A review of the development of transgenic animals at the company DNX to provide tissues for organ transplants is GEN (15 Oct 1993), 1, 22. Two papers arguing for and against matching MHC genes in human organ transplants are in Nature Genetics 5 (1993), 210-3. They represent the organ transplant policy systems of America and Europe (in Europe HLA matching is considered the most important factor in matching donated organs and recipients). A letter on unrelated living donor transplantation is in Lancet 342 (1993), 1061-2.

There was recent controversy in Germany over the use of corpses for car-crash tests at Heidelberg University; Lancet 342 (1993), 1416-7. The tests took place in the 1970s and 1980s using 200 bodies of adults and 8 children. Further tests are planned, and the scientists now say they will only use the bodies of those who have given their body to "science". These tests are not unusual, and have also been done at Hannover. In France, Renault says about 450 bodies have been used. Similar research has occurred elsewhere. Is this research beneficial? It may be more beneficial to saving human life in car accidents than the unknown benefits from some other bodies given for research have been used for.

A general paper arguing that people who have not had any transplant should come before those who have already had one is P.A. Ubel et al., "Rationing failure. The ethical lessons of the Retransplantation of scarce vital organs", JAMA 270 (1993), 2469-74. A debate on the ethical problems in the current Hungarian organ transplantation law is BME 92 (Oct 1993), 20-4. The European transplant systems discussion of opting in or opting out is discussed in Bioethics News 12(5), (1993), 20-9. Also on this issue, JAMA 270 (1993), 1930-1. The organisation of the US Medicare End Stage Renal Transplantation Service is reviewed in NEJM 329 (1993), 1395-9.

In mid-January an opinion poll of 2116 interviews conducted nation-wide in Japan in Dec 1993 was released in Yomiuri Shimbun (12 Jan 1994), 1, 20-21. Agreement that brain death is human death is rising, to 53.6%, with 18.2% saying no, and 28.2% saying not sure or either is OK. Over 60% agreed with the passage of an organ transplant law to allow transplants, with 20% opposed. The support for heart and liver transplants was basically the same, with 74-76% supporting them and 12-14% against. This agreement is in the same range as general opinion across Western countries.

Attitudes to organ donation and autopsy in the United States and Sweden are discussed in M. Sanner, "A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection: A Swedish survey", JAMA 271 (1994), 284-8, 317. The Swedish survey found 80% acceptance for personal autopsy, 60% willingness to donate organs, and 40% to donate the organs of a close relative. The autopsy rate is about 25% in practice. The autopsy rate in US hospitals has dropped from 60% in the 1950s to 12% in the 1990s, and under 5% in nonteaching community hospitals. For comparison the University of Tsukuba may have a rate of 30%, and it has also been falling. In a 1990 survey in the USA, 85% said they would donated a loved one's organs and 60% their own organs - suggesting a need for further investigation.

A special issue of Kennedy Institute of Ethics J. 3 (2) (1994),is on the topic, "Ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadavers". A system on distribution of livers is discussed in O. Bronsther et al., "Prioritization and organ distribution for liver transplantation", JAMA 271 (1994), 140-3.

A company called Xenogenex has awarded a US$1.85 million grant to a research team at St Louis University to develop the synthetic bioliver ; GEN (15 Jan1994), 1. This raises future possibilities for liver transplants. The costs of heart transplants are debated in CMAJ 149 (1993), 1829. Letters on survival after renal transplantation are in JAMA 271 (1994), 269-71. The use of umbilical cord blood transplants is discussed in Biotechnology 12 (1994), 23-4; Science 262 (1993), 1511.

The NIH has pledged that it will pay the costs for the development of three total implantable artificial hearts; HCR 24(1) (1994), 2-3. Three research teams will be given US$1.8 million over the next three years to produce a heart with an expected five year lifespan. The testing on humans may commence in the year 2000, following various long term animal tests.

A discussion of bioethics and genetic engineering of animals to provide organs for transplants is in GEN (1 Feb 1994), 28. The use of cell infusion to replace diseased parts of liver, as an alternative to some liver transplants, is raised from mouse studies, Science 263 (1994), 1149-52. On HLA matching and hearts, NEJM 330 (1994), 857

The use of children as organ donors is supported in L.F. Ross, "Justice for children: The child as organ donor", Bioethics 8 (1994), 105-26. The wide use of parental discretion is encouraged. Papers on the cost of transplants include: NEJM 330 (1994), 858-60; CMAJ 149 (1993), 1829-30. Commercialisation is discussed in New Scientist (19 Feb 1994), 44-5; JME 19 (1993), 148-53; Hospital Ethics (Sept 1993), 7-9.

Another paper reporting the attitudes in Sweden and USA to organ transplants by the same author (EEIN 4: 24) is SSM 38 (1994), 1141-52. A paper on the ethics of postmortem exams in Islam is JME 19 (1993), 164-8. The balance between forensic medicine and organ donation is discussed in JAMA 271 (1994), 891-2. In Japan, the draft law to enable organ transplants from brain dead donors has been tabled to Parliament, and has wide support, but the recent political chaos (With the latest scandal being the new Justice Minister's denial of the Nanjing massacre), is bound to further delay it.

A review is M.M. Farrell & D.L. Levin, "Brain death in the pediatric patient: Historical, sociological, medical, religious, cultural, legal and ethical considerations", Critical Care Med. 21 (1993), 1951-65. Two child cases of brain death and treatment are reported in BMJ 308 (1994), 618. On the philosophy of brain death, J. Med. Phil. 18 91993), 351-74.

The use of kidneys from non-heart beating donors is being used in some UK hospitals to increase the number of organs, BMJ 308 (1994), 549-50, 575-6. The results of kidney transplants in persons over 60 years are said to be the same as younger people in Lancet 343 (1994), 461-4; see also CMAJ 149 (1993), 1003. The computerised kidney donor registry in Wales is described in BMJ 308 (1994), 30-1.

Donations and gift-giving is debated in N. Gerrand, "The notion of gift-giving and organ donation", Bioethics 8 (1994), 127-50. She argues that charitable act is a better image - though in general perceptions one could comment there is not much difference. The availability of organs for donation is discussed in Lancet 343 (1994), 484-5.

A survey in Japan of the 18 hospitals ready for organ transplants from brain dead donors has found 6 of them say they consider performing them before the law allowing such transplants is passed; Asahi Shimbun (23 June 1994), 3. A Yokohama hospital has reported 4 cases of brain dead organ donors, from which 8 kidneys have been donated in the past year; Yomiuri Shimbun (19 June 1994), 15. The level of kidney donation has dropped in the last few years, at least the reported level, with the high profile of brain death. From 1980-85 96/314 kidneys were donated from brain dead donors, and in 1984-1988, 152/429 kidneys reported by a survey from Japan's Women's hospitals, were from brain dead donors. However, there were 11 court cases brought by opponents of transplants from brain death, making hospitals cautious to publicise the transplants. An alleged scheme for payment of Philippine kidney donors is reported in Yomiuri Shinbun (4 June 1994), 31. The donor was said to receive 3 million yen, however, the bad publicity in the newspaper may discourage the transplant.

In Japan the bone marrow donor network has now 50,000 listed, half of their target. Osaka University hospital has reported the implantation of an artificial heart, in a woman who died two days later; Yomiuri Shinbun (19 June), 30. A correction of a lysosomal storage disease by transplantation is reported in PNAS 91 (1994),, 2970-4.

A survey of religion conducted by Yomiuri Shinbun (26 June), 26; found that 53% of Japanese accept throwing the cremated ashes of the deceased into nature, but only 13% would like to do so themselves. They survey also found them quite suspicious of religious cults, who are seen as making money. A survey of the attitudes of doctors to postmortems in the UK is BMJ 308 (1994), 1080-1.

In the UK, a man has returned home after a 6 organ transplant, Times (25 June 1994), 4; Guardian (25 June 1994), 2. Equal rights for older patients in kidney transplants are called for in Lancet 343 (1994), 1169-70; and on racial inequities, JAMA 271 (1994), 1402-3. also see JAMA 271 (1994), 1157-8; Lancet 343 (1994), 971-2. The proceedings of the 4th International Congress on Pancreas and Islet Transplantation are in Transplantation Proceedings (April 1994). On liver-heart transplant for thalassemia, NEJM 330 (1994), 1125+; and on liver transplants for hepatitis B, NEJM 330 (1994), 1317-8. Parent to child transplant often has a higher rejection rate than thought, JAMA 271 (1994), 1716-7.

The procedural guidelines for obtaining organs in Canada are discussed in BME 96 (March 1994), 10-1. The French bioethics law (see above) has approved presumed consent, BMJ 308 (1994), 1119. There is continued shortage of organs everywhere, on the UK, BMJ 308 (1994), 938. The European Parliament resolution prohibiting trade in organs and promoting self-sufficiency in blood is in IDHL 45: 111-6. A debate over giving or selling blood is SSM 39 (1994), 201-6. There may be too many transplant centers in the USA for efficiency, JAMA 271 (1994), 1062-4.

In New Zealand many of the health services have been privatised, but the gift status of blood will be maintained, under the Blood Transfusion Trust. There are 161,500 registered donors among the 3.6 million people. The ethical issue is debated in JME 20 (1994), 31-5. The recent French law prohibits organ sale, New Scientist (2 July 1994), 6; BMJ 308 (1994), 1528; as does an Indian law; BMJ 308 (1994), 1657; Lancet 344 (1994), 48-9. A critical letter on organ trafficking is BME 99 (July 1994), 2.

A 15 year old boy in the USA who had stopped taking drugs and is losing a second liver, will not be coerced to have another transplant; BMJ 308 (1994), 1660-1. Part of a document produced on organ transplantation which includes rules for tissue banks, and a discussion of it, is in BME 98 (May 1994), 1, 10-11. It is also discussed in HCR 24(4) (1994), 5. On dissection, D.G. Jones, "Use of bequeathed and unclaimed bodies in the dissecting room", Clinical Anatomy 7 (1994), 102-7; Royal College of Pathologists of Australia, "Autopsy and the use of tissues removed at autopsy", MJA 160 (1994), 442-4.

The 15th World Congress of the Transplantation Society was held in Kyoto, Japan at the start of September. The debate on the brain death and organ transplant bill is set to begin finally at the end of September in the Japanese Diet (Parliament). The latest opinion poll suggests 70% agree that brain death is human death. The major objection to brain death was found to be fears of doctors taking organs out only to pursue their own interests. In the USA an average of 7 people die a day waiting for organs. One of the papers reported findings that ethnic counseling among blacks in Washington reduced their concerns and increased donor rate.

Methods to increase organ donation rates are discussed in CMAJ 150 (1994), 1401-6; BMJ 308 (1994), 1512; 309: 341; and on allocation, JME 20 (1994), 26-30; a study showing that small volume centres have higher mortality is J.D. Hosenpud et al., "The effect of transplant of transplant center volume on cardiac transplant outcome. A report of the United Network for organ sharing scientific registry", JAMA 271 (1994), 1844-9. See also SSM 39 (1994), 744-5.

A successful pig liver transplant for emergency purposes into a human for 10 days is reported in NEJM 331 (1994), 234-7, 268-9. A retrospective study suggests alcohol use does not threaten liver transplants as much as thought, JAMA 271 (1994), 1815. On bone marrow transplants, Lancet 343 (1994), 1486-8; BMJ 309 (1994), 4-5.

A discussion of the rights to sell organ parts is in J. Law & Med. 1 (1994), 229-34. A system for improving the local use of kidneys by HLA matching is reported in NEJM 331 (1994), 760-4, 803-5; and on liver matching, JAMA 272 (1994), 848-9. A study finding that exact kidney HLA matching would increase survival at five years by 4.4% only, is Held, P.J. et al., "The impact of HLA mismatches on the survival of first cadaveric kidney transplants", NEJM 331 (1994), 765-70. A report on access to kidney transplants in New Zealand, and restrictive lists of conditions, is in Lancet 344 (1994), 675.

Organ salvage policies are discussed in Council on Ethical and Judicial Affairs, AMA, "Strategies for cadaveric organ procurement. mandated choice and presumed consent", JAMA 272 (1994), 809-2, 814-5. They recommend mandated choice, e.g. in driver's licenses, as a way to increase organ donation. A study on the attitudes of medical students in New Zealand is Charlton, R. et al., "Effects of cadaver dissection on the attitudes of medical students", Med. Education 28: 290-5. They found some significant changes in first year students' attitudes to death, and to the cadavers.

The efforts to ensure safe organ transplants are discussed in FDA Consumer (Sept 1994), 10-3. The trends in mortality from coronary graft surgery are discussed in Lancet 344 (1994), 563-70. A comparison of New York and Canadian access to bypasses is JAMA 272 (1994), 934-41.

A report from the continuing brain death debate in Japan is in Lancet 344 (1994), 395-6. See also the editorial. A review of organ transplants in Asia is Ota, K. et al. "Situation of organ transplantation in Asian countries (1989-1990)", Transplantation Proceedings 26: 2457-60. A metal spine replacement is being improved, Science 265 (1994), 1806-7. An artificial liver used in the UK has saved at least 5 lives, keeping a person alive for up to 48 hours while waiting for a donor, Times (13 Sept 1994), 10.

A Dutch insurer has been ordered by a court to fund a Belgian transplant, that was against the advice of Dutch surgeons, BMJ 309 (1994), 689-90. The costs of transplants are discussed in NEJM 331 (1994), 813. In Denmark one of the two liver transplant centres has been closed, because of a high mortality rate,BMJ 309 (1994), 499-500. Bone marrow transplants for breast cancer are debated in Lancet 344 (1994), 418-9. A umbilical cord bank has been established in Israel, Lancet 344 (1994), 466-7. Technical book reviews are in JAMA 272 (1994), 1077-8.

Transplants of fetal pig pancreas to diabetic patients has found that it can survive, Groth, C.G. et al. "Transplantation of porcine fetal pancreas to diabetic patients", Lancet 344 (1994), 1402-4; Science 266 (1994),1323. Genetic engineering is another route to transplant survival; Biotechnology 12 (1994), 1054-5; Fodor, W.L. et al. "Expression of a functional human complement inhibitor in a transgenic pig as a model for the prevention of xenogeneric hyperactive organ rejection", PNAS 91 (1994),, 11153-7. A discussion titled "Xenotransplants set to resume", which includes discussion of animal ethics, is Science 266 (1994), 1148-50. Technical papers include PNAS 91 (1994), 10864-7.

A series of papers on organ transplants, reviewing the laws in Germany, Austria, Switzerland, Czech and the UK, are in IJB 5: 97- 120. In the USA another case of a baby being born to provide bone marrow to a sick sibling has been reported, and in this case the cells could come from the umbilical cord, USA Today (23 Nov 1994), 7.

In the September meeting of the Transplantation Society in Kyoto, a policy statement on ethics was released (see earlier), and a summary is in BME 101 (Sept 1994), 5. In a recent television program in Japan, a telephone service for buying a kidney was testing, and the conclusions were mixed as to whether it is happening. The organ transplant law in Japan does not forbid selling kidneys from live donors, and the new law is still in the waiting stage in the Parliament (rather than a debate stage some would say).

The denials of coroners have been suggested to have led to the deaths of up to 3,000 people in the USA, Shafer, T. et al. "Impact of medical examiner/coroner practices on organ recovery in the United States", JAMA 272 (1994), 1607-13. This count could be said to be more important in Japan were coroner laws prevent almost any donations. The European policies on marginal donor livers are arguably causing waste of some livers, Lancet 344 (1994), 1480-3; see also p. 1080. However, in the UK some dead bodies have been maintained on ventilators awaiting the set up for the transplant operation, which is illegal, Lancet 344 (1994), 1081. A general discussion on transplants is JAMA 272 (1994), 1704-9. A review of the mental problems that recipients may experience is Patchell, R.A. "Neurological complications of organ transplantation", Ann. Neurol. 36: 688-703.

The use of laboratory grown cartilage cells to treat knee injuries has been reported, ; NEJM (6 Oct 1994);GEN (15 Oct 1994), 3. Artificial retinas are discussed in Nature 372 (1995), 197-8. A way to remove toxins for people waiting for a liver is reported in New Scientist (26 Nov 1994), 26. Research on the dead is discussed in Lancet 344 (1994), 1517-8.

A summary of the report of the committee of the Health Council of the Netherlands on the use of human tissue is in BME 104 (Jan 1995), 8-9. A debate on the use of dead bodies for teaching is NEJM 331 (1994), 1652-5. On postmortems, BMJ 310 (1995), 141-2, 155-8.

A paper on some aspects of the brain death debate in Japan is Hardache, H. "Response of Buddhism and Shinto to the issue of brain death and organ transplant", CQHE 3 (1994), 585-601. As she says, they have not been very influential either way, and are recently following other discussion using some religious terms. There is no one view. The Christians have been most positive in promoting organ transplants using the love of giving one's body. The paper represents the academic views, which may be different to the public view, as I have said in previous issues. The number of Japanese who have received heart transplants overseas is now 20.

Comments on the low heart transplant rate in the Netherlands are BMJ 310 (1995), 78-9. Several papers on the issues of living liver donation are in CQHE 3 (1994), 602-621. A further series of papers on organ donation from a 1993 Trieste conference of the International Association of Law, Ethics and Science, is in IJB 5 (1994), 199-228. In order to combat the decline in donation rates they call for more international cooperation, including public information, technical assistance, and consideration of new techniques.

A philosophical paper examining brain death concepts for persons and human organisms is McMahan, J. "The metaphysics of brain death", Bioethics 9 (1995), 91-126.

A vote in the Netherlands Parliament has settled for an opting out system of organ donation, Lancet 345 (1995), 573-4.

In Japan an organ donor network was established in April, and the first member died and gave kidneys after brain death in early April; Yomiuri Shimbun (7 April 1995), 1.

A series of papers of interest to the success of organ transplants, the best system and the situation in Asian countries are in Transplantation Proceedings 27 (February 1995). Some of interest include a call for use of living donors for better matching, pp. 102-5; genetic methods to reduce rejection, pp. 180-3. On ethical issues, pp. 87-9; and donor difficulties in Asia, pp. 83-6. Ohkubo, M. "The quality of life after kidney transplantation in Japan: Results from a nationwide questionnaire", pp. 1452-7, which concludes that technically they are successful but the economic system is not yet established to aid recipients. The problem of the difference in those who say they will donate and the number who do is raised in pp. 1450-1. The countries in Asia reported on include Japan, Bangladesh, Saudi Arabia, Malaysia, Pakistan, Singapore, and Taiwan, pp. 1461-77.

A general review of trends in organ transplants, Lancet 345 (1995), 600; Nature Medicine 1 (1995), 20-2. On HLA typing, JAMA 273 (1995), 586-91. An artificial liver is discussed in New Scientist (4 March, 1995), 14; and a skin factory in New Scientist (11 March, 1995), 32-7.

The Nuffield Council on Bioethics in the UK has published its second report, Human Tissue. Ethical and Legal Issues (April 1995, ISBN 0-9522701-1-0, £10, 153pp.). It includes guidelines for consent procedures, restraints on commercial practices, the responsibilities of tissue banks, and calls for the UK and Europe to adopt a protocol relevant to the use of human and animal tissue in the European Patent Convention. The major conclusions are reproduced in BME 107 (1995), 8-9; also, NS (22 April, 1995), 8;BMJ 310 (1995), 1159. Germany may have an organ law soon, Lancet 345 (1995), 1230. India is making it more difficult for commercial organ trade, Nature Medicine 1 (1995), 190.

The dilemmas of organ allocation for undocumented foreigners ("called aliens in the USA!"), is CQHE 4 (1995), 229-38. A report on obtaining organs from a non-heart beating donor is KIEJ 5 (1995), 35-42; and they are useful for kidney transplants, Lancet 345 (1995), 1067-70. In the USA two undertakers were sentenced to four years prison for removing organs from dead bodies, and selling them to organ banks. On ventilation of potential organ donors, BMJ 310 (1995), 714-8. Ways to increase donation are discussed in BMJ 310 (1995), 1149-50, 1404; JAMA 273 (1995), 1176-8, 1578-9. Using newly dead for teaching is debated in NEJM 332 (1995), 1445-7; and on perinatal autopsy, MJA 162 (1995), 469-70.

The FDA will regulate xenotransplants, Science 268 (1995), 349, 630-1. On living donors, JME 21 (1995), 91-6.

There was controversy over the VIP treatment given to retired sports hero, Mickey Mantle in the USA for a liver transplant. He only had to wait for a couple of days for a liver, and although the hospital claims it was for medical reasons it also is likely it was because he was a VIP. There are problems in the way VIPs are treated - but it is difficult to envisage a situation where some will not have better access. In an older review of access to transplants, high ability to pay was the most powerful predictor of access to transplant for persons with end-stage disease and who have major, disqualifying contraindications to getting on the queue, Ozminkowski, R.J. et al. "Access to heart and liver transplantation in the late 1980s", Medical Care 31 (1993), 1027-42.

Artificial blood technology based on pyridoxylated hemoglobin conjugate is reviewed in GEN (1 May 1995), 1, 34; and freeze-dried blood, PNAS 92 (1995), 2419-20. Artificial retinas are being developed, Science 268 (1995), 637-8. The use of neo-organs for drug delivery in patients is being developed following successful trials on dogs, EBN 200 (1995), 2. Also on the science of transplants, JAMA 273 (1995), 876-9; Int. J. Art. Organs 18 (1995), 64-8; SA (June 1995), 46; Biotechnology 13 (1995), 449-53.

The Nuffield Council on Bioethics in the UK is reviewed in Science and Engineering Ethics 1 (1995), 194-6; BMJ 310 (1995), 1423-4.

The importance of spouse-donated kidneys is found following their high survival rates in recipients despite low graft compatibility, Terasaki, P.I. et al. "High survival rates of kidney transplants from spousal and living unrelated donors", NEJM 333 (1995), 333-6, 379-80. The high rate of survival is attributed to the healthy state of the donors. On living organ donors, JME 21(1995), 91-96.

An estimate that up to 50 illegal kidney transplants are carried out each day in India is reported in BME 109 (1995), 4. This is despite the 1994 Human Organs Transplant law. Methods to protect people in a commercial system are discussed in Banks, G.J. "Legal & ethical safeguards: protection of society's most vulnerable participants in a commercialized organ transplantation system", AJLM XXI (1995), 45-110.

Pathologists are calling for increasing the autopsy rate, to better identify causes of death, JAMA 274 (1995), 1889-91. Another reason may be to check the mistakes of medical doctors. A UK survey of 218 who wanted their body to be donated for dissection is Richardson, R. & Hurwitz, B. "Donors' attitudes towards body donation for dissection", Lancet 346 (1995), 277-9. The reasons included altruism, avoiding funerals, avoiding waste. 44% understood their bodies would be used for teaching and 42% for experiments. They all rejected financial incentives. A US survey is in JAMA 273 (1995), 1907. Consent for invasive procedures on the newly deceased is a matter of contention, for training of medical students, JAMA 273 (1995), 128-9. On the history of dissection, Nature 376 (1995), 561.

Letters against elective ventilation of potential organ donors in the UK are BMJ 311 (1995), 121-2. French GPs are launching an organ donor campaign, BMJ 311 (1995), 214-5.

The Muslim Law Council of the UK has accepted that Muslims should donate and receive organs, Lancet 346 (1995), 303. There has been controversy in Japan following the apology of a Tokyo Women's College doctor for using 13 kidneys that had been rejected in the USA, for Japanese operations, Lancet 345 (1995), 41-2. The low survival of non-heart beating donor kidneys are debated in Lancet 346 (1995), 53-4, 322. The same hospital is also criticised for hepatitis transfer, Japan Times (245 August, 1995), 2. Related to the subject of the legal situation in Japan regarding criminal investigations obstructing organ donation: There has also been some controversy in Auckland, New Zealand, with a Coroner ruling that organs could not be taken from a body which may have died the result of a criminal act. The body is dead when a doctor certifies it is dead, but there are doubts like this expressed occasionally in countries where there are major organ transplant programs.

The naturality of dying in Japan is debated in Lock, M. (1995) "Contesting the natural in Japan: Moral dilemmas and technologies of dying", Culture, Medicine and Psychiatry 19: 1-38; Lock, M. "Contests with death: ideologies of nationalism and internationalism in Japan", pp. 169-188 in I. Robinson, ed., Life and Death under High Technology (Manchester University Press, 1994); and paper forthcoming in Daedalus. Also see her commentary in the September 1995 issue of EJAIB.

A call for reexamination of the concept of death is Emanuel, L.L. "Reexamining death. The asymptotic model and a bounded zone definition", HCR 25 (July 1995), 27-35. The ethics of organ transplants are discussed in Kielstein, R. & Sass, H.-M., "From wooden limbs to biomaterial organs: The ethics of organ replacement and artificial organs", Artificial Organs 19 (1995), 475-80.

A series of papers on organ transplantation are in IJB 6 (!995), 102-145, 166-7 (many in French with English abstracts); JAMA 273 (1995), 1723-5. A report after 210 transplants at Ottawa Heart Institute is CMAJ 152 (1995), 2029 -32. In South Africa there has been debate over the high cost and limited budget for heart transplants, BMJ 311 (1995), 280. The gene responsible for female anti-male organ immune rejection has been found, Nature 376 (1995), 642. Umbilical cord transplants are discussed in JAMA 273 (1995), 1813-5; NEJM 333 (1995), 67. Treating diabetes with transplanted cells is reviewed in SA (July 1995), 50-8.

One company that is pursuing pigs as transplant donors is Imutran (Cambridge, UK). It has the world's largest herd of transgenic pigs with genetically engineered organs, GEN (1 June 1995), 8-9, 16. A research proposal using baboon bone marrow has been backed for a HIV trial in Nature 376 (1995), 204; Lancet 346 (1995), 369; Science 269 (1995), 293-4. The complete reconstitution of mouse liver with rat cells is reported in Rhim, J.A. et al. "Complete reconstitution of mouse liver with xenogenic hepatocytes", PNAS 92 (1995), 4942-6. On xenotransplantation, Nature Medicine 1 (1995), 403-4; Biotechnology 13 (1995), 737-8; Lancet 346 (1995), 107. One of the fears of cross-species transplants is viruses, Nature 376 (1995), 8; which is also a fear for human tissue, Lancet 345 (1995), 69-74.

Ethics of xenografts are discussed in the animal ethics section. The trials involved pig heart transplants to rhesus monkeys with an average survival in 10 monkeys of 40 days, although the initial goal was 2 days survival!, Lancet 346 (1995), 766. Another way to deal with rejection was reported using antioxidant drugs, Science 270 (1995), 234-5.

The ethical issues of intrafamily transplants are discussed in Dwyer, J. & Vig, E. "Rethinking transplantation between siblings", HCR 25 (5, 1995), 7-12. A discussion of heart transplants is NEJM 333 (1995), 660-1. The national need for liver transplants is assessed to be about 10-15 per million population for Israel in Lancet 346 (1995), 660-2. Methods to lower the rejection of bone marrow transplants by transplanting more cells are given in Immunology Today 16 (1995), 437-40; also Nature 377 (1995), 576-7. Autologous blood donation is being encouraged in the UK, Lancet 346 (1995), 1029; and the future of umbilical cord-blood transplants, Lancet 346 (1995), 921-2. On skin-replacement, Biotechnology 13 (1995), 933; and artificial organs, Science 270 (1995), 230-33; SA (Sept 1995), 130-4.

In Australia there is controversy over charges for recipients to receive organs, donated freely, Lancet 346 (1995), 628. In the UK there is debate over blood charges, with an editorial titled, "Trading trust for blood money", Lancet 346 (1995), 855. A new Polish organ transplant law was passed, based on presumed consent. On increasing the number of transplants, BMJ 311 (1995), 685; and a rejection of mandated choice is JAMA 274 (1995), 942-3.

A survey of sixty patients 16 years of age or less declared brain dead from January 1987 through December 1992 in southwestern Ontario, was made to document the criteria used to declare brain death in a pediatric critical care unit (PCCU); Parker, B.L. et al., "Declaring pediatric brain death: current practice in a Canadian pediatric critical care unit CMAJ 153 (1995), 909-916. Pediatricians used clinical criteria based on the 1987 guidelines of the CMA to diagnose brain death in pediatric patients, including neonates. When clinical criteria cannot be fully applied, ancillary methods of investigation are consistently used. Although the soundness of this pattern of practice is established for adults and older children, its applicability to neonates and infants still needs to be validated. A US study is Mejia, R.E. & Pollack, M.M. "Variability in brain death determination practices in children", JAMA 274 (1995), 550-3. On the difficulties of treating coma patients, JAMA 274 (1995), 562-9.

Dilemmas to medical students and staff from organ transplants are discussed in BME 113 (1995), 13-9. Protocols for recovery of organs from non-heart-beating cadavers are discussed in KIEJ 5 (1995), 323-34, 335-42. SCOPE Note 29 is on Organ Transplant Allocation, and is in KIEJ 5 (1995), 365-84. A review is Sugarman, J. et al. "Ethical aspects of banking placental blood for transplantation", JAMA 274 (1995), 1783-5.

Brain death law and religion is discussed in J. Law, Medicine & Ethics 23 (1995), 291-4. Criteria in children are discussed in JAMA 274 (1995), 1761-2. Letters on anencephalic infants as donors are in JAMA 274 (1995), 1757-9. Efforts to increase organs are suggested in JME 21 (1995), 195-6, 199-204. The New Zealand experience is reviewed in NZMJ 108 (1995), 295-6, 329-31.

Xenotransplants are discussed in the section on Animal Ethics. A paper on genetic and immune engineering of organs to lessen rejection is TIBTECH 13 (1995), 100-5. Dangers of cytomegalovirus transfer are discussed in Lancet 346 (1995), 1380-1. Increased heart transplant survival after HLA-DR matching is shown in Lancet 346 (1995), 1318-22. The need for liver transplantation is made in Lancet 346 (1995), 1168-9; and a study showing livers donated by men are more likely to be rejected than those donated by women is NS (4 Nov 1995), 12; and on sex mismatching, Lancet 346 (1995), 1117-21. Frozen organs should soon be possible, NS (2 Dec 1995), 15.

In 1994, 19,017 people received organs from 8,114 donors in the USA (United Network for Organ Sharing), NS (2 March 1996). 76á9% of people who had a lung transplant in 1993 were still alive a year later, up from 47% in 1988. Kidney transplants from living donors had the highest one-year survival rate at 97á2%. However there are longer waiting lists as transplant operations become more routine. In 1988 there were 27,644 people waiting for an organ, but by 1994 the figure had more than doubled to 56, 066. Medical directors of all seven Canadian adult liver transplantation centres, or their designates were surveyed in Michelle A. Mullen, MA et al. "Access to adult liver transplantation in Canada: a survey and ethical analysis", CMAJ 154 (1996), 337-342. Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list).

A successful program to obtain consent using social workers is in Haire MC & Hinchliff JP, "Donation of heart valve tissue: seeking consent and meeting the needs of donor families", MJA 164 (1996), 28-31. A review of the sociality of giving is Machado N, "The Swedish transplant acts: Sociological considerations on bodies and giving", SSM 42 (1996), 159-68. A debate on childhood donations is Delaney L et al. "Altruism by proxy: volunteering children for bone marrow donation", BMJ 312 (1996), 240-3. The ethics of umbilical cord transplants, Science 271 (1996), 586-8.

A High Court judge in the UK rightly criticized a surgeon who transplanted a cancerous kidney into a patient, and waited 7 months after the surgeon knew that the donor had cancer to tell the recipient, BMJ 312 (1996), 205-6. Fortunately the recipient survived. Xenografts are discussed in the animal rights section, see also Nature 379 (1996), 578.

On the 27 Feb - 1 March there was the Second International Symposium on Brain Death in Havana, Cuba. A female cybercadaver is now on-line and can be downloaded, like the male, on , JAMA 275 (1996), 269-70.

On the technical success of liver transplants due to carrying stem cells, Nature Medicine 2 (1996), 163-5. A recommendation that kidney-pancreas transplants be reserved for young patients with no history of congestive heart failure or patients with life-threatening hypoglycemia is Lancet 346 (1995), 1658-62. Cochlear implants in the deaf can improve communication ability, JAMA 274 (1995), 1955-61.

A new report is Nuffield Council on Bioethics, Animal-to-Human Transplants, the ethics of xenotransplantation, 1996, ISBN 0-9522701-2-9 146pp, 10 pounds). They recognize a potential benefit, and say breeding of pigs for patients who need organs is ethically justified, rather than primates, call for establishment of a committee to monitor the safety. There have been several other reports on the subject, BME 116 (1996), 3-4; Science 271 (1996), 1357; Nature 380 (1996), 6; Nature Medicine 2 (1996), 378; BMJ 312 (1996), 651, 657; Lancet 347 (1996), 683; NS (6 March 1996), 4. An analysis of the ethical issues is Mepham, TB et al. "An ethical analysis of the use of xenografts in human transplant surgery", BME 116 (1996), 13-9; and on technical ones, TIBTECH 14 (1996), 3-5.

A comparison of kidney transplant mortality rates is Lancet 347 (1996), 826-7. Liver transplants for treating small hepatocellular carcinomas are advised in NEJM 334 (1996), 693-9; and on effects of hepatitis C, NEJM 334 (1996), 815-20. Artificial heart research is discussed in Lancet 347 (1996), 960. A 35 year old women with Down's syndrome was given a heart transplant, after initial rejection, in the USA, Nature Medicine 2 (1996), 264. On umbilical cord transplants, JAMA 275 (1996), 910.

Poland has passed a new organ donation law, based on the opting out system, Lancet 347 (1996), 754. The law is in effect but the procedure for registering objections was still to be introduced! Brazil has also approved an opting out system. A discussion of surgery scars on Indian villagers who may have not even given consent for kidney removal is SA (March 1996), 12. Problems with organ donation in Italy are discussed in Lancet 347 (1996), 531. On the shortage of organs for transplantation, BMJ 312 (1996), 989-90.

The proper burial of archeological age human remains is being reexamined in Israel, NS (10 Feb 1996), 9. On medical uses of tissue, JME 22 (1996), 5-7.

An English summary of the Health Council of the Netherlands January 1995 report on brain death criteria is Network 10 (March 1996), 7-8. A call to change the law to prolong maintenance of dead bodies on respirators is Shaw, AB. "Non-therapeutic (elective) ventilation of potential organ donors: the ethical basis of changing the law", JME 22 (1996), 72-7.

Ethical issues are discussed in Zohar, NJ. "Toward justice in the organ trade", Israel Law Review 27 (1993), 541-65. On the shortage of organs for transplants, BMJ 312 (1996), 1357-8; SSM 42 (1996), 1049-55. Eurotransplant is using a computer to allocate kidneys, Lancet 347 (1996), 1326. Sweden is campaigning to increase organs by requiring consent form each person, but the distribution of forms to many patients has raised concerns, Lancet 347 (1996), 1256, 1401. Germany also has problems, Nature Medicine 2 (1996), 615. The social contract and kidney transplants are reviewed in JAMA 275 (1996), 1123-6. The attitudes of blood donors in New Zealand to receiving money is reported in BMJ 312 (1996), 1114, 1131-2. On the Indian Organ Transplant Act, IDHL 47 (1996), 88-91.

Xenotransplants are discussed in McCarthy, CR "A new look at animal-to-human organ transplantation", KIEJ 6 (1996), 183-8. The BMA has issued a statement generally agreeing with the Nuffield Council Report, BME 117 (1996), 3-4. Also, Nature Medicine 2 (1996), 403-4, 424-5; BMJ 312 (1996), 1186.

On organ donation schemes, comparing Spain and Australia, Monash Bioethics Review 15 (No. 2, 1996), 33-43; and in the USA, CQHE 5 (1996), 281-3, 285-299. A series of papers on the subject in Italian are in Bioetica e Cultura V (1996) 9, 27-70; and on brain death, pp. 71-80.

In the Netherlands surgeons are conducting heart bypass operations without stopping the heart, NS (8 June 1996), 20; and new devices are being made, Science 272 (1996), 668-70. On artificial blood, Lancet 347 (1996), 1322.

In the UK there are at least two groups campaigning against the transplantation of humanized organs from pigs into humans, one is Doctors and Lawyers for Responsible Medicine and the Basel Appeal against Gene Technology; GenEthics News (May/June 1996), 5. However, the BMA endorsed the Nuffield Council Report recommending their use. A review is HCR 26 (July/August 1996), 3; The US Institute of Medicine has backed some experimentation also, at the decisions of institutional ethics boards Science 273 (1996), 305-6; NS (27 July 1996), 7; Lancet 348 (1996), 324. On ethical issues, Biologist 43 91996), 144; and the public health risk, Science 273 (1996), 746-7. Monkey tests by Imutran suggest human trials for kidneys will soon begin, NS (26 July 1996), 10. In Switzerland 6 patients were given cow cell implants into their spines to control pain, NS (3 August 1996), 20.

A series of papers in Italian on organ donation are in Bioetica e Cultura V (1996), 27-70. Misinformation has been found in one community after an attitude survey, Exley, C. et al. "Attitudes and beliefs within the Sikh community regarding organ donation: A pilot study", SSM 43 (1996), 23-8. The commercial transactions of some doctors in Israel with kidneys has been exposed in a newspaper, and the government is investigating, Lancet 348 (1996), 189, 260; and donations to non-family members are now endorsed. Kidney allocation and ethics is discussed in Lancet 348 (1996), 194-5, 422, 453-7. Promotion of organ donor cards are analyzed in SSM 43 (1996), 401-8. In a campaign in Sweden 48% have agreed to be organ donors, and 52% declined, Lancet 348 (1996), 54.

As discussed in the animal experiments section, human organs that are left over from operations will be used to replace some animals, NS (22 June 1996), 6. Tissue engineering is reviewed in Nature Medicine 2 (1996), 824-6; Lancet 348 (1996), 466. Methods to reduce rejection continue to be developed, NS (7 Sept 1996), 20; Science 273 (1996), 109-12. Cord blood transfusion with unrelated recipients is reported in NEJM 335 (1996), 167-70; and placental blood in NEJM 335 (1996), 157-66, 199-201.

There have been ethical concerns expressed that the visible human man on the Internet from the NIH is actually an executed prisoner who gave consent and was chosen because his body could be quickly used for 1800 1mm thick frozen sections, after MRI; Nature 382 (1996), 657.

Japan is still to pass the organ transplant law allowing transplants from brain dead donors, Nature Medicine 2 (1996), 835. On brain transplantation and personal identity, JME 22 (1996), 131-2.

The future of pigs in xenotransplantation is discussed in Nature Biotechnology 14 (1996), 698-9. Imutran has predicted the first pig to human kidney transplant will take place within a year following monkey trials, BME 121 (1996), 3. There are methods being developed to overcome hyperacute xenograft rejection reactions based on reshaping the foreign sugar molecules that cause much of this problem, GEN (1 Sept. 1996), 1, 28. A summary of the US Institute of Medicine guidelines is BME 121 (1996), 3-4; JAMA 276 (1996), 589-90; and the USDHHS has released new guidelines, Lancet 348 (1996), 953; NS (28 Sept. 1996), 7.

A new book in French is Vaysse, Jocelyne, Images du coeur, (Desclee de Brouwer 1996; 256pp., 140FF, 76 bis, rue des Saints Peres, 75007 Paris, ISBN 2-220-03841-6). As a cardiologist and psychologist, she has looked at people's images of the heart, and includes some examples of more than 200 drawings people made about their heart. It is related to the images of life question discussed in Bioethics for the People by the People.

A review is Kerrdige, IH. et al. "The clinical and ethical implications of hepatitis C for organ transplantation in Australia", MJA 165 (1996), 282-5. A book review on history of transplants is Lancet 348 (1996), 599-600. Vascularised pancreas transplants for diabetes may become possible, BMJ 313 (1996), 703-4; as may frozen heart transplants, NS (28 Sept. 1996), 22.

Diagnosing death is discussed in BMJ 313 (1996), 956-7. Misdiagnosing the persistent vegetative state is discussed in BMJ 313 (1996), 943. On world views and organ transplantation, Nature Medicine 2 (1996), 1062.

On the rise of organ tourism, and loosened kidney donation rules in Israel, BMJ 313 (1996), 1282-3; Lancet 348 (1996), 1374. A letter on allocation of cadaver kidneys is Lancet 348 (1996), 1246-7. The US has started rationing liver transplants, BMJ 313 (1996), 1350; USA Today (22 Nov 1996), 11A; (26 Nov 1996), 3C; NS (14 Dec 1996), 9. On the retrieval of organs for transplants in Australia, MJA 165 (1996), 356-7, 375-8.

Japanese moves to allow transplantation from brain dead patients are still anticipated, Lancet 348 (1996), 1373. A review on the death debate is Powner, DJ et al. "Medical diagnosis of death in adults: historical contributions to current controversies", Lancet 348 (1996), 1219-23. A new implant that can sustain heart patients waiting for a heart transplant has been tested, SA (Nov 1996), 44-5. Skin graft tolerance has been obtained for xenotransplants, Nature Medicine 2 (1996), 1185-6, 1211-6; Network 10 (Dec 1996), 10-2; Science & Engineering Ethics 2 (Oct 1996), 481-90.

A survey of 384 postoperative adult surgical patients in the UK found strong support among patients for the use of tissues in medical education, research, and science with the exception of those tissues which may transmit disease to others. Few patients (39; 10%) believed that they retained ownership of tissue removed at surgery. Most believed that the tissue belonged to the hospital (103; 27%), to nobody (103; 27%), or to the laboratory (77; 20%). Most patients had not been given any information about the possible uses of their tissues after removal; Start, RD. et al. "Ownership and uses of human tissue: Does the Nuffield bioethics report accord with opinion of surgical inpatients?" BMJ 313 (1996), 1366-8. The inpatients seem to endorse the conclusions of the Nuffield report regarding the ownership and uses of human tissue.

The question of who decides whether children have transplants (see also Fetal Environment and Neonates section) is discussed in BME 122 (1996), 3-4. An editorial on the teaching of resuscitation on the newly deceased, MJA 165 (1996), 412-3.

Ethical issues of organ transplants are discussed in IJB 7 (1996), 195-8, 199-201; and papers on a Jewish perspective are in ASSIA: Jewish Medical Ethics III (No.1, 1997), 5-17. Ethics of kidney sales are debated in Radcliffe Richards, J. "Nephrarious [sic] goings on: Kidney sales and moral arguments", J.Med. & Phil. 21 (1996), 375-416. The Brazilian law on organ donation was passed by the Congress and sanctioned by the President in February, 1997, Lancet 349 (15 Feb 1997). The law, which will come into force in March, makes every citizen a donor after death, unless a person's opposition has been documented.

On xenografts, the UK government report, Advisory Group on the Ethics of Xenotransplantation. Animal Tissue into Humans (The Stationary Office, formerly HMSO, London 1997, 25 pounds, ISBN 011-321866-4), has recommended no animal tissue be transplanted into humans at present, BME 124 (1997), 6-7; Science 275 (1997), 473; Nature 385 (1997), 279, 285; NS (18 Jan, 1997), 6; BMJ 314 (1997), 242, 247. There have been claims of a pig heart transplant into humans in India, but the autopsy suggested "butchery" with some pig organs inserted into the body of a patient who soon died. On research to produce artificial hearts, CMAJ 156 (1997), 553-5. Human xenotransplants banned in UK, NatBio 15 (1997), 214. The US FDA is still considering the issue, FDA Consumer (Dec 1996). On the use of tolerance for transplantation across xenogeneic barriers, NatBio 15 (1997), 26-7, 48-53, 196-204, 235-8.

On blood substitutes, NatMed 3 (1997), 10. Overcoming rejection is discussed in NatMed 3 (1997), 11. On skin transplants, FDA Consumer (Jan/Feb 1997), 13-7. On tumors after transplants, JAMA 277 (1997), 154-5.

Japan is reconsidering the organ donation bill, Lancet 348 (1996), 1727. A review of procurement of solid organs is NEJM 334 (1997), 422-31, 436-8.

On 24 April, 1997, the Lower House of Parliament of Japan passed a bill to recognize brain death as the legal definition of human death. If the bill, passed by a vote of 320 to 148 through the 500-seat lower chamber, is also approved by Upper House members, doctors would be allowed to remove organs from brain-dead patients whose hearts are still beating, on condition that the donors give their written consent for the procedure in advance. Dr. Taro Nakayama, lawmaker of the ruling Liberal Democratic Party and a leading proposer of the bill, said at a press conference that he hopes the passage will lead to more patients' lives being saved. Before that bill was passed, another bill which allowed organ transplants without defining brain death as legal death was rejected 76-399.

Before the vote, every political party except the Japanese Communist Party allowed its members to vote according to their personal convictions - the first time since the War that this has been done for any bill. To date about 170 patients have reportedly gone to foreign countries to try to receive transplants of organs from brain-dead bodies. The Japan Society for Transplants said it will work to encourage surgeons to establish ethical standards that will lead to a broad public acceptance of organ transplants. The Ministry of Health and Welfare set out the medical conditions that mark brain death in 1985, specifying that a patient is acknowledged as brain-dead only when the person is in a deep coma, unable to breathe unaided, with no pupilary reaction to stimulus and no brain stem reflexes, and that the condition must have continued for at least six hours. Children under the age of six are not included in the set of conditions. The ministry conducted a study that found only 1.5 percent of the deaths in Japan qualify as brain death under the stipulations (Asahi English News, 25 April, 1997).

A critique of brain death because of confusing definitions is Truog, RD. "Is it time to abandon brain death?", HCR 27 (Jan 1997), 29-37. On definitions of death, Lancet 349 (1997), 662-3; JME 23 (1997), 7-11. Brain transplants in chickens are being used to examine brain function, NS (15 March 1997), 16.

Allocating donor livers is discussed in BMJ 314 (1997), 1140-1. The way that implants can overcome immune rejection is discussed in NS (1 March 1997), 10. On artificial organs, NS (29 March 1997), 36-9; Nature Medicine 3 (1997), 373. In the UK organs may be able to be donated for research in the future, NS (5 April 1997), 5. A group of US nuns is donating their brains to research, Time (24 March 1997), 48-9. Criteria for umbilical cord blood banking may be adopted from gamete ones, Lancet 349 (1997), 642-3. Patients undergoing bone marrow transplantation have more risk of new solid cancers later in life, so they need monitoring, NEJM 336 (1997), 897-904, 949-50.

The main conclusions of the UK government report on xenotransplantation are in BME 125 (1997), 8-11; also on the issue, Dorlin, A. et al. "Clinical xenotransplantation of solid organs", Lancet 349 (1997), 867-71, 735-6; NS (1 March 1997), 6. The proviruses that may be transferred are one of the main concerns, Nature 386 (1997), 126-7; BMJ 314 (1997), 623. Fetal pig neural cells may have survived in a Parkinson's disease patient, Nature Medicine 3 (1997), 350-3.

On 24 April, 1997, the Lower House of Parliament of Japan passed a bill to recognize brain death as the legal definition of human death. If the bill, passed by a vote of 320 to 148 through the 500-seat lower chamber, is also approved by Upper House members, doctors would be allowed to remove organs from brain-dead patients whose hearts are still beating, on condition that the donors give their written consent for the procedure in advance. Dr. Taro Nakayama, lawmaker of the ruling Liberal Democratic Party and a leading proposer of the bill, said at a press conference that he hopes the passage will lead to more patients' lives being saved. Before that bill was passed, another bill which allowed organ transplants without defining brain death as legal death was rejected 76-399.

Before the vote, every political party except the Japanese Communist Party allowed its members to vote according to their personal convictions - the first time since the War that this has been done for any bill. To date about 170 patients have reportedly gone to foreign countries to try to receive transplants of organs from brain-dead bodies. The Japan Society for Transplants said it will work to encourage surgeons to establish ethical standards that will lead to a broad public acceptance of organ transplants. The Ministry of Health and Welfare set out the medical conditions that mark brain death in 1985, specifying that a patient is acknowledged as brain-dead only when the person is in a deep coma, unable to breathe unaided, with no pupilary reaction to stimulus and no brain stem reflexes, and that the condition must have continued for at least six hours. Children under the age of six are not included in the set of conditions. The ministry conducted a study that found only 1.5 percent of the deaths in Japan qualify as brain death under the stipulations (Asahi English News, 25 April, 1997).

A critique of brain death because of confusing definitions is Truog, RD. "Is it time to abandon brain death?", HCR 27 (Jan 1997), 29-37. On definitions of death, Lancet 349 (1997), 662-3; JME 23 (1997), 7-11. Brain transplants in chickens are being used to examine brain function, NS (15 March 1997), 16.

Allocating donor livers is discussed in BMJ 314 (1997), 1140-1. The way that implants can overcome immune rejection is discussed in NS (1 March 1997), 10. On artificial organs, NS (29 March 1997), 36-9; Nature Medicine 3 (1997), 373. In the UK organs may be able to be donated for research in the future, NS (5 April 1997), 5. A group of US nuns is donating their brains to research, Time (24 March 1997), 48-9. Criteria for umbilical cord blood banking may be adopted from gamete ones, Lancet 349 (1997), 642-3. Patients undergoing bone marrow transplantation have more risk of new solid cancers later in life, so they need monitoring, NEJM 336 (1997), 897-904, 949-50.

The main conclusions of the UK government report on xenotransplantation are in BME 125 (1997), 8-11; also on the issue, Dorlin, A. et al. "Clinical xenotransplantation of solid organs", Lancet 349 (1997), 867-71, 735-6; NS (1 March 1997), 6. The proviruses that may be transferred are one of the main concerns, Nature 386 (1997), 126-7; BMJ 314 (1997), 623. Fetal pig neural cells may have survived in a Parkinson's disease patient, Nature Medicine 3 (1997), 350-3.

Following the 24 March, 1997 bill allowing organ transplants in Japan; EJAIB (May 1997); Nature 387 (1997), 5, 835; a further bill has emerged; Yomiuri Shimbun (18 June 1997), 1. The donor must give consent in writing, then the family (who can also refuse to accept the consent). The very strict rules may make it unworkable, NatMed 3 (1997), 598; NS (3 May 1997), 11; BMJ 314 (1997),1298; Lancet 349 (1997), 1304. Some background on the organ transplant situation in Japan as reported overseas is Washington Post (25 April, 1997); NS (3 May, 1997), 11; Monash Bioethics Review 16 (3, July 1997), 10. It is expected that 8,000 people/year may be classified as brain dead but it is unknown how many will be put off respirators. Germany has also redefined death to make transplants easier, Nature 388 (1997), 4.

On xenografts, a review is Lanza, RP. et al. "Xenotransplantation", SA (July 1997), 54-9; a paper in French is Baertschi, B. "Xenografts and respect to animals", IJB 7 (1996), 289-95. British kidney association attitudes were 78% would accept a pig's kidney, and 17% would not, Lancet 349 (1997), 1775. A series of extracts from the Indian pig organ transplant, called "a national disgrace" by the editor, SK Pandya, are in Issues in Medical Ethics 5 (1997), 35-6.

In Egypt it is estimated that 98% of organs are bought, including 2000 kidneys, Yomiuri Shimbun (13 May 1997), 6; Aru Affu Bar Newspaper. On assigning organs, Medical Decision Making 17 (1997), 160-70, 231+; and paired programs, NEJM 336 (1997), 1752-5. A UK doctor was accused of refusing to conduct a liver transplant because the girl took an ecstasy tablet, BMJ 314 (1997), 1370. Privacy issues are discussed in BMJ 314 (1997), 1356. Danish donation data are in Lancet 349 (1997), 1558; and on China, SSM 44 (1997), 1271-83. Also on the ethics, Lancet 349 (1997), 1111; SSM 44 (1997), 1259-69; 45 (1997), 137-47; and technical, Lancet 349 (1997), 1282-4, 1358-60; Science 276 (1997), 15, 1646; Nature 387 (1997), 449.

Japan is soon to commence organ transplants and a series of hospitals licensed to obtain organs and conduct transplants has been set up. The Bill was issued in the official gazette of the Parliament in mid-July, Lancet 349 (1997), 1895. Germany has passed a law recognizing brain stem death as human death, BMJ 315 (1997), 11. Romania has adopted a new transplant law permitting transplants but not commerce, BMJ 314 (1997), 1784. Italy is reorganising its donation system, Lancet 349 (1997), 1821. In Papua New Guinea a 5 year old boy was sold to a childless family for US$1500 and 17 pigs, AAP (1 August 1997).

Canada's organ shortage is getting worse, CMAJ 157 (1997), 179-82. Every year about 1500 Canadians receive life saving organs. Decisions about organ donation should rest with potential donors, not next of kin, CMAJ 157 (1997), 160. Chaplains on transplant teams facilitate permission being given, BMJ 314 (1997), 1831. Kidneys in the USA may be pooled to increase chances of receiving organs from living donors, which have a 70% success rate compared to 58% from dead donors, NS (21 June 1997), 13; NEJM 336 (1997), 1752. A report from the 1995 Rotterdam Symposium on living organ donation is IDHL 48 (1997), 77-80.

On xenotransplants, Science 276 (1997), 1893; JAMA 277 (1997), 1902-3; Nature 388 (1997), 411. The blockade of CD2-LFA-3 interactions protects human skin allografts in immunodeficient mouse/human chimeras the SCID mice, NatBio 15 (1997), 759-62, 720. On trials of stem cell transplants for breast cancer, JAMA 277 (1997), 1827-9; and cell storage, O&G 89 (1997), 300-3.

Japan's new law that allows procurement of organs from brain-dead donors took effect October 16, 1997. Organ donor cards were circulated among government employees, see the conditions in past issues of EJAIB. On liver transplants in Japan, Lancet 350 (1997), 593. Gulf countries are reconsidering organ transplantation, Lancet 350 (1997), 574. On PVS, Lancet 350 (1997), 795-9.

Discussion on xenotransplantation is in BME 130 (August 1997), 1; NatMed 3 (1997), 935, 944-8, 951-2. The benefits and risks of hosting animal cells in the human brain are reviewed in NatMed 3 (1997), 964-9.

Children who help sick siblings appear to end up depressed, NS (23 Aug. 1997), 20. A letter arguing for anonymity in bone marrow donations is BMJ 315 (1997), 548-9. India is establishing and organ bank at AIIMS, Lancet 350 (1997), 500.

A study on the fate of individual myoblasts transplanted into DMD patient muscles is NatMed 3 (1997), 970-7. Immune cells can be taught to tolerate organs, NS (16 Aug. 1997), 9. On reduction of heart size to reduce heart failure, Lancet 350 (1997), 456. A review of cord blood banks in Europe is NEJM 337 (1997), 373-81.

A book review of Lanza, RP. et al., eds, Principles of Tissue Engineering (Academic 1997, 808pp., US$125) is in Nature 389 (1997), 453. Also, SA (Oct. 1997), 15-6. There has been a fall in the number of postmortem examinations in France, BMJ 315 (1997), 503.

On the Japanese view of life and death and bioethics, Japan Foundation Newsletter XXVI (August 1997), 1-5.

Endogenous human-tropic pig retroviruses are causing concern for cell and tissue engineering using pigs as donors, GEN 17 (1 Nov 1997), 1, 7, 34; Lancet 350 (1997), 868, 1148; Nature 390 (1997), 11; NS (18 Oct 1997), 3-4. A report from the Fourth International Congress for Xenotransplantation, Nantes, France (Sept 7-11, 1997) is in NatBio 15 (1997), 1239. On anencephalic babies as organ donors, Ethics & Medicine 13 (1997), 28-35.

The recovery of persons from states near brain death is discussed in Linacre Quarterly 64 (Feb 1997), 30-96. A discussion paper is Hoffenberg, R. et al. "Should organs from patients in permanent vegetative state be used for transplantation?", Lancet 350 (1997), 1320-1. On gifts, Lancet 350 (1997), 1713-4; BMJ 315 (1997), 1319. Grave-robbing is discussed in JAMA 278 (1997), 1115.

A series of papers in German and English on organ transplants and ethics are in Fritsch-Oppermann, ed., Organtransplantation und kulturelle Unterschiede (Loccumer Protokolle 61/96, 1997, 176pp.). Discussion of prisoners in China over donation of their organs is in Lancet 350 (1997), 1307. There is a shortage of organ donor cards in Japan, and the first actual donation occurred only recently, a few months after the law allowed donations, NatMed 3 (1997), 1309. On allocation of donor organs, Lancet 350 (1997), 1107.

On tissue engineering advances, GEN 18 (Jan 1, 1998), 1, 11; PNAS 94 (1997), 13380-2, 13885-90. Bioengineered skin is reported in Lancet 350 (1997), 1142. On artificial blood, NS (29 Nov 1997), 46-9. There is controversy over myoblast cell transplant therapy for MD, NatMed 3 (1997), 1058. Papers on cord blood transplants, Sugarman, J. et al. "Ethical issues in umbilical cord blood banking", JAMA 278 (1997), 938-43; Blood 90 (1997), 4665-78; which is generating increasing commercial interest, NatMed 3 (1997), 1184. The status of in utero stem cell transplants is reviewed in JAMA 278 (1997), 932-7. The end of transplant rejections is a hope for researchers, Lancet 350 (1997), 1526, 1718, 1729-33; and on HLA matching systems, BMJ 315 (1997), 1354-5.

By the end of 1997 157 patients from Japan went overseas for organ transplants from brain dead donors, with an average age of 11 years, 11 went to Australia, 27 to USA, and 6 to Germany; with the costs on average being Y22 million. There is still to be a transplant from a brain dead donor in Japan since the law went into effect in Sept. 1997. On liver transplants in rural Australia, MJA 167 (1997), 354-7. A ban on payment of blood donors in India is leading to a shortage in India, BMJ 316 (1998), 172; NatMed 4 (1998), 139. On blood substitutes, SA (Feb. 1998), 72-7. Kidneys can often be successfully transplanted from donors whose hearts have stopped beating, NEJM 338 (1998), 221-5. Priorities for lung transplants are discussed in Lancet 351 (1998), 4-5.

A paper arguing that decisions for organ donation should rest with donors not family is Monash Bioethics Review 17 (1, 1998), 1-2, 10-12. The political and economic aspects of organ shortages are discussed in SSM 46 (1998), 299-311. Embalming of bodies was used in the Old Kingdom of Egypt, Nature 391 (1998), 343-4; and research on neurotransmitters is being conducted, NS (10 Jan. 1998), 22. On organ donation from PVS, Lancet 351 (1998), 211-3; and on PVS, Lancet 351 (1998), 144.

The US FDA seeks more safety data before removing a hold on porcine xenotransplantation trials, NatBio 16 (1998), 224; NatMed 4 (1998), 131, 135-6; NS (24 Jan. 1998), 5; Nature 391 (1998), 423; Lancet 351 (1998), 271; Science 279 (1998), 648. There will not be a general moratorium on such trials, despite scientists' concern. There is public opinion in favour of the personal use if needed (about 80%), Nature 391 (1998), 315. On the UK views, NatBio 16 (1998), 120; Nature 391 (1998), 300. A general debate on the risks is NatMed 4 (1998), 141-4; Nature 391 (1998), 320-8.

Cultured blood vessels are being made, L'Heureux, N. et al. "A completely biological tissue-engineered human blood vessel", FASEB J. 12 (1998), 47-56, 43-6; NS (24 Jan. 1998), 6. Morphogenesis is the developmental cascade of pattern formation and body plan establishment, ending in the adult form. It has formed the basis for tissue engineering, a review is Reddi, AH., "Role of morphogenetic proteins in skeletal tissue engineering and regeneration", NatBio 16 (1998), 247-52. Neural transplantation suggests the brain has continuos capacity for reconstruction, TINS 20 (1997), 477-82.

A review of the US Institute of Medicine Report on Non-heart Beating Organ Transplantation is in KIEJ 8 (1998), 83-90. The US may change organ donation priorities, NatMed 4 (1998), 376. A case of donation from an intellectually handicapped cohabitant is discussed in J. Clinical Ethics 8 (1997), 165-70. There is a law suit in Hungary over allegations that tissue were removed without consent, BMJ 316 (1998), 647. Two people have been arrested in the USA for selling organs from executed Chinese prisoners to US clients, BMJ 316 (1998), 725. Israel has introduced an organ swap scheme, between families that do not have suitable matches - so that someone on the family gives if someone receives, NatMed 4 (1998), 377. There has also been a case of selling alleged in Israel, Lancet 351 (1998), 812.

Research to stop organ mismatching by Chimeric Therapies, Inc., is reviewed in GEN 18 (15 March, 1998), 1, 21, 28; see also, NS (28 Feb. 1998), 22. Also on tissue engineering, NatMed 4 (1998), 272-3. Muscle regeneration by bone marrow-derived myogenic progenitors is recorded in Science 279 (1998), 1528-30. Xenotransplantation is discussed in NatMed 4 (1998), 372-3. The risk of cancer after renal transplants is discussed in Lancet 351 (1998), 610-1, 623-8. Neonatal blood may be a source of stem cells for transplants, Lancet 351 (1998), 647-8.

A report from the Health Council of the Netherlands on xenotransplants is discussed in Network 13 (May 1998), 13. A critique of xenotransplants is Lancet 351 (1998), 1347-50; GenEthics News 23 (April/May 1998), 6-7, 9; and also Splice 4 (August 1998), 12-3; CMAJ 159 (1998), 41-3; MJA 168 (1998), 516-9. On cross species infection, NatMed 4 (1998), 644-5; NS (4 April 1998), 23.

Pregnancy after heart-lung transplants are found to be safe in Troche, V. et al. "Pregnancy after heart of heart-lung transplantation: a series of 10 pregnancies", Brit. J. O&G 105 (1998), 454-8. They reviewed 10 cases among 1400 recipients in France. On organ and tissue donation, NEJM 337 (1998), 1780-1.

Blood substitutes are described in Agnillo, FD. & Change, TMS. "Polyhemoglobin-superoxide dismutase-catalase as a blood substitute with antioxidant properties", NatBio 16 (1998), 667-71; Doherty, DH. et al. "Rate of reaction with nitric oxide determines the hypertensive effect of cell-free hemoglobin", NatBio 16 (1998), 672-6; 621-2. The development of biocompatible synthetic extracellular matrices for tissue engineering is reviewed in TIBTECH 16 (1998), 224-30. A review is Kirsner, RS. et al. "The development of bioengineered skin", TIBTECH 16 (1998), 246-50. Bioartificial nerve grafts are being developed also, TIBTECH 16 (1998), 163-8; NS (21 March 1998), 40-43; and a trial for Parkinson's is reported in rat models in NatMed 4 (1998), 569-74; Science 280 (1998), 1301; BMJ 316 (1998), 1407; and Huntington's disease, NatMed 4 (1998), 669-70, 727-9. The question of who to give pancreas transplants to is discussed in Lancet 351 (1998), 1072-3. An artificial bladder is suggested in NS (13 June 1998), 16. Stem cells are discussed in SA (June 1998), 11-2.

On presumed consent, CMAJ 159 (1998), 135; Lancet 351 (1998), 1650-2. US organ transplant lists are being revised, Lancet 351 (1998), 1041. Kidney swapping is uniting some Jews and Muslims in Israel, Lancet 351 (1998), 1641. The WMA and Chinese Medical Association have organized a joint meeting on organ trafficking, Lancet 351 (1998), 1262, 1365. On regulation of placenta and other tissue products for commercial purposes, BMJ 316 (1998), 1928. Predictions on the fate of transplanted kidneys are discussed in Lancet 351 (1998), 963. Genes may help protect grafts, Lancet 351 (1998), 1749-50; and a new method to induce tolerance of organs by injecting spleen cells into the portal vein is reported in mice in PNAS 95 (1998), 6947-52.

In July a first planned organ donation after the 1997 Japanese Organ Transplant law had to be given up when the donor suffered major organ failure after becoming brain dead, Japan Times (5 July 1998), 2. 19 known organ donor card carriers have died to date since last year, but tough requirements mean that he was the first to meet the requirements! A paper defending a whole brain death definition of death is Bernat, JL. "A defense of the whole-brain concept of death", HCR 28 (March-April 1998), 14-23. A discussion of prediction of recovery from vegetative state is Lancet 351 (1998), 1751, 1763-7.

Ethical issues in the use of brain tissue in research are discussed in JME 24 (1998), 118-22. Cell transfer may aid recovery of stroke victims, NS (18 July 1998), 23; Lancet 352 (1998), 119. Recovery for PVS is discussed in Lancet 352 (1998), 485. Cortical processing in PVS is reported in Lancet 352 (1998), 200. The use of newly dead bodies for practicing resuscitation procedures is discussed in Otago Bioethics Report 7 (2, August 1998), 3-7.

Ethical issues in xenografts are discussed in JME 24 (1998), 18-24; Transplantation Proceedings 30 (1998), 2463-4; IDHL 49 (1998), 402-3. Human trials of xenotransplants can proceed with a licensing system in the UK, Lancet 352 (1998), 464; Science 281 (1998), 767; BMJ 317 (1998), 365; NS (8 August 1998), 3-4; Nature 394 (1998), 513. The FDA is issuing new rules on them, NatMed 4 (1998), 876. A series of papers on the techniques are in Transplantation Proceedings 30 (1998), 2458-83. An idea of fusing cow and human cells to make organs for donation is discussed in NS (11 July 1998), 4-5.

An algorithm to calculate rejection in cardiac recipients is Lancet 352 (1998), 263-70. Tumours can be transplanted by transplants, Lancet 352 (1998), 2-3, 31. Skeletal myoblast transplantation has been used in myocardial failure, NatMed 4 (1998), 929-33. New blood vessels can be grown, Lancet 351 (1998), 1826-7. Tissues may be grown in microgravity in space, NatMed 4 (1998), 901-7. On pancreatic transplants, NEJM 339 (1998), 115-7. Growth factors can be delivered by gene therapy to enhance tissue grafts, Human Gene Therapy 9 (1998), 453-6. Paraplegic rats can be recovered partially by macrophage implantation, NatMed 4 (1998), 814-21; and success in transplants for Huntington disease in a primate has been reported, NatMed 4 (1998), 963-6. A discussion of whether an ancient Roman dental artifact was an implant is Nature 394 (1998), 534.

France is creating a computer register of those people who register an objection to donating their organs, BMJ 317 (1998), 234. Presumed consent is discussed in Lancet 352 (1998), 150-1. The US transplant system should be changed as geographical location influences finding an organ, Lancet 352 (1998), 79. On organ donation and ethics, JME 24 (1998), 166-70; J. Med. & Phil. 23 (1998), 31-74; BMJ 317 (1998), 172-5. Rationing organs using psychosocial and lifestyle criteria is reviewed in Research in Nursing & Health 21 (1998), 328-37. There is renewed debate on the possibility of organ sale, especially in the case of kidneys, Lancet 351 (1998), 1950-2; 352 (1998), 166, 483-5. A study in japan finds that about 60 Japanese patients have gone to Asian countries to buy kidneys, and there is still a business even though it was prohibited in the 1997 Organ Transplant Law, Bioethics (in Japanese) 8 81889), 69-74. On kidney transplants from donors who hearts stop, NEJM 339 (1998), 48. Spain has the best record for organ donation in the world, with only 21% of families refusing to be donors and in surveys 85%+ of people support donating their organs, Lancet 351 (1998), 1868.

A paper discussing use of the body is Campbell, CS. "Religion and the body in medical research", KIEJ 8 (1998), 275-306. On the ethics of unknown kidney donors, Bioethics Examiner 2(3) (Fall 1998), 1, 5. Also on ethical aspects, Yoshida EM, Ferre E, Barrable BM: Issues in organ procurement: presumed consent, bioethical type II errors, and organ donor registries. Annals RCPSC 31 (1998), 333-5. A serially transplanted heart is still beating in the second recipient in Italy, Lancet 352 (1998), 1041. On pediatric transplants, BMJ 317 (1998), 897.

A review on research into tissue engineering is GEN (15 Sept. 1998), 11, 28, 38. The UK is expected to proceed with xenotransplant trials soon, GenEthics News 25 (Aug. 1998), 7-8; and guidance from the UK Xenotransplantation Interim Regulatory Authority is in BME 140 (1998), 19-24. There is less xenophobia in the UK now, NatBio16 (1998), 816; NatMed 4 (1998), 988; BMJ 317 (1998), 931-4. Technically also, less xenoreactive Abs are reported in Science 281 (1998), 1845-7; NatBio16 (1998), 994. Two trials of ex vivo connection to pig kidneys found no retrovirus transfer, Lancet 352 (1998), 666-7, 695-9, 699-701. However another trial found retroviral transfer, Martin, U. et al. "Expression of pig endogenous retrovirus by primary porcine endothelial cells and infection of human cells", Lancet 352 (1998), 692-4, 1390-1; see also Nature 392 (1998), 10-2.

The US transplant system is discussed in Lancet 352 (1998), 1071; Time (5 Oct. 1998), 50. There is geographic favoritism in liver transplants which raises ethical issues, NEJM 339 (1998), 1322-5; also JAMA 280 (1998), 1148-52, 1153-60, 1184-5. Brazil has stopped the presumed consent part of organ donation, and will require family or individual consent, Lancet 352 (1998), 1367. There have been no brain dead donors of hearts or livers in Japan since the organ donation law was enacted in 1997, so the government has agreed to the use of stickers expressing willingness or not upon driver's licenses, and health insurance cards.

A hand transplant was performed in France, which is still waiting for final results of immune tolerance, NS (3 Oct. 1998), 3. Prevention of skin graft rejection by immune tolerization is NatMed 4 (1998), 1015-9. The question of whether to search for optimal or maximal HLA matching is in NEJM 339 (1998), 1177-85, 1186-93, 1238-9. On cartilage transplants, Lancet 352 (1998), 1202. The history of blood use is reviewed in NS (24 Oct. 1998), 48-9.

There is growth of neural tissues, seen in advances in repair of rat spinal cord, NatMed 4 (1998), 1207; GEN (Dec. 1998), 1, 10, 47; Lancet 352 (1998), 1529; Science 282 (1998), 1018-9; Science News 154 (1998), 276; SA (Nov. 1998), 19-20. There are challenges to the idea of myoblast transplants in MD, Lancet 352 (1998), 1527; NatMed 4 (1998), 1208-9. The concept of brain death should be legally accepted in South Korea this year and a draft bill is being considered by Parliament, Lancet 352 (1998), 1996. A call for the rights of the dead to be protected for funerals etc. in the UK is called the Dead Citizens Carter, BMJ 317 (1998), 1472. A child who was intentionally buried 55,000 years ago is the oldest known intentional burial, Science News 154 (1998), 235.

The question of ownership of cord blood is discussed in Bioethics Examiner 2 (No. 4, Winter 1999), 1, 4. Cord blood is an alternative stem cell source to bone marrow, Lancet 352 (1998), 1835. Unmatched bone marrow can treat leukemia, BMJ 317 (1998), 1175. On placental blood transfusion, NEJM 339 (1998), 1565-77, 1628-9. A decline in altruism has endangered blood supplies in the UK, BMJ 317 (1998), 1405. On the supply and funding in Australia, MJA 169 (1998), 407-8; and in general, SA (Jan. 1999), 112-3. On selling eggs, University of Illinois at Chicago Dept. Medical Education Bulletin 5 (no.2, Jan 1999), 3-4. The question of consent is discussed in Clark, RE. "Bone-marrow donation by mentally incapable adults", Lancet 352 (1998), 1847-8. Legal issues in blood transfusion are reviewed in IDHL 49 (1998), 561-7.

A method to predict organ donation is proposed in AJPH 88 (1998), 1645-50. A paper on discrimination in organ transplants is Whitehead, AT. "Rejecting organs: The organ allocation process and the Americans with Disabilities Act", AJLM 24 (1998), 481-98. Better standards are called for in UK transplant services, BMJ 317 (1998), 1475. A review of cardiac transplants is JAMA 280 (1998), 1692-8. Retinal transplants could partially restore sight, NS (7 Nov. 1998), 23. Cochlear transplants are discussed in Lancet 352 (1998), 1836. A transplanted female crab claw onto a male adopted female behaviour, NS (14 Nov. 1998), 11.

Risks of viruses continue to be a fear in xenotransplants, Lancet 352 (1998), siv26; World Health 51 (No. 4, July 1998), 30. Herpes virus 8 can be transplant through kidney transplants, NEJM 339 (1998), 1358-63, 1391-2. On the risks and benefits of transplants in general, IDHL 49 (1998), 570-2. Transplant tolerance is discussed in NEJM 339 (1998), 1700-2; NS (12 Dec. 1998), 21; and a mismatch is better tolerated if between a mother and child than a father, probably because of pregnancy, NS (12 Dec. 1998), 29. The prospects of prolonging storage life of donor organs is explored in NS (7 Nov. 1998), 7.

A criticism of the wait for implementation of organ transplant supply improvements is Probe 7 (No. 6, 1 May 1999), 1, 4-5. UK surgeons have called for more donors, Nature 397 (1999), 380. An ethical analysis is Ubel, PA. et al. "Social responsibility, personal responsibility, and prognosis in public judgments about transplant allocation", Bioethics 13 (1999), 57-68. Letters on geographic bias in US liver allocation are in NEJM 340 (1999), 963-5. Switzerland has introduced a new organ transplant guideline which requires fair and equal access, and no commerce, Nature 397 (1999), 553. On Spanish donor rates which are the highest in the world, Lancet 353 (1999), 476. The National Funerals College of the UK has a Dead Citizens Charter, but it does not mention organ transplants, BME 144 (Jan. 1999), 10-1. In India a live kidney transplant was performed from a deaf and dumb brother without his specific consent, but mother's consent, Lancet 353 (1999), 1076. A discussion on liver kidney donors is BMJ 318 (1999), 409-10.

On tissue engineering, NatBio 17 (1999), 508 - 510; Humes, HD. et al. "Replacement of renal function in uremic animals with a tissue-engineered kidney", NatBio 17 (1999), 451 - 455, 421; Oberpenning, F. et al. "De novo reconstitution of a functional mammalian urinary bladder by tissue engineering" , NatBio 17 (1999), 149-155, 133-4; GEN 19 (15 April 1999), 7, 33. Bioartificial organs have been transplanted from research to reality, NatBio 17 (1999), 335-336. Book reviews of Starr, D., Blood. An Epic History of Medicine and Commerce, are NatMed 5 (1999), 258; NEJM 340 (1999), 973-4; Nature 398 (1999), 303-4.

The Swiss have banned xenotransplants, NatBio 17 (1999), 316. A French survey has found positive support, Lancet 353 (1999), 726. Europe has been asked to hold back from trials, Nature 397 (1999), 281; but Spanish researchers have protested, NatMed 5 (1999), 361. The FDA has decided against allowing xenotransplants from non-human primates because of viral fears, Nature 398 (1999), 543, 549, 643. Xenotransplants are discussed in Schlaudraff, U. "Xenotransplantation: benefits and risks to society", BME 146 (March 1999), 13-15; NatBio 17 (1999), 205-6. A series of papers on animal-to-human organ transplants are in Bulletin WHO 77 (1999), 54-81. A series of case studies on organ transplants are in AgBioethics Forum 10 (No. 2, Nov. 1998), 2-6. Recent laws are discussed in Dickens, BM. Guest Editor, Legal Developments in Transplantation. Annals of Transplantation 3(No. 3, 1998): 30-63.

Researchers have implanted tissue engineered bladders into dogs, BMJ 318 (1999), 350. A special report on tissue engineering is in SA (April 1999), 59-73. On artificial corneas, BMJ 318 (1999), 821-2. Adults may have the right cells to regenerate their organs if the cells could be controlled, NS (30 Jan. 1999), 6.

A report on the first legal heart transplant in Japan (see March issue) is Lancet 353 (1999), 821; Nature 398 (1999), 95. A series of papers in Japanese on organ transplants are in International Bioethics Network Newsletter (Waseda University) 28 (1999), 1-24. On brain death, Bioethics 13 (1999), 69-72. Parents of dead children in Bristol have protested that their children's hearts were removed during autopsies without telling them, BMJ 318 (1999), 486.

A report on Chinese use of executed prisoner's organs is Probe VII (No. 7, 1999), 2-3. A study of the charts of 209 patients who died at a Hospital in Calgary found a significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors, CMAJ 160 (1999), 1573-6. Pennsylvania plans to directly reward organ donation, BMJ 318 (1999), 1371. On resource allocation in liver donation, JAMA 281 (1999), 1381-6.