4 research outputs found
Global Kidney Exchange: Analysis and Background Papers from the Perspective of Medical Anthropology
Global Kidney Exchange (GKE) is a program aimed at facilitating trans-national kidney donation. Although its proponents aim at reducing the unmet demand of kidneys in the United States through the trans-nationalization of kidney exchange programs, the World Health Organization (WHO) and The Transplantation Society (TTS) have expressed concerns about its potential effect on black markets of organs and transnational organ trafficking, as well as on low- or middle-income countries health systems. For GKE to be implemented, it would need to be permitted to operate in at least some low- or middle-income countries. Should a low- or middle-income country allow GKE’s implementation?
With the aim of answering this question, the eighteen University of Denver students in the Medical Anthropology course I [Alejandro CerĂłn] taught in autumn 2017, identified and researched the different aspects that would affect this issue, and delved in a holistic analysis we present in this report.
Based on our analysis, health authorities in low- or middle-income countries faced with decisions about GKE need to consider the following aspects: the country’s current and projected needs related to kidney transplant, as well as the capacity for addressing those needs; the country’s current situation related to organ trafficking, transplant tourism and black markets of organs; the current and projected legislation related to both organ donation and human trafficking; the prevailing ethical considerations that inform the practice of all professionals related to organ transplant in the country; analyze end-stage renal failure as a preventable disease needing public health measures; and the sociocultural aspects that surround organ donation in the country. We consider that the concrete configuration of these aspects would influence the effects of implementing GKE. Additionally, we identified some issues of concern that are beyond the level of influence of local authorities: the unmet demand of kidneys in high-income countries is a reality that incentivizes organ trade and transplant tourism, and this is a problem in need of solutions; transnational organ trafficking as well as human trafficking with the purpose of organ donation are problems that need more visibility; for a global exchange of organs to be implemented, it would need to rely on supranational or transnational regulation and oversight; and the global epidemic of chronic kidney disease needs to be addressed through a public health perspective that emphasizes prevention
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EPIREGULIN creates a developmental niche for spatially organized human intestinal enteroids
Epithelial organoids derived from intestinal tissue, called enteroids, recapitulate many aspects of the organ in vitro and can be used for biological discovery, personalized medicine, and drug development. Here, we interrogated the cell signaling environment within the developing human intestine to identify niche cues that may be important for epithelial development and homeostasis. We identified an EGF family member, EPIREGULIN (EREG), which is robustly expressed in the developing human crypt. Enteroids generated from the developing human intestine grown in standard culture conditions, which contain EGF, are dominated by stem and progenitor cells and feature little differentiation and no spatial organization. Our results demonstrate that EREG can replace EGF in vitro, and EREG leads to spatially resolved enteroids that feature budded and proliferative crypt domains and a differentiated villus-like central lumen. Multiomic (transcriptome plus epigenome) profiling of native crypts, EGF-grown enteroids, and EREG-grown enteroids showed that EGF enteroids have an altered chromatin landscape that is dependent on EGF concentration, downregulate the master intestinal transcription factor CDX2, and ectopically express stomach genes, a phenomenon that is reversible. This is in contrast to EREG-grown enteroids, which remain intestine like in culture. Thus, EREG creates a homeostatic intestinal niche in vitro, enabling interrogation of stem cell function, cellular differentiation, and disease modeling