• Archives of Craniofacial Surgery
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• v.17 no.2
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• pp.68-76
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• 2016

Background: In scalp allotransplantation, the scalp from a brain-dead donor, including hair, is transferred to a recipient with scalp defects. Opinions differ on the appropriateness of scalp allotransplantation. In order to maintain graft function and cosmetic outcomes, scalp transplantation recipients would need to receive lifelong immunosuppression treatments. The risks of this immunosuppression have to be balanced against the fact that receiving a scalp allotransplant does not extend lifespan or restore a physical function. Therefore, the present study aimed to investigate risk acceptance and expectations regarding scalp allotransplantation in different populations. Methods: A questionnaire survey study was conducted. A total of 300 subjects participated; survey was conducted amongst the general public (n=100), kidney transplantation recipients (n=50), a group of patient who required scalp reconstruction due to tumor or trauma (n=50), and physicians (n=100). The survey was modified by using the Korean version of the Louisville instrument for transplantation questionnaire. Results: Risk acceptance and expectations for scalp transplantation varied widely across the groups. Kidney transplantation recipients revealed the highest risk acceptance and expectations, whereas the physicians were most resistant to the risks of scalp transplantation. Conclusion: Our study demonstrates that, in specific groups, scalp allotransplantation and the need for immunosuppression carries an acceptable risk despite the lack of lifeextending benefits. Our results suggest that scalp allotransplantation can be an acceptable alternative to existing scalp reconstruction surgeries in patients with pre-existing need for immunosuppression.

• Journal of Chest Surgery
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• v.55 no.4
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• pp.288-292
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• 2022

Ex vivo lung perfusion (EVLP) is a technique that enables active metabolism of the lung by creating an environment similar to that inside the body, even though the explanted lungs are outside the body. The EVLP system enables the use of lung grafts that do not satisfy the acceptance criteria for lung transplantation (LTx) by making it possible to evaluate the function of the lung grafts and repair lungs in poor condition, thereby reducing the waiting time of patients requiring LTx and consequently mortality.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.505-512
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• 2014

Background Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a functional or aesthetic result, which is not directly related to life extension. The purpose of this study was to analyze the difference in risk acceptance and expectations of LA between four population groups. Methods A survey was performed to examine patients' risk acceptance and expectations of LA. The survey included 287 subjects in total (general public, n=100; kidney transplant recipients, n=53; post-laryngectomy patients, n=34; doctors, n=100), using a Korean translated version of the louisville instrument for transplantation (LIFT) questionnaire. Results All four groups responded differently at various levels of their perception in risk acceptance and expectations. The kidney transplant recipients reported the highest risk acceptance and expectations, and the doctor group the lowest. Conclusions This study examined the disparate perception between specific population groups of the risks and benefits of using LA for the promotion of the quality of life. By addressing the information gaps about LA in the different populations that have been highlighted from this survey, we suggest that LA can become a more viable alternative to classical surgery with resultant improved quality of life for patients.

• The Journal of Art Theory & Practice
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• no.3
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• pp.109-116
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• 2005

• Journal of Chest Surgery
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• v.46 no.5
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• pp.328-339
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• 2013

Background: Ischemic injury and the rejection process are the main reasons for graft failure in tracheal transplantation models. To enhance the acceptance, we investigated the influence of mesenchymal stem cells (MSCs) on tracheal allografts. Methods: Extracted tracheal grafts from New Zealand white rabbits were cryopreserved for 4 weeks and orthotopically transplanted (control group A, n=8). In group B (n=8), cyclosporin A (CsA, 10 mg/kg) was injected daily into the peritoneal cavity. In group C (n=8), MSCs ($1.0{\times}10^7$ cells/kg) from the same donor of the tracheal allograft, which had been pre-cultured for 4 weeks, were infused intravenously after transplantation. In group D (n=8), MSCs were infused and CsA was injected daily. Four weeks after transplantation, gross and histomorphological assessments were conducted for graft necrosis, measuring the cross-sectional area of the allograft, determining the degree of epithelization, lymphocytic infiltration, and vascular regeneration. Results: The morphologic integrity of the trachea was retained completely in all cases. The cross-sectional areas were decreased significantly in group A (p=0.018) and B (p=0.045). The degree of epithelization was enhanced (p=0.012) and the lymphocytic infiltration was decreased (p=0.048) significantly in group D compared to group A. The degree of vascular regeneration did not differ significantly in any of the groups. There were no significant correlations among epithelization, lymphocytic infiltration, and vascular regeneration. Conclusion: The administration of MSCs with concurrent injections of CsA enhanced and promoted epithelization and prevented lymphocytic infiltration in tracheal allografts, allowing for better acceptance of the allograft.

• Journal of Korean Academy of Nursing
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• v.47 no.1
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• pp.110-120
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• 2017

Purpose: The purpose of this study was to describe the lived experience of patients with heart transplantation in Korea. Methods: Individual indepth interviews and a focus group interview were used to collect the data from nine patients who had heart transplantations in 2015. All interviews were audio-taped and verbatim transcripts were made for the analysis. Data were analyzed using Colaizzi's phenomenological method. Results: Among the nine participants, eight were men. Mean age was 57.30 years. Six theme clusters emerged from the analysis. 'Joy of rebirth obtained by good luck' describes the pleasure and expectation of new life after narrow survival. 'Suffering from adverse drug effects' illustrates various psychosocial difficulties, such as low self-esteem, helplessness, alienation, and burnout, arising from the side effects of medications. 'Body and mind of being bewildered' illustrates disintegrated health and haunting fear of death. 'Alienation disconnected with society' describes isolated feeling of existence due to misunderstandings from society. 'Suffering overcome with gratitude and responsibility' includes overcoming experience through various social supports and suitable jobs. Finally, 'acceptance of suffering accompanied with new heart' illustrate changed perspective of life itself. Conclusion: The findings in this study provide deep understanding and insights of the lived experience of heart related illness for these patients and should help in the development of tailored-interventions for patients with heart transplantation.

• IMMUNE NETWORK
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• v.4 no.1
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• pp.53-59
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• 2004

Background: Minor histocompatibility HY antigen, as a transplantation antigen, has been known to cause graft rejection in MHC (major histocompatibility complex) matched donor-recipient. The aim of our study is to investigate the role of male antigen (HY) disparity on MHC matched pancreatic islet transplantation and to examine the mechanism of the immune reaction. Methods: Pancreatic islets were isolated and purified by collagen digestion followed by Ficoll gradient. The isolated islets of male C57BL6/J were transplanted underneath the kidney capsule of syngeneic female mice rendered diabetic with streptozotocine. Blood glucose was monitored for the rejection of engrafted islets. After certain period of time, tail to flank skin transplantation was performed either on mouse transplanted with HY mismatched islets or on sham treated mouse. The rejection was monitored by scoring gross pathology of the engrafted skin. Results: HY mismatched islets survived more than 300 days in 14 out of 15 mice. The acceptance of second party graft (male B6 islets) and the rejection of third party graft (male BALB/c islets) in these mice suggested the tolerance to islets with HY disparity. B6 Skin with HY disparity was rejected on day $25{\pm}7$. However, HY mismatched skin transplanted on the mice tolerated to HY mismatched islets survived more than 240 days. Tetramer staining in these mice indicated the CTL recognizing MHC Db/Uty was not deleted or anergized. Conclusion: The islet transplantation across HY disparity induced tolerance to HY antigen in C57BL6 mouse, which in turn induced tolerance to HY mismatched skin, which otherwise would be rejected within 25 days. The MHC tetramer staining suggested the underlying mechanisms would not be clonal deletion or anergy.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.427-437
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• 2011

Purpose: Composite tissue allotransplantation is a new therapeutic modality to reconstruct major tissue defects of the head and neck region and extremities. However, there is a serious ethical debate about whether the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving this non-life saving procedure. The purpose of this study is to examine differences between expert and non-expert groups in risk acceptance and expectations regarding hand and foot allotransplantations. Methods: The author conducted a survey of 345 subjects in total (lay public n=110; medical students, n=120; doctors, n=115), using a questionnaire-based instrument, the Louisville Instrument for Transplantation (translated to Korean). Results: Of the three groups studied, risk acceptance was found to be lowest in the doctor group and highest in the non-expert group, and the difference was significant (p < 0.05). The expectations of aesthetic and functional improvement from the procedure, however, were found to be highest in the non-expert group and lowest in the doctor group, and the differences were also significant (p < 0.05). Conclusion: The results of this study shows that the three populations have noticeable differences in risk acceptance and expectations regarding hand and foot allotransplantations. Therefore, accurate and sufficient information on these procedures should be provided to patients from both medical and ethical perspectives.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1204-1212
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• 1990

Recent social and medical developments have significantly changed both the concept of death and the criteria for its pronouncement. Instead of considering. the heart as central to the determination for death, it is now prevalent to use death of the brain as adequate for death regardless of cardiac function in most western countries. But the brain death theory is not yet legally accepted despite growing public interest in our country due mainly to customary and moral reasons. Subsequently heart transplantation, which necessitates the concept of brain death, still remains a possible surgical entity in the future. As a part of endeavor the evaluate social atmosphere for the legal acceptance of the concept of brain death and the availability of potential heart donors, a four-page questionnaire on brain death and cardiac transplantation was given to the sophomore students of a medical college in Seoul[n=116, group I] and their family members[n=83, group II ]. The groups were chosen under the assumptions that they lacked sophisticated medical knowledge but had general medical interest so reliable data could be obtained. The majority of respondents in both group I and II thought that they knew the concept of brain death[group I 99.1%, group II 93.3%] and the definition of heart transplantation[group I 94%, group II 67.6%] at least to some extent, but only a small proportion of them was proven to have correct knowledge: brain death[74.4%, group II 39. 8%], heart transplantation[group I 31.9%, group II 30.1%]. Most respondents answered in the affirmative for the legal approval of brain death[group I 87.8%, group Il 97.9%]. The possibility of medical usage of brain dead organs was the biggest reason for brain death[group I 52.9%, group Il 47.9%]. Ninety-one percent of group I and 89.1 percent of group II responded that they were willing to give permission for donating the heart of brain-dead family members. Fifty-nine percent of group I and 51.9 percent of group II wanted their own heart donated. These results suggest, despite some inherent sampling limitations, that favorable responses to brain death and heart transplantation can be obtained among the general public if they are properly informed.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.555-560
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• 2010

Purpose: Facial allotransplantation (FA) could provide an excellent alternative to current treatments for facial disfigurement. However, despite being technically feasible, there continues to be various ethical and psychosocial issues associated with the risks and benefits of performing FA. The purpose of this study is to investigate risk acceptance and expectations in FA. Methods: In a quantitative assessment of risk versus benefit with respect to FA, from 2004 to 2008, Barker et al. developed and published a questionnaire-based instrument (Louisville Instrument for Transplantation [LIFT]), which contained 237 standardized questions. In the current study, the authors assessed risk versus benefits and expectations of FA using a Korean version of the LIFT. Respondents in three study groups (lay public, n=140; medical students, n=120; doctors, n=34) were questioned about risk acceptance as related to immunosuppression and tissue rejection, and expectations as related to quality of life improvement, and functional and aesthetic outcomes. A summary of the data has been provided and statistical analyses were performed. Results: Among the three study groups, results indicated that doctors accept the least amount of risk for a facial allotransplant, followed by medical students, and finally lay public. There was a significant statistical difference in three of the four questions regarding risk acceptance between the groups (p < 0.05). In general, lay public exhibited higher expectations for facial allotransplantation than the other groups. Additionally, there was a significant statistical difference in the importance of aesthetic outcome between the groups (p < 0.05). Conclusion: The authors' data indicate the three populations have vastly different levels of risk acceptance and expectations with regard to FA. Therefore, it is very important that surgeons establish clear, open, and thorough communication with patients in their consultations regarding FA. This is particularly important with respect to whether or not a patient's level of risk acceptance and expectations are progmatic.