Organ Transplantation: The Ethics of Consequences
Organ allograft transplantation, as a life-saving procedure for those in endstage irreversible organ failure, has benefited and progressed because of the innovations in clinical and pharmacological research. Advancing the early studies in transplantation Dr. Joseph Murray and colleagues were among the first to use pharmacological agents in transplant patients. I Initially, the agents used to enhance graft acceptance were either cytotoxic and suppressed all dividing cells in the body or cytostatic, such as the steroids, which attenuated the immune cells. These drugs, however, were non-specific, had unpredictable efficacy, and usually grave side effects. As knowledge and understanding of the immune system unfolded, so did new concepts for designing better methods of preventing organ allograft rejection. Early on, attention centered on the theory of graft "foreignness", but in the era of molecular biology, it has expanded to include the intricacies of the intracellular environment and the events, which comprise the recognition, activation and cellular proliferation of the immune response. This science has unmasked new strategies for the identification of targets for immunopharmacological intervention, so that each phase in the intracellular signaling system is available for modification or inhibition to alleviate the aggressive response that destroys the transplanted organ. Now more specific agents, which are directed to a distinct component of the immune response, are used to inhibit the initiation phase. In 1984, the discovery and use Cyclosporin-A (CsA), a powerful new immunosuppressive drug that lowers significantly the chances of rejecting