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- Feeling worn out? We can make you better, faster, stronger
than you ever were before. Well, maybe not all of the above. But surgeons
are on the cusp of being able to transplant nearly any body part we can
think of -- arms, legs, knees, hips, muscles, even ears, throats, tongues
and whole faces. These are promising therapies for victims of disfiguring
accidents or disease, effectively taking the next steps in reconstructive
surgery, from creating often poor facsimiles or artificial body parts to
replacing them with the real thing -- albeit from someone else's body.
Such advances don't come without costs, however, both medical and financial.
How much health risk should patients take in return for a transplant that
may be life-enhancing but not lifesaving? Will people be willing to donate
all their body parts when they die, or only those that can save lives?
Who should bear the financial costs, and are they worth it?
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- How much risk for how much benefit?
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- The major obstacle to transplanting any tissue from one
person to another is the body's natural rejection response. Our immune
systems, which protect our bodies from foreign invaders such as bacteria,
viruses and other infectious agents, view other people's organs in the
same way -- as unwelcome intrusions into our body that must be attacked.
To combat these natural defenses, powerful drugs that suppress the immune
system must be taken every day for the remainder of the transplant recipient's
life. Suppressing the immune system to allow foreign organs to survive
lowers the body's defenses against illness and infection.
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- Since transplants usually save the lives of the patients
receiving them, the benefits of heart, liver, lung or kidney transplants
outweigh the side effects of a lifetime of drugs and the chances of complication
and organ rejection. But what about transplants that may only improve
function, appearance, or both? Are the benefits of such non-lifesaving
transplants sufficient to outweigh their risks? Restoring basic life functions
may offer sufficient benefit, say transplanting a hand to a double amputee
or a voice box to a throat cancer patient. But why shouldn't the gain
in self-esteem of an accident victim who gets a new nose count as much?
When the risks are made clear, and as long as claims are reasonable that
the benefits outweigh the risks, then patients are in the best position
to decide. Purely cosmetic transplants -- one can envision requests for
newer knees or smaller ears -- wouldn't meet these standards.
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- Limited resources on limited benefits?
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- The extreme expense of heart, liver and other lifesaving
transplants hasn't raised questions about their value. But the experience
with non-lifesaving transplants is likely to be different. Spending increasingly
limited resources for transplants of increasingly less value will force
questions about their worth. In the end will we see such transplants available
only to those can pay for them out-of-pocket or who have the foresight
to buy special body part replacement insurance?
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- Are parts just parts?
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- Are we approaching a time when we perceive people as
made up of interchangeable parts that can be swapped out once they're finished
being used by one person and needed by another? We may well need to allow
donors to choose whether to be universal donors or to select which parts
they'll donate.
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- At least we don't have to worry about incompatibility
among manufacturers. A Ford transmission won't work in a Toyota, but ears
are ears. In a way, it's comforting to know that we're all of the same
stuff. And from the standpoint of replacing body parts, it's also convenient,
if controversial. Of course, I write these last few sentences with tongue
planted at least partly in cheek -- and don't worry, it's my own.
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- Feeling worn out? Surgeons are on the cusp of being able
to transplant nearly any body part we can think of. Such advances don't
come without costs, however. How much health risk should patients take
in return for a transplant that may be life-enhancing but not lifesaving?
Will people be willing to donate all their body parts when they die, or
only those that can save lives? Who should bear the financial costs, and
are they worth it?
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