On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self‐evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We (...) present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost‐benefit, or patient autonomy. (shrink)

This book supports the emerging field of vascularized composite allotransplantation for face and upper-limb transplants by providing a revised, ethically appropriate consent model which takes into account what is actually required of facial and upper extremity transplant recipients. In place of consent as permission-giving, waiver, or autonomous authorization, this book imagines consent as an ongoing mutual commitment, i.e. as covenant consent. The covenant consent model highlights the need for a durable personal relationship between the patient/subject and the care (...) provider/researcher. Such a relationship is crucial given the recovery period of 5 years or more for VCA recipients. The case for covenant consent is made by first examining the field of vascularized composite allotransplantation, the history and present understandings of consent in health care, and the history and use of the covenant concept from its origins through its applications to health care ethics today. This book explains how standard approaches to consent are inadequate in light of the particular features of facial and upper limb transplantation. In contrast, use of the covenant concept creates a consent model that is more appropriate ethically for these very complex surgeries and long-term recoveries. (shrink)

Human uterus transplantation is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such (...) as face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx. (shrink)

The options currently available to women with uterine infertility are adoption or surrogacy. Recently the option of uterine transplantation has been explored which would allow a woman to carry her own genetically related child. Although this type of transplant raises similar ethical considerations to other types of non-life-saving organ transplantation, such as facial tissue and limb, it also raises its own very unique considerations. In this paper, some of the considerations surrounding uterine transplantation, such as informed consent and an (...) individual's rights, and potential limit to reproductive autonomy are explored. (shrink)

Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in (...) mind, we examine the current state of hand transplantation research in the context of available alternatives. We examine the ethics of carrying out these operations in minors, including under the protections of clinical research. We argue that children should not be considered for this surgery due to the substantial risks of immunosuppressive medication, the likelihood that the graft will need to be replaced during the patient’s lifetime and the lack of significant compensatory advantages over modern prosthetics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Transformative Journey of TransplantationValen KeeferThe moisture from the ocean floated effortlessly through the air as it glided over the rocky cliff. The steady stream of mist covered my face and frizzy hair with beaded water droplets. I had been sitting on a bench alone for hours admiring the Northern California coast at a magnificent overlook featuring a bird’s-eye view of the endless sea and campground I called home (...) for the past month. The stunning mountain landscape behind me, the soothing colors of the coastal shrubbery, and the smell of eucalyptus made for a trifecta of surreal beauty. The ocean disappeared from my view and I became engulfed in the precipitation and felt like I was suspended in a cloud. I was soaking in every moment as it was the last day of my solo RV trip.The fog slowly separated and exposed bits and pieces of the ocean again and then a breathtaking rainbow came into sight. Each end appeared to be touching either side of the campground like it was giving it a hug. I was eye-level with the center and highest point of the rainbow, arching above our home on wheels. I stood on the bench with my arms wide open, embracing nature and the gift of life in all its glory. This moment would not have possessed such deep meaning if it wasn’t for the journey that came before it—the transformative journey of transplantation.Some may think of transplantation as a singular event when in reality, it’s a lifelong journey that can start with a diagnosis many years prior. My transplant journey began when I was diagnosed with polycystic kidney disease (PKD) at 10-years-old. Being diagnosed with a hereditary disease that has deeply impacted multiple generations of our family and with no known treatment or cure was a lot to carry as a child.My youth was full of love from my parents and filled with illness and the limitations and long-term impacts of growing up with multiple chronic illnesses. My education on PKD was the brutal real-life experiences of enduring it firsthand—with no support groups, resources, or internet to seek answers. I always felt different during a time when you’d do anything to fit in. I couldn’t play sports and had to sit on the sidelines in gym class. I was often in the nurse’s office, hospital, or recovering from a surgery. I hid my scars and unattractive body while changing in gym class. Friendships were really hard. Relationships were even harder.Growing up with chronic illnesses takes away from the fun of dreaming. It’s like that bright future full of endless possibilities is blocked by a huge mountain you know you have to summit first with no supplies, no friends, and no paved path to follow.Complications from PKD followed me from high school right into college, when I spent almost a year in the hospital. Both of my kidneys were removed, I was on dialysis, had pancreatitis, received over 70 blood transfusions, survived an internal bleed, and was in dire need of a lifesaving kidney transplant.At 19-years-old, I was too sick to be placed on the transplant waiting list, but needed a kidney to survive. My parents were living at the Ronald McDonald House, wondering if they would be the next ones to lose their teenage daughter. A close family friend forever changed our lives when she restored my health by selflessly donating her kidney to me. While it was an arduous path to transplantation, in some ways, the journey was just beginning.Fifteen years following my kidney transplant and summiting what I thought was going to be the most challenging mountain of my health journey, I found myself back on death’s doorstep with another battle ahead. I was in need of a second miracle, this time a lifesaving liver transplant. It was PKD again. The bile ducts in my liver were so gnarly that they looked like limbs of an oak tree rather than the desired smooth straw-like appearance. Their malformations led to chronic liver infections and multiple sepsis... (shrink)

The goals of vascular composite allotransplantation for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This (...) study aimed to understand patients’ knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: knowledge and education around VCA as a treatment option; adaptation of individuals with limb loss; fear of risk associated with transplantation; issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options–prosthetics, rehabilitative strategies, and VCA—can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized. (shrink)

The concept of positional information is applied to a large amount of data obtained previously in experiments on developing and regenerating amphibian limbs. Only the proximo-distal axis of the limb is considered. It is shown that the concept provides a simple, unitary hypothesis which satisfactorily accounts for the experimental data, and may moreover suggest meaningful new approaches. It is suggested that the boundaries of the bipolar limb system lie in the girdle skeleton and at the distal end of (...) the limb, respectively, and that it is the apical epidermis of the growing or regenerating limb which defines the distal boundary conditions. A relatively stable gradient of positional information is assumed to be set up in the mesoderm . It is further shown that the differentiated limb retains its positional information and upon amputation imparts it to the base of the blastema. To explain an apparent discrepancy between the developing and the regenerating limb, it is proposed that dedifferentiation of mesodermal limb tissues upon amputation entails a change of positional value in the mesenchyme. Consequently, the amputation level does not once and for all specify the positional value at the proximal end of a mass of blastemal mesenchyme, particularly when the mesenchyme is transplanted in such a way that its linear size decreases or increases. (shrink)

This study explored the effect of kinesthetic motor imagery training on reaching-to-grasp movement supplemented by a virtual environment in a patient with congenital bilateral transverse upper-limb deficiency. Based on a theoretical assumption, it is possible to conduct such training in this patient. The aim of this study was to evaluate whether cortical activity related to motor imagery of reaching and motor imagery of grasping of the right upper limb was changed by computer-aided imagery training in a patient who (...) was born without upper limbs compared to a healthy control subject, as characterized by multi-channel electroencephalography signals recorded before and 4, 8, and 12 weeks after CAIT. The main task during CAIT was to kinesthetically imagine the execution of reaching-to-grasp movements without any muscle activation, supplemented by computer visualization of movements provided by a special headset. Our experiment showed that CAIT can be conducted in the patient with higher vividness of imagery for reaching than grasping tasks. Our results confirm that CAIT can change brain activation patterns in areas related to motor planning and the execution of reaching and grasping movements, and that the effect was more pronounced in the patient than in the healthy control subject. The results show that CAIT has a different effect on the cortical activity related to the motor imagery of a reaching task than on the cortical activity related to the motor imagery of a grasping task. The change observed in the activation patterns could indicate CAIT-induced neuroplasticity, which could potentially be useful in rehabilitation or brain-computer interface purposes for such patients, especially before and after transplantation. This study was part of a registered experiment. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

Abstract Gender and Ethics Committees: Where’s the Different Voice? -/- Prominent international and national ethics commissions such as the UNESCO Bioethics Commission rarely achieve anything remotely resembling gender equality, although local research and clinical ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject matter of modern bioethics so disproportionately concerns women’s bodies, and when such committees claim to derive ‘universal’ standards. Are women missing from many ethics committees because of relatively straightforward, if discriminatory, demographic (...) factors? Or are the methods of analysis and styles of ethics to which these bodies are committed somehow ‘anti-female’? It has been argued, for example, that there is a ‘different voice’ in ethical reasoning, not confined to women but more representative of female experience. Similarly, some feminist writers, such as Evelyn Fox Keller and Donna Haraway, have asked difficult epistemological questions about the dominant ‘masculine paradigm’ in science. Perhaps the dominant paradigm in ethics committee deliberation is similarly gendered? This article provides a preliminary survey of women’s representation on ethics committees in Eastern and Western Europe, a critical analysis of the supposed ‘masculinism’ of the principlist approach, and a case example in which a ‘different voice’ did indeed make a difference. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to (...) form, prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: -/- I gathered it in my hands as it fell from my hair-brush, too saturated to hold anymore. It felt as if I were inside a movie and waiting for someone to yell “Cut!” but no call came. It continued to fall, feather-like onto the ground, individual strands glinting in the light of the bathroom window. My hair, nearly all of it, was gone. Between the time of (...) my heart transplant and the moment my hair began to fall out, I arguably had suffered enough. Transplant brought four open-heart surgeries, ten days on ECMO, an intra-aortic balloon pump, delirium, necrotizing pneumonia, and so much muscular atrophy that I had to re-learn how to walk. CPR, broken ribs, and the scar of a tricuspid clip from a botched biopsy: it was not the miracle I was hoping for. The internal trauma had certainly taken its toll. I no longer knew how I really felt, thanks to copious pain meds that altered my mind and body. Each limb was foreign as I re-acclimated to how one grabs hold of a cup, signs their name, touches their legs. Externally, I was a mess: covered in deep purple bruises across my torso from the diabetes treatments, dead skin pooling in unwashed pores, my ankles swollen and indiscernible from my legs. But lacking a good mirror (or the desire to find one), I still felt like “myself” during my forty-five day hospital stay. I could feel my cheekbones protruding from thinning skin, saw through unfocused eyes from the tempestuous blood sugars, and my hair sat in a rat’s nest atop my head; but I was still me. -/- Arriving home, I felt like a newborn being brought into the real world for the first time. I needed help with everything—showers, sitting up, putting on shoes, even going to the bathroom. At age twenty-four, I felt I had regressed to the point of no return as I relied on others to do the simplest tasks. In addition, I was quarantined inside for three months, due to the risk of obtaining a fungal infection from the outside. Caged, and alone in my body, I a trapped and wounded tiger: angry, hurting, and scared. [End Page 109]When I had been prepared for transplant—and I use “prepared” loosely because the information packet I was handed was insulting at best—I knew to expect the scars. I had no issue with that, having been cut open at my throat and chest for previous surgeries. I knew to expect a 12-inch line from neck to navel: the most evident sign I would now carry that I was disabled. -/- What I did not expect were the bullet holes— the sealed entrances of thick chest tubes that now dotted my lower torso. I did not anticipate the bruises on my arms and groin from arterial pokes. I felt violated as if I had walked into some kind of abduction and was rolled out, beaten, bruised, and, worst, touched. But it wasn’t the physical trauma that hurt the most. It was that no one seemed surprised. Immediately after transplant, the team’s focus is purely on survival. Survive the 30 days post-surgery. Survive the year. Metrics, uncomfortably tied to transplant center success statistics, funding, and clout have little to do with the patients themselves. What did I care to only survive a year? I wanted years. I wanted decades. It felt I wanted more than anyone was willing to pay attention to. -/- The conversation was narrowed to high-risk issues: infection, rejection, or other life-threatening conditions. While this makes sense on a clinical level, what constitutes a major event for a clinician may not be of the same emotional value to the patient. In my case, I was less occupied by how the steroids were working and more obsessed with their side effects, such as how much weight I was rapidly gaining. I walked into the clinic one day with the beginnings of stretch marks and a week later had claw-like ripples down my sides. My mood swings were explosive... (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

The Research Center for Surgery (RCS) in Moscow is recognized as one of the largest and most prestigious surgical institutions in Russia. In this 400-bed facility more than 3,000 surgical procedures are performed annually, including heart, liver, and pancreas interventions and the reimplantation of limbs. The main focus of the research program at the RCS is on the transplantation of organs and reconstructive surgery. All procedures are free of charge to the patient.

Fractal structure is a ubiquitous property found in nature and biology, and has been observed in processes at different levels of organization, including rhythmic behavior and musical structure. A temporal process is characterized as fractal when serial long-term correlations and statistical self-similarity (scaling) are present. Previous studies of sensorimotor synchronization using isochronous (non-fractal) stimuli show that participants' errors exhibit persistent structure (positive long-term correlations), while their inter-tap intervals (ITIs) exhibit anti-persistent structure (negative long-term correlations). Auditory-motor synchronization has not been investigated (...) with anti-persistent stimuli. In the current study, we systematically investigated whether the fractal structure of auditory rhythms was reflected in the responses of participants who were asked to coordinate their taps with each event. We asked musicians and non-musicians to tap with 12 different rhythms that ranged from anti-persistent to persistent. The scaling exponents of the ITIs were strongly correlated with the scaling exponents of the stimuli, showing that the long-term structure of the participants' taps scaled with the long-term structure of the stimuli. Surprisingly, the performance of the musicians was not significantly better than that of the non-musicians. Our results imply that humans are able to readily adapt (rather than simply react) to the overall statistical structure of temporally fluctuating stimuli, regardless of musical skill. (shrink)

The possibility of a human head transplant poses unprecedented philosophical and neuroethical questions. Principal among them are the personal identity of the resultant individual, her metaphysical and social status: Who will she be and how should the “new” person be treated - morally, legally and socially - given that she incorporates characteristics of two distinct, previously unrelated individuals, and possess both old and new physical, psychological, and social experiences that would not have been available without the transplant? We contend that (...) this situation challenges linguistic conventions and conceptual binaries, and calls into question the major philosophical approaches to personal identity: animalism and reductionism. We examine these views critically vis-a-vis head transplantation and conclude that they fail to provide an adequate account of the identity of the resultant individual because both neglect the key role of embodiment for personal identity. We maintain that embodiment is central to personal identity and a radical alteration of the body will also radically alter that person, making her a different person. Consequently, a human head transplant will result in an individual partly continuous with the head/brain, and partly continuous with the body donor. We conclude that the resultant person would be different from both the individual whose head was transplanted and the one to whose body the “new” head is attached. (shrink)

Uterus transplantation (UTx) research has been introduced in several countries, with trials in Sweden and the United States producing successful outcomes. The growing interest in developing UTx trials in other countries, such as Spain, the Netherlands, Japan, and Australia, raises important questions regarding the ethics of surgical innovation research in the field of UTx. This paper examines the current state of UTx in the context of the surgical innovation paradigm and IDEAL framework and discusses the ethical challenges faced by those (...) considering the introduction of new trials. We argue that UTx remains an experimental procedure at a relatively early stage of the IDEAL framework, especially in the context of de novo trials, where protocols are likely to deviate from those used previously and where researchers are likely to have limited experience of UTx. We conclude that countries considering the introduction of UTx trials should build on the strengths of the reported outcomes to consolidate the evidence base and shed light on the uncertainties of the procedure. Authorities responsible for the ethical governance of UTx trials are advised to draw on the ethical framework used in the oversight of surgical innovation. (shrink)

The potential of the vertebrate limb as a model system to study developmental mechanisms is particularly well illustrated by the analysis of the Hox gene network. These genes are probably involved in the establishment of patterns encoding positional information. Their functional organisation during both limb and trunk development are very similar and seem to involve the progressive activation in time, along the chromosome, of a battery of genes whose products could differentially instruct those cells where they are expressed. (...) This process may be common to all organisms that develop according to an anterior‐posterior morphogenetic progression. The possible linkage of this system to a particular mechanism of segmentation as well as its phylogenetic implications are discussed. (shrink)

Uterus transplants provide another treatment for infertility. Some might think that we should embrace such transplants as one more way to assist people to have children. However, in this paper I argue that uterus transplants are not something that we ought to fund, nor something that we should make easy to access. First, I argue that any justification of providing uterus transplants must be based on the value of the experience of gestation, rather than on claims (...) of meeting medical need or promoting normal functioning. Second, I demonstrate that such a justification has limited prospects of success. The value of experiencing gestation is unlikely to be sufficient to justify state funding of uterus transplants and, further, we have reason to refrain from enabling such transplants. (shrink)

Brain transplant thought experiments figure prominently in the debate on personal identity. Such hypotheticals are usually taken to provide support for psychological continuity theories. This standard interpretation has recently been challenged by Marya Schechtman. Simon Beck argues that Schechtman's critique rests upon ‘two costly mistakes’—claiming that (1) when evaluating these cases, philosophers mistakenly try to figure out the intuitions that they think people inhabiting such a possible world ought to have, instead of pondering their own intuitions. Beck further asserts that (...) (2) brain transplant thought experiments cannot confirm any given theory of personal identity but rather they can only rule out theories. I argue on grounds of the social ontology of personhood that Beck has things back to front. Since our concept of personhood is shaped and informed by contingent de facto norms and structures of the natural world, and as such is heavily normatively laden, the conceptual genesis of personhood must be taken into account. This calls for constructing thought experiments as realistically as possible in order to trigger reliable intuitions. Furthermore, drawing on recent evidence from cognitive science, an empirically informed look at brain transplant thought experiments considering ‘Embodied Cognition’ reveals that Beck's arguments not only fall short for supporting psychological continuity theories, but also suggests an advantage of Schechtman's ‘Person Life View’. (shrink)

In this paper, we thoroughly investigate the various solutions proposed to solve the problems of transplantation system in Romania. Three types of solutions are especially envisaged: legislative ones, institutional ones and cultural/religious ones. We carefully analyze the main ethical and logistical arguments on presumed consent and its alternatives in Romania: family consent provided by the relatives and mandated choice. Special attention is dedicated both to institutional solutions (organizational, educational and information issues) and to religious arguments and motivations, for there were (...) several indicators of their importance for Romanian bioethical discourse in general and for their prevalence in transplantation debates in particular. . (shrink)

‘Transplant’ thought-experiments, in which the cerebrum is moved from one body to another, have featured in a number of recent discussions in the personal identity literature. Once taken as offering confirmation of some form of psychological continuity theory of identity, arguments from Marya Schechtman and Kathleen Wilkes have contended that this is not the case. Any such apparent support is due to a lack of detail in their description or a reliance on predictions that we are in no position to (...) make. I argue that the case against them rests on two serious misunderstandings of the operation of thought-experiments, and that even if they do not ultimately support a psychological continuity theory, they do major damage to that theory’s opponents. (shrink)

Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not (...) a necessary condition for objective meaning in life. (shrink)

Retinoic acid is a good candidate for a morphogen in chick limb bud development. The challenge now is to determine how retinoic acid interacts with limb bud cells and how the retinoic acid signal is integrated with other signals to mould and pattern the developing limb.

Previous studies have shown that the motion intention recognition for lower limb prosthesis mainly focused on the identification of performed gait. However, the bionic prosthesis needs to know the next movement at the beginning of a new gait, especially in complex operation environments. In this paper, an upcoming locomotion prediction scheme via multilevel classifier fusion was proposed for the complex operation. At first, two motion states, including steady state and transient state, were defined. Steady-state recognition was backtracking of a (...) completed gait, which would be used as prior knowledge of motion prediction. In steady-state recognition, surface electromyographic and inertial sensors were fused to improve recognition accuracy; five typical locomotion modes were recognized by random forest classifier with over 97.8% accuracy. The transient state was defined as an observation period at the initial stage of upcoming movement, in which only the sEMG signal was recorded due to the limitation of sliding window length. LightGBM classifier was validated to outperform other methods in the accuracy and prediction time of transient-state recognition. Finally, a simplified HMM model based on prior knowledge and observation result was constructed to predict upcoming locomotion. The results indicated that the locomotion prediction was over 91% accuracy. The proposed scheme implements the locomotion prediction at the initial stage of each gait and provides critical information for the gait control of lower limb prosthesis. (shrink)

The ethics of medically-authorized limb amputation in individuals with Body integrity identity disorder (BIID) remains extremely controversial. One factor to consider is the putative locus of a disease process, and whether the proposed treatment--in this case, limb amputation—reasonably addresses the issue of what organ is mediating the patient’s complaint.

According to the International Register of Organ Donation and Transplantation, Japan is one of the countries with the lowest number of registered deceased donors. In 2019, Japan was ranked 61st out of 70 countries. The authors of this article have decided to explore the reasons for this phenomenon. In the first part of the work, religious influences (Shinto and Buddhism), the tradition of gotai manzoku, the importance of altruism and the family in the perception of death and organ transplantation by (...) the Japanese are considered. The second part of the article presents the arguments of Alan Shewmon, who believes that brain death is not death in the biological sense. Undermining the brain’s death criterion raises doubts concerning death of patients in irreversible coma, what in result discourages transplantology in Japan. In the third part, the authors compare the results of JOTN, IRODaT and the Fact Book of Organ Transplantation 2018 in Japan from 2010 to 2018. The aim of the article is to explain the cultural determinants of transplantology in Japan, taking into account the influence of philosophical and bioethical aspects of human death. (shrink)

To controlforceaccurately under a wide range of behavioral conditions, the central nervous system would either require a detailed, continuously updated representation of the state of each muscle (and the load against which each is acting) or else force feedback with sufficient gain to cope with variations in the properties of the muscles and loads. The evidence for force feedback with adequate gain or for an appropriate central representation is not sufficient to conclude that force is the major controlled variable in (...) normal limb movements.Morton's hypothesis, thatlengthis controlled by a follow-up servo, has a number of difficulties related to the delays, gains, variability, and specificity in feedback pathways comprising potential servo loops. However, experimental evidence is consistent with these pathways providing servo assistance for some movements produced by coactivation of α- and static γ-motoneurons. Dynamic γ-motoneurons may provide an additional input for adaptive control of different types of movements.The idea that feedback is used to compensate for changes in musclestiffnesshas received experimental support under static postural conditions. However, reflexes tend to increase rather than decrease the range of variation in muscle stiffness during some cyclic movements. Theoretical problems associated with the regulation of stiffness are also discussed. The possibilities of separate control systems forvelocityorviscosityare considered, but the evidence is either negative or lacking. I conclude that different physical variables can be controlled depending on the type of limb movement required. The concept of stiffness regulation is also useful under some conditions, but should probably be extended to the regulation of the visco-elastic properties (i.e., the mechanical impedance) of a muscle or joint. (shrink)

Transplantation is becoming an increasingly more common approach to treatment of diseases of organ failure, making organ donation an important means of saving lives. Most world religions find organ donation for the purpose of transplantation to be acceptable, and some even encourage members to donate their organs as a gift of love to others. Recent developments, including artificial organs, transplants from nonhuman species, use of stem cells, and cloning, are impacting the field of transplantation. These new approaches should be (...) discussed with bioethical considerations in mind, particularly the notion of human beings as a unity of body and spirit. (shrink)

Organ availability for transplantation has become an increasingly complex and difficult question in health economics and ethical practice. Advances in technology have seen prolonged life expectancy, and the global push for organs creates an ever-expanding gap between supply and demand, and a significant cost in bridging that gap. This article will examine the ethical implications for the nursing profession in regard to the procurement of organs from an impoverished seller’s market, also known as ‘Transplant Tourism’. This ethical dilemma concerns itself (...) with resource allocation, informed consent and the concepts of egalitarianism and libertarianism. Transplant Tourism is an unacceptable trespass against human dignity and rights from both a nursing and collective viewpoint. Currently, the Australian Nursing and Midwifery Council, the Royal college of Nursing Australia, The Royal College of Nursing (UK) and the American Nurses Association do not have position statements on transplant tourism, and this diminishes us as a force for change. It diminishes our role as advocates for the most marginalised in our world to have access to care and to choice and excludes us from a very contemporary real debate about the mismatch of organ demand and supply in our own communities. As a profession, we must have a voice in health policy and human rights, and according to our Code of Ethics in Australia and around the world, act to promote and protect the fundamental human right to healthcare and dignity. (shrink)

“Medical Tourism” is the travel of residents of one country to another country for treatment. In this article I focus on travel abroad to purchase organs for transplant, what I will call “Transplant Tourism.” With the exception of Iran, organ sale is illegal across the globe, but many destination countries have thriving black markets, either due to their willful failure to police the practice or more good faith lack of resources to detect it. I focus on the sale of kidneys, (...) the most common subject of transplant tourism, though much of what I say could be applied to other organs as well. Part I briefly reviews some data on sellers, recipients, and brokers. Part II discusses the bioethical issues posed by the trade, and Part III focuses on potential regulation to deal with these issues. (shrink)

Many upper limb amputees experience an incessant, post-amputation “phantom limb pain” and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural (...) changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech “rubber hand” illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the “BairClaw” presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden. (shrink)

The field of reproductive medicine witnessed a breakthrough in September 2014 with the first successful live birth post uterine transplantation. This success represents the culmination of decades' worth of research on infertility and reproductive medicine. This subject of infertility gathers special attention in the Middle East, as childbearing is given paramount importance in the family unit. And as with any new medical advancement, Middle Eastern people look to their religious authorities for guidance. This paper describes the various ethical quandaries related (...) to uterine transplantation, from a perspective of the religious and societal factors that are unique to the Middle East, and embeds them within the conversation of its alternative solutions. (shrink)

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness requires a process of re-identification. (...) Medical interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has. (shrink)

Uterus transplants (UTx) provide women without a uterus the possibility of experiencing gestational motherhood. This paper delineates the complex bioethical landscape surrounding UTx, focusing on the critical aspects of informed consent, risk–benefit analysis, justice considerations, and the distinct challenges encountered by both donors and recipients. While not discussing UTx directly, John Harris’ seminal work, The Value of Life: An Introduction to Medical Ethics (1985) in its advocacy for reproductive freedom and informed consent provides an informative starting point for the (...) discussion. As an example, UTx is analyzed within the socio-political context of Mexico. The impact of the Mexican healthcare and legal systems on UTx procedures is discussed and the regulatory measures necessary to ensure that UTx is conducted ethically and equitably are outlined. (shrink)

This paper urges reconsideration of analyses of the alternatives to reproductive uterus transplantation (UTx). I focus here specifically on the adoption alternative. Importantly, my purpose is not to oppose UTx provision. Rather, it is to propose ways in which ethical analysis and provision of UTx can potentially accommodate the concerns discussed here. I argue that the adoption alternative to UTx is too readily dismissed, and that this is a dismissal with significant moral costs. I suggest that the radical nature of (...) UTx as a form of assisted reproduction calls for an equivalently radical socio‐moral agenda for reform and transformation of adoption law, policy and practice, as well as of the norms that prevail within our presently strongly bio‐normative reproductive context. In doing so I widen the ethical frame of responsible provision of assisted reproduction to encompass not just obligations towards donors and recipient, but also our broader social responsibilities to ensure that we are doing our best to meet the significant needs of some of the most vulnerable members of our society. (shrink)

Transplanting the Metaphysical Organ reconstructs Romantic Organology, a discourse that German Romantics developed by combining scientific and philosophical discourses about biological function and speculative thought. Organology attempted to think a politically and scientifically destabilized world, and offered a metaphysics meant to alter the structure of that world.

In this paper, changes in identity and selfhood experienced through organ transplantation are analyzed from a phenomenological point of view. The chief examples are heart and face transplants. Similarities and differences between the examples are fleshed out by way of identifying three layers of selfhood in which the procedures have effects: embodied selfhood, self-reflection, and social-narrative identity. Organ transplantation is tied to processes of alienation in the three layers of selfhood, first and foremost a bodily alienation experienced through illness (...) or injury and in going through and recovering from the operation. However, in cases in which the organ in question is taken to harbor the identity of another person, because of its symbolic qualities (the heart) or its expressive qualities (the face), the alienation process may also involve the otherness of another person making itself, at least imaginatively, known. (shrink)

This book analyzes the reasons for organ shortage and ventures innovative ideas for approaching this problem. It presents 29 contributions from a highly interdisciplinary group of world experts and upcoming professionals in the field. Every year thousands of patients die while waiting for organ transplantation. Health authorities, medical professionals and bioethicists worldwide point to the urgent and yet unsolved problem of organ shortage, which will be even intensified due to the increasing life expectancy. Even though the practical problem seems to (...) be well known, the search for suitable solutions continues and often restricts itself by being limited through disciplinary and national borders. Combining philosophical reflection with empirical results, this volume enables a unique insight in the ethics of organ transplantation and offers fresh ideas for policymakers, health care professionals, academics, and the general public. (shrink)

Definition of the problem: Stem cell transplantations from umbilical cord blood, especially if from autologous origin, are often treated with distrust. Not only are the therapeutic effects controversial, but the question of ownership is also hard to answer from an ethical point of view. Furthermore, the extraction of umbilical cord blood is already related to information about the factual and potential health condition of the child and its parents. Arguments and conclusion: The three problems will be discussed separately. Despite certain (...) uncertainties, there are no weighty ethical arguments against the extraction of umbilical cord blood for autologous purposes. The owner of the umbilical cord blood should be the mother. The question of information is not at all typical for this problem area and does not carry more weight here than in other relevant medical situations. (shrink)