transplants, which is 10% better than combined heart/lung transplants. Unfortunately the six year survival rate is only 40%. The cause of death is due to obliterative bronchiolitis.


The third talk of the morning was from Dr Pat Lawford, from the Department of Medical Physics at Sheffield. She briefly described the numerous artificial organs and life support systems that currently exist.

There are those that are regularly used such as heart bypass machines, bone fixators, pace-makers, vascular grafts, prosthetic valves and intra-aortic balloon pumps.

There are those that are used with some reservations - small joint prostheses, cochlear implants and extra-corporeal membrane oxygenation in neonates.

Then those with limited use such as artificial tendons, extra-corporeal membrane oxygenation in adults, ventricular assist devices.

Finally there are those which are experimental:- Artificial pancreas, intravenous oxygenation, implanted lungs and total artificial hearts.

The major issues she examined were pathophysiology of device dependency, the emotional aspects of device dependency, eg how a person feels knowing that there life is entirely dependent on an artificial heart. There were problems of definition of quality of life and whether artificial organs just prolonged life without any quality. She addressed the issue of the economics of these devices and whether they should be publicly funded, privately funded or by charitable donation. There were important legal implications particularly relating to product liability. She illustrated the problem by giving a case study on the Bjork-Shiley heart valve. This is a tilting disk valve which reduced the incidence of thrombo-embolic events. Following the introduction of larger discs it was discovered there was a problem with the struts holding the disc failing, with possible subsequent death of the patient. The valve was introduced into the UK in 1979, with 5,000 devices in use currently. Supply of the valve was discontinued in 1986 following the failures. In the UK there have been 57 failures. Some people are attempting to sue the company for introducing a device with a design fault. The company’s defence is that the rate of failure is offset by the low risk of embolism with their device. The problem is what to do with those patients still having a device. Device failure is a two stage process making it is possible to identify those whose valve is likely to fail catastophically. However, re-operation carries a 10% mortality, which compares with < 3% mortality in the first operation.


The morning finished with a talk by Luke Gormally, giving an overview of the ethical considerations in organ transplantation. He separately addressed the issue of living donors, and cadaveric organ donation. He questioned the parts which a living person may give linking it to the concept of self mutilation, with the concept of functional and anatomical integrity of a person. In conclusion a person may not donate if the consequence would be significant impairment of their functional integrity.

He then addressed the issue surrounded cadaveric transplantation. Is it only right for a person to donate if they have given prior consent. Can the family give independent permission for donation without prior knowledge of the wish to donate by the deceased person. If organ donation by the living is regarded as a true gift of self, cadaveric donation by the relatives cannot be regarded in the same light. He addressed the issue of determination of death. To minimise the period of warm ischaemic time it was practice in some centres to determine the place of death (in the operating theatre) so that organs could be rapidly removed for maximum viability. He questioned how this could respect the dying in their final moments and the impact on religious rituals surrounding death.

It was obvious from his arguments that he was strongly opposed to organ donation. It is hoped that the full text of his presentation will be published in the quarterly in due course.


After lunch there was a brief talk from Fr. Peter Cullen, who was the chaplain to the Sheffield branch of the Guild, as well as the University chaplain. He used the scriptures and church documents to explain how the Church had moved from opposition to organ donation, arguing that it was self mutilation, to using the distinction between anatomical and functional integrity to support the use of living organ donation where there were two organs available, or for partial liver transplants.


There then followed an open forum discussion. The panel consisted of individuals holding opposing moral positions on transplantation together with two patients. One was a religious sister who had spent three years on peritoneal dialysis and had then received a kidney transplant. She described her experiences of both and her approach to them as a religious sister. The other patient was a local priest who was in renal failure and on dialysis awaiting a transplant. He gave his views. The discussion with patients who could address both the emotional aspects of the problems as well as a more philosophical and spiritual approach was very illuminating.


The symposium finished with a presentation by Professor Deryck Beyleveld, Professor of Jurisprudence and the director of the Sheffield Institute of Biotechnological Law and Ethics.

He addressed the issue of live related transplantation and the psychological coercion that might take place. He addressed the possible exploitation of children and how some may have a child to use as a donor for other of their siblings. He then examined the issue of live unrelated donation and how that might violate human dignity by using the organs as commodities. In such situations it was likely that it was the poor who would be exploited as they would go donate their organs to support their families. He continued his logical arguments by discussing the issue of human dignity on the basis of human rights and human freedoms. His conclusion was that autonomy was the main maxim of human dignity. He argued that we have free will and therefore unless you harmed others you were totally free to do what you wanted.

He discussed issues of xenotransplantation including those of safety and the moral rights of animals. His discussion included addressing religious taboos, resource issues, the problems of consent. In conclusion he said that the ultimate solution would be the cloning of yourself to provide perfectly matched organs for use.

Not surprisingly his presentation generated a very lively discussion.