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15.4K: Organ Transplants - Biology


New parts for old

Many organs and tissues are now routinely transplanted from one human to another. Except for the rare cases where the donor and recipient are monozygotic ("identical") twins, such grafts are called allografts.

  • kidney
    • Living donors can be used because they have two kidneys and can get along with only one.
  • heart
    • For patients with failing hearts (often because of inherited defects). Only cadavers can be used as donors.
  • lungs
    • Usually transplanted along with a heart. Some attempts have been made with portions of lungs from living donors.
  • pancreas
    • For people with Type 1 diabetes mellitus.
  • liver
    • For irreversible liver failure (e.g., from toxins, hepatitis B infection).
  • skin
    • For burns; usually taken from elsewhere on the patient's own body.
  • cornea
    • To restore sight; taken from cadavers.
  • blood
    • To temporarily restore blood volume.
  • bone marrow
    • As a source of blood ("hematopoietic") stem cells to repopulate the patient's own marrow that is
      • congenitally deficient in its ability to make one or more kinds of blood cells — Example: severe combined immunodeficiency (SCID)
      • has been destroyed by cancer therapy.
  • cord blood
    • Blood drained (through the umbilical cord) from the placenta of newborn infants. A convenient source of blood stem cells.
  • ovary
    • Has restored fertility and produced healthy babies but so far only when donor and recipient were monozygotic (identical) twins.

The Problems

  • Graft rejection
    • The patient's immune system "sees" an allograft as foreign (antigenic) and mounts an immune response against it.
  • Graft-versus-host disease (GVHD)
    • T cells in the graft "see" the tissues of the recipient as foreign antigens and mount an immune attack against them. This a particularly serious problem with grafts of bone marrow because of the many T cells in it.
  • Infections
    • Attempts to suppress the immune response to avoid graft rejection and GVHD weaken the ability of the body to combat infectious agents (bacteria, viruses, fungi).
    • More rarely, the donated organ may be infected and transmit the agent to the recipient. Tuberculosis, rabies, syphilis, hepatitis B, HIV-1, and several other diseases have been transmitted in this way. Potential organ donors are now routinely tested for evidence of infection by HIV-1 and -2, HTLV-1 and -2, hepatitis B and C (HBV, HCV), human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) as well as by Treponema pallidum (syphilis).
  • Cancer
    • Suppressing the host's immune responses also increases the risk of cancer.

Coping with the Immunological Problems

  • Use the patient's own tissue when possible (skin, bone marrow, blood vessels).
  • Use tissue from an "identical" (monozygotic) twin in the very rare cases that one is available. Being genetically identical, the recipient sees the transplant as "self", not as foreign, and does not mount an attack against it. The first successful kidney transplants (done in the mid 1950s) were between identical twins, and both donors and recipients went on to lead normal lives.
  • Use an "immunologically privileged" site. These are parts of the body where the immune system is prevented from mounting an attack. They include the eye, testes, and brain, but only the eye's privileged status has so far been exploited (for corneal grafts).
  • Use a relative, preferably a sibling, as the donor. While never identical, they may have inherited some of the same histocompatibility antigens so the recipient's immune response may not be as strong as it otherwise would be.
  • Tissue-typing. Determine the histocompatibility antigens of both recipient and potential donor and use the organ with the fewest mismatches.
  • Immunosuppression. Use immunosuppressive agents to blunt the recipient's immune response. Invariably required for all allografts.

Tissue Typing

The strongest antigens expressed by tissues are the class I and class II histocompatibility molecules. These are encoded by an array of genes on chromosome 6 called the major histocompatibility complex (MHC).

Class I molecules consist of a transmembrane protein to which are attached (noncovalently), a molecule of beta-2 microglobulin, and a short peptide. The class I transmembrane proteins are encoded by three loci: HLA-A, HLA-B, and HLA-C. Class I molecules are expressed at the surface of almost all the cells of the body (except for red blood cells and the cells of the central nervous system).

Class II molecules consist of two transmembrane polypeptides: an alpha (α) chain and beta (β) chain between which is nestled (noncovalently) a short peptide. The alpha and beta chains are encoded by clusters of loci in the region of chromosome 6 designated HLA-D. Unlike class I molecules, class II molecules are expressed on only a few types of cells, chiefly antigen-presenting cells (APCs) such as dendritic cells and macrophages, as well as other cells where inflammation is occurring.

Why so many MHC alleles

The genes of the MHC are the most polymorphic known. The graphic above shows the latest counts of alleles found at each locus in the human population. Of course, any one human can inherit a maximum of two alleles at each locus. The diversity of alleles in the population makes possible thousands of different combinations. In a study of 1000 blood and organ donors in San Francisco that were typed for HLA-A and HLA-B,

  • Over half the group had a combination that was unique.
  • Another 111 donors had a set of these molecules that they shared with only one other person in the group.
  • The most frequent phenotype (HLA-A1, HLA-A3, HLA-B7, and HLA-B8) was found in 11 donors.

The extreme polymorphism of the MHC did not evolve to frustrate transplant surgeons and their patients.

Why, then?

The function of class I and class II molecules is to "present" antigenic peptides to the T cells of the immune system. The peptides — usually about 9 amino acids long — are bound by noncovalent forces in a groove at the surface of the MHC molecule. These peptides can include fragments of protein antigens derived from intracellular pathogens (e.g. viruses). Different pathogens generate different antigenic fragments. Different MHC molecules differ in the efficiency with which they bind particular sequences of amino acids in these fragments. Therefore, we might expect that some MHC products would be better than others at presenting pathogen antigens to the immune system.

One piece of evidence: People infected with the human immunodeficiency virus (HIV-1) who have one particular HLA-B molecule are more resistant to developing a full-blown case of AIDS than those with other HLA-B molecules (even though some of these differ by only a single amino acid).

Another piece of evidence: Wegner and colleagues reported in the 5 September 2003 issue of Science the results of a direct test of this hypothesis. They exposed groups of sticklebacks — differing in the number of their class II alleles — to three types of parasite (all at once). They used two species of parasitic nematode and one species of trematode). Those fish with 5–6 different alleles resisted infection better than those with fewer (or more).

So it may well be that the great diversity of class I and class II alleles in the human population has helped ensure that no single pathogen can wipe out the entire population.

Techniques of tissue typing

Most tissue typing is done using serological methods: antibodies specific for those HLA antigens that have been identified in the human population. A reaction between cells of the subject and, for example, anti-HLA-A28 antibodies and HLA-A9 antibodies — but no other antibodies — establishes the phenotype. At the present time, routine typing is limited to establishing the phenotype at HLA-A, HLA-B, and HLA-DR.

Coming into wider use is DNA typing, especially for HLA-D antigens. It promises to improve the sensitivity and specificity of tissue typing. The totals of numbers of alleles at each HLA locus given in the graphic above are based on DNA typing.

How useful is tissue typing?

So what hope do these data hold for the dialysis patient awaiting a kidney transplant? If the patient has a large family of willing donors, the odds for a good match are not bad because of the tight linkage of the HLA loci.

Assuming that no crossing over occurs within the HLA region of either the mother's or the father's two number 6 chromosomes, there are four possible combinations in which they may transmit their alleles to their children. So even if the parents carry different alleles at each locus (which is often the case), there is a 1:4 probability that any one of their children will be an exact match with any other. (Only the HLA-A and HLA-B antigens are shown here, but the tight linkage of the entire HLA region makes it likely that all the loci on each chromosome will be passed on as a block.)

But most organs are transplanted from cadavers to complete strangers. In the United States, the program is monitored by the United Network for Organ Sharing (UNOS). Tissue typing is usually limited to looking for 6 HLA antigens: the two each at HLA-A, HLA-B, and HLA-DR. If only one antigen is found at a locus, it means that either the tissue is homozygous for that allele or no reagent exists yet to detect the second allele. This table shows the results of one study of several thousand kidney recipients.

Number of HLA
mismatches
% kidneys surviving
after 5 years
068
161
261
358
458
557
656

The results tell us that:

  • Having no mismatches provides a clear, but modest, advantage over mismatched kidneys. (This advantage is cumulative: at 17 years, 50% of the kidneys with no mismatches are still functioning while 50% of those with one or more mismatches have been lost after 8 years.)
  • However, the incremental disadvantage of additional mismatches is small. In fact, the procedures to prevent rejection are now sufficiently good that ~90% of all kidneys — even those with all loci mismatched — can be expected to be functioning at the end of the first year.

Minor histocompatibility antigens

Even if it were possible to match donor and recipient at every locus of the MHC, some tissue incompatibility would still remain (except between identical twins). Few of the antigens responsible have been identified, but they include:

  • H-Y, an antigen encoded on the Y chromosome and thus present in male, but not female, tissue
  • HA-2, an antigen derived from the contractile protein myosin.

The number and variety of histocompatibility antigens tell us that probably no two humans (again, except for identical twins) exist on earth with perfectly compatible tissues. Therefore successful transplantation of allografts requires some degree of immunosuppression to avoid graft rejection.

Graft-versus-host disease (GVHD)

Allografts that contain T cells of the donor can cause graft-versus-host disease (GVHD). The T cells in the transplant see the host as "foreign" and proceed to mount a widespread attack against the tissues of the host. GVHD is an especially serious problem with grafts of bone marrow (the source of all blood cells) and cord blood. Even when the donor and recipient have identical HLA alleles, grafts of bone marrow often cause GVHD because of differences in their minor histocompatibility antigens.

Some cancer patients are now deliberately treated so vigorously with radiation and chemotherapy that their bone marrow is destroyed along with their cancer cells. In order to survive, these patients must be given stem cells to repopulate their marrow after their therapy. In some cases, their own bone marrow is used. Some of it is removed prior to the onset of treatment of the patient and is itself treated to remove any cancer cells that may be lurking in it. If allografted bone marrow is required, there is a strong danger of GVHD. If the GVHD can be controlled, the stem cells should eventually establish themselves in the bone marrow of their new host and in due course generate some or even all of the patient's blood cells. Cord blood — another source of stem cells — presents less of a risk of serious GVHD even from a donor with HLA molecules not present in the recipient. This is because cord blood does not contain any mature T cells.

In mice, GVHD can be minimized by injecting large numbers of regulatory T cells, but for humans, control of GVHD — like control of graft rejection — still depends on the use of immunosuppression.

Immunosuppression

Immunosuppression is the treatment of the patient with agents that inhibit the immune response. The following is the list of immunosuppressants currently used.

Purine analogs

These are relatives of the purines used in DNA synthesis. Because they interfere with DNA synthesis, they interfere with the rapid cell proliferation needed for immune responses. Azathioprine (trade name = Imuran) is a widely-used purine analog.

Unfortunately, these drugs also interfere with the many other tissues that depend on rapid cell division (e.g., lining of the intestine, hair follicles) so they have many unpleasant side effects. Therefore, the search for agents that specifically target immune cells goes on.

Corticosteroids

These relatives of cortisol interfere with a transcription factor needed to turn on the genes for T cells to become activated. Prednisone and prednisolone are most commonly used.

Tacrolimus (Prograf®) and cyclosporine (Neoral®)

These are natural products isolated from microbial cultures. They inhibit the signaling pathway used by T cells to turn on their genes for activation, e.g., for IL-2 secretion.

Rapamycin

This is a macrolide antibiotic produced by an actinomycete found on Easter Island (which the inhabitants call Rapa Nui — hence the name). Rapamycin inhibits T cell proliferation, and shows great promise in reducing the problems of transplant rejection.

Rapamycin is also known as sirolimus and is sold under the trade name Rapamune.

Mycophenolate mofetil

This small molecule inhibits an enzyme needed by B and T cells for purine synthesis. Other types of cells are not dependent on the enzyme so side effects are mild. The trade name is CellCept.

Antithymocyte globulin (ATG)

This preparation contain antibodies — raised in horses or rabbits — directed against T cells.

Monoclonal antibodies

Several preparations are now used:

  • Muromonab-CD3 (OKT3) and two humanized anti-CD3 monoclonals. They bind to the CD3 molecule on the surface of T cells.
  • Daclizumab and basiliximab. Target the IL-2 receptor and thus inhibit only activated T cells.
  • Alemtuzumab (Campath-1H®). Binds to CD52, a molecule found on lymphocytes and depletes both T cells and B cells.

Belatacept

This is a protein, produced by recombinant DNA technology, that combines

  • the extracellular portion of CTLA-4 ("cytotoxic T-lymphocyte-associated antigen 4", one of the ligands for B7) with
  • the Fc region (the C-terminal two-thirds of the constant region) of a human IgG1 antibody.

It blocks the "Signal Two" needed to activate T cells.

Side effects of immunosuppression

They are serious.

Infections

The immune system is vital to protect us against infectious agents (bacteria, viruses, fungi). So infection is a frequent side effect of immunosuppression in transplant recipients. Fortunately, the infections can usually be controlled by the appropriate antibiotic, antiviral drug, etc.

Cancer

5% or more of transplant recipients will develop cancer within a few years of receiving their allograft. This may not seem to represent a great risk, but it does represent a 100-fold increase in risk compared to the general population. Allograft recipients are particularly prone to developing skin cancers and lymphomas. Curiously, transplant recipients do not seem to be at any greater risk for developing the most common types of cancer in the rest of the population: cancers of the lung, breast, colon, and prostate. One exception: recipients of allografted bone marrow run a slightly, but significantly, higher (2–3 fold) risk of developing these types of tumors. In most cases, these cancers arise from a cell of the host. But in some cases of melanoma and Kaposi's sarcoma the cancer cells were present in the graft and proliferated in the immunosuppressed host.

Things that can be done to help in such cases include stopping the immunosuppression. The chief culprit seems to be the immunosuppression that these patients have been receiving. In most cases,this leads to regression of the cancer, but often rejection of the transplant as well. The choice is usually clear for patients with allografted kidneys; they can go back on dialysis and anticipate receiving another kidney at a future date. But what of the cancer patient with a heart transplant?

Future prospects for transplantation

Although organ transplants have helped thousands of people, much remains to be done. In particular, ways need to be found to

  • increase the number of available organs (the need now far exceeds the supply)
  • find more precise methods of immunosuppression in order to prevent rejection without the dangerous side effects of infection and cancer.

Both these problems may be helped by xenotransplantation.

Xenotransplantation

Xenotransplantation is the use of organs from other animals. A number of attempts have been made to use hearts, livers, and kidneys from such primates as chimpanzees and baboons — so far with limited success. One reason is that xenotransplants usually are attacked immediately by antibodies of the host resulting in hyperacute rejection. But perhaps the use of pigs as organ donors will be feasible.

  • Their organs are about the right size for use in humans.
  • They can be made transgenic for molecules that may circumvent
    • hyperacute rejection (by knocking out the genes responsible for cell-surface antigens that humans have preformed antibodies against);
    • the chronic, T-cell-mediated, rejection that plagues all allografts.
  • They can be produced in the numbers needed.

However, pigs contain retroviruses (called PERV = porcine endogenous retrovirus), and there is fear that these might infect the human recipient.

Only a few transplants of pig tissue into humans have been done to date: skin grafts and grafts of pancreatic islets. A larger number of people have been temporarily hooked up to pig organs or "bioreactors" containing pig cells to provide support for their failing spleen, liver, or kidneys. Most of these recipients have been monitored for signs of infection by PERV and — even though PERV can infect human cells growing in culture — there is no evidence that any of these people exposed to pig tissue have become infected.

Is xenotransplantation safe?

Pigs are not the only animals that contain latent viruses in their cells. Could the viruses in the cells of other kinds of animal donors infect the transplant recipient? start an epidemic? The danger seems greater for xenotransplants from other primates. (HIV, the retrovirus that causes AIDS appears to have entered humans from a primate host)

For these reasons, many biologists are urging that transplant surgeons proceed cautiously with xenotransplants.

Immune Privilege

It has long been know that certain sites in the body, for example,

  • the anterior chamber of the eye
  • the testes
  • the brain

are "privileged". They are protected from attack by the immune system.

This can cause problems. Several cases have emerged of survivors of Ebola who no longer have Ebola virus in their blood and are symptom-free but still retain live virus in such privileged sites as brain, testis, and aqueous humor of the eye where the virus has escaped attack by the immune system.

Many factors are involved in immune privilege, such as

  • tight junctions between the cells of the tissue
  • little expression of class I histocompatibility molecules
  • expression of the Fas ligand, FasL.

The presence of FasL on their surface protects cells in privileged locations from immune attack because when threatened by a cytotoxic T cell, they force the T cell to commit suicide by apoptosis. Activated cytotoxic T cells express Fas on their surface. When they engage (with their T cell receptor) a privileged cell expressing FasL, instead of killing the target, the target kills them!

So if the organs of transgenic pigs can be made to expresses human FasL, perhaps they will be resistant to T-cell mediated rejection.

The human placenta also enjoys immune privilege. It is almost as foreign to the mother as a kidney transplant from her husband would be, but unlike the kidney, she will not reject it (at least not for 9 months). In lab rats, the embryos (and the mother's endometrium) secrete corticotropin-releasing hormone (CRH). This hormone induces the expression of Fas ligand (FasL) on the cells of the placenta. Activated T cells express Fas, so any threatening T cells would commit suicide by apoptosis when they encounter FasL on their target.


Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ.

With regard to the donor, the transplantation can be categorized into three types, i.e. :

  1. Donors(Organ donation) in a state of still alive.
  2. Donors(Organ donation) is in a coma.
  3. Donors(Organ donation) in the state of death. It's mean transplanted organs will be taken when the donor has died under the provisions of medical and juridical, durability should also be considered to be taken for organ transplantation

1.Donors(Organ donation) in a state of still alive.

If the transplantation of organs taken from people who are still alive, then the law 'Haram', with reason:

has been described in Surah Al-Baqarah ayah 195 (The Cow)

And spend in the way of Allah and do not throw [yourselves] with your [own] hands into destruction [by refraining]. And do good indeed, Allah loves the doers of good.

The aayah reminded humans, so do not be reckless and careless in doing something, but still weigh the consequences are likely to be fatal for the donor himself, even though it has the purpose of humanitarian action is good and noble. Eg someone donating a kidney or eyes on others who need it because of family ties, friends or because he hoped the reward of those who require the grounds of economic crisis. In the last issue, ie organ donors in return or sell it, is prohibited, because the human body organ that belongs to God (milk ikhtishash), then it should not memperjualbelikannya. Humans are only entitled to use it, although part of the body of another person. People who donate their organs at the time still a healthy life to others, he will face the risk of impropriety, since it is impossible that God created the eyes or kidneys in pairs if there is no wisdom and benefits for a human being. So when the donor kidneys no longer function, then it is difficult to be helped back. Then as well, eliminating the disease from the recipient by creating new diseases for the donor. It is not allowed because the fiqh Qaeda mentioned:

الضَّرَرُ لاَ يُزَالُ بِالضَّرَرِ دَرْءُ اْلمَفاَسِدِ مُقَدَّمٌ عَلىَ جَلْبِ اْلمَصَالِحِ

"Danger (harm) should not be eliminated with danger (harm)an the other. Avoid damage / risk, take precedence over / above attractive benefit"

Related transplants, someone should give more priority to keep himself from destruction, rather than helping others by sacrificing yourself and be fatal, ultimately he was unable to carry out their duties and obligations, especially in carrying out his duty of worship.

2.Donors(Organ donation) is in a coma.

Transplanting donor organs is in a coma, the ruling remains forbidden, although according to the doctor, that the donor was going to die soon, because it can speed up his death and precedes the will of God, it can be said 'euthanasia' or hasten death. It is not callous / immoral conduct organ transplant or taking in a state of dying. A healthy person should attempt to cure the person who is in a coma, though according to the doctor, that the person who had the coma there is no hope for recovery. Because there are also people who can recover even though it was only a small part, but according to the medical, the patient had no hope for life. Therefore, taking donor organs is in a coma, should not be according to Islam for the following reasons:

Hadith of the Prophet Muhammad, Malik history of 'Umar ibn Yahya, al-Hakim, al-Bayhaqi and al-Daruquthni of Abu Sa'id al-Khudri and Ibn Majah history of Ibn' Abbas and 'Ubadah ibn al-Samit:

"There should not be making madharat to yourself anyway and should not make madharat on someone else".

Based on the above hadith, harvesting organs from people is in a coma / dying haram, because it can make the donor madharat to accelerate resulting in death, which is called euthanasia. A person must try to cure the illness in order to maintain its life, because life and death are in God's hands. Therefore, the humans should not take his own life or hasten the death of another person, even if it was done by a doctor in order to reduce or eliminate the suffering of patients.

3.Donors(Organ donation) in the state of death.

Taking donor organs (heart, eye or kidney) legally dead, and medical, legal or permissible, ie permissible according to Islamic views on condition :

Recipient (the recipient organ donation) in a life-threatening emergency if not done the transplant, while he was in an optimal treatment both medical and non-medical, but to no avail. It is based on Fiqhiyyah Qaeda:

الضَّرَرُ يُزَالُ الضَّرُوْرَاتُ تُبِيْحُ اْلمَحْظُوْرَاتِ

"Emergency will allow the forbidden. The danger must be eliminated"

Also fits with the organ transplant recipient and will not lead to more serious complications of the disease compared to her previous state. Besides, there should be a testament to the heirs of the donor, to donate his organs when he died, or have permission from their heirs.

has been described in Surat Al-Mā'idah ayah 5:32 (The Table Spread)

"Because of that, We decreed upon the Children of Israel that whoever kills a soul unless for a soul or for corruption [done] in the land - it is as if he had slain mankind entirely. And whoever saves one - it is as if he had saved mankind entirely. And our messengers had certainly come to them with clear proofs. Then indeed many of them, [even] after that, throughout the land, were transgressors."


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15. Journal of Pediatric Gastroenterology and Nutrition

About Blog The Journal of Pediatric Gastroenterology and Nutrition (JPGN) provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition. Frequency 30 posts / quarter Blog journals.lww.com/jpgn/pages/..
Twitter followers 2.4K ⋅ Domain Authority 86 ⋅ Alexa Rank 6.3K View Latest Posts ⋅ Get Email Contact

16. Current Opinion in Gastroenterology

About Blog Published bimonthly and offering a unique and wide-ranging perspective on the key developments in the field, each issue of Current Opinion in Gastroenterology features hand-picked review articles from our team of expert editors. With twelve disciplines published across the year including gastrointestinal infections, nutrition, and inflammatory bowel disease every issue also contains annotated references detailing the merits of the most important papers. Frequency 30 posts / quarter Blog journals.lww.com/co-gastroen..
Twitter followers 585 ⋅ Domain Authority 86 ⋅ Alexa Rank 6.3K View Latest Posts ⋅ Get Email Contact

17. Gut

London, England, United Kingdom About Blog Gut is a leading international journal in gastroenterology and hepatology and has an established reputation for publishing first-class clinical research of the alimentary tract, the liver, biliary tree, and pancreas. Gut delivers up-to-date, authoritative, clinically oriented coverage in all areas of gastroenterology and hepatology. Frequency 30 posts / month Blog gut.bmj.com
Twitter followers 18.7K ⋅ Domain Authority 90 ⋅ Alexa Rank 4.2K View Latest Posts ⋅ Get Email Contact

18. Neurogastroenterology & Motility

About Blog The field of gastrointestinal motility has undergone phenomenal growth and change in the past three decades since it emerged as a distinct specialty. Neurogastroenterology & Motility provides a forum where current issues and advances relating to the motor function of the GI tract can be presented and discussed. It is of interest to both clinicians and researchers. Frequency 28 posts / month Blog onlinelibrary.wiley.com/jour..
Twitter followers 15.4K ⋅ Domain Authority 93 ⋅ Alexa Rank 619 View Latest Posts ⋅ Get Email Contact

19. Annals of Gastroenterology

Athens, Attiki, Greece About Blog Annals of Gastroenterology is published on behalf of the Hellenic Society of Gastroenterology, representing the Society's official Journal. The journal aims to cover all sections of gastroenterology and hepatology, providing teaching, practical and professional support for clinicians dealing with the gastroenterological disorders. It publishes, after peer-review process papers concerning both clinical and basic research. Frequency 24 posts / month Blog annalsgastro.gr/index.php/an..
Domain Authority 48 ⋅ Alexa Rank 3.1M View Latest Posts ⋅ Get Email Contact

20. Journal of Gastrointestinal Oncology

About Blog Journal of Gastrointestinal Oncology, the official journal of the Society for Gastrointestinal Oncology (SGO), is an open-access, international peer-reviewed journal. It is published quarterly and openly distributed worldwide. Frequency 30 posts / quarter Blog jgo.amegroups.com
Domain Authority 62 ⋅ Alexa Rank 79.5K View Latest Posts ⋅ Get Email Contact

21. Saudi Journal of Gastroenterology

Riyadh, Ar Riyad, Saudi Arabia About Blog The Saudi Journal of Gastroenterology (ISSN-1319-3767) is published Bimonthly by the Saudi Gastroenterology Association (SGA). The journal publishes peer-reviewed articles covering all the aspects of digestive diseases, including the prevention, diagnosis, and management and related genetics, pathophysiology, and epidemiology as relevant to gastrointestinal and hepatobiliary disorders. Frequency 9 posts / quarter Blog saudijgastro.com
Domain Authority 43 ⋅ Alexa Rank 2.6M View Latest Posts ⋅ Get Email Contact

22. BMJ Open Gastroenterology

London, England, United Kingdom About Blog BMJ Open Gastroenterology is an online-only, peer-reviewed, open-access journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology and hepatology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. BMJ Open Gastroenterology adheres to the highest possible industry standards concerning publication ethics. Frequency 1 post / week Blog bmjopengastro.bmj.com
Twitter followers 1.7K ⋅ Domain Authority 90 ⋅ Alexa Rank 4.2K View Latest Posts ⋅ Get Email Contact

23. Japanese Journal of Gastroenterology and Hepatology

Niigata, Japan About Blog Japanese Journal of Gastroenterology and Hepatology is a division of medicine focused on the digestive system and its disorders. Our journal is fast-growing and High citation of each article. Japanese Journal of Gastroenterology and Hepatology is a peer-reviewed, Open Access and Mega journal which publishes original Research Articles, Review Articles, and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. Frequency 3 posts / day Blog jjgastrohepto.org
Domain Authority 13 ⋅ Alexa Rank 5.8M View Latest Posts ⋅ Get Email Contact

24. JGH Open

About Blog JGH Open is a new peer-reviewed open access journal focused on the rapid dissemination of clinical and experimental research in all areas of gastroenterology, hepatology and endoscopy. The journal aims to educate and connect the global gastroenterology and hepatology community. Frequency 1 post / week Blog onlinelibrary.wiley.com/jour..
Twitter followers 15.4K ⋅ Domain Authority 93 ⋅ Alexa Rank 619 View Latest Posts ⋅ Get Email Contact

25. Endoscopy

Stuttgart, Baden-Wurttemberg, Germany About Blog Endoscopy is the premier journal for information on the latest technologies and international developments in gastrointestinal endoscopy. Under the expert direction of an international editorial board, this journal presents high-quality content that addresses the needs of endoscopists, surgeons, clinicians, and researchers across the globe. Frequency 14 posts / week Blog endoscopy.thieme.com/current..
Twitter followers 3.5K ⋅ Domain Authority 53 ⋅ Alexa Rank 222.9K View Latest Posts ⋅ Get Email Contact

26. Therapeutic Advances in Gastroenterology

About Blog Therapeutic Advances in Gastroenterology (TAG) is open access, peer-reviewed journal which focuses on pioneering efforts and innovative studies across all areas of gastroenterology and hepatology. This journal is a member of the Committee on Publication Ethics (COPE). Frequency 1 post / week Blog journals.sagepub.com/home/tag
Twitter followers 10.3K ⋅ Domain Authority 91 ⋅ Alexa Rank 1.3K View Latest Posts ⋅ Get Email Contact

27. Nature Reviews Gastroenterology & Hepatology

London, England, United Kingdom About Blog Nature Reviews Gastroenterology & Hepatology aims to be the premier source of Reviews and commentaries for the scientific and medical communities we serve. We strive to publish articles that are authoritative, accessible and enhanced with clearly understandable figures, tables, and other display items. We want to provide unparalleled service to authors, referees, and readers, and we work hard to maximize the usefulness and impact of each article. Frequency 6 posts / week Blog nature.com/nrgastro
Twitter followers 158K ⋅ Social Engagement 2 ⋅ Domain Authority 93 ⋅ Alexa Rank 982 View Latest Posts ⋅ Get Email Contact

28. Annals of Gastroenterological Surgery

About Blog Annals of Gastroenterological Surgery is an international, peer-reviewed, academic journal for surgery, oncology, gastroenterology, and hepatology. Frequency 3 posts / week Blog onlinelibrary.wiley.com/jour..
Twitter followers 15.4K ⋅ Domain Authority 93 ⋅ Alexa Rank 619 View Latest Posts ⋅ Get Email Contact

29. GastroHep

About Blog GastroHep is an international, peer-reviewed, quality publication focussing on current and cutting-edge research in academic and clinical gastroenterology and hepatology. GastroHep provides the platform for submissions of articles of interest to the practicing clinician and research workers and academic staff in all aspects of gastroenterology and hepatology. Its aim is to help disseminate up-to-date information of the latest developments in clinical gastroenterology and hepatology and thus to promote best practice. Frequency 7 posts / month Blog onlinelibrary.wiley.com/jour..
Twitter followers 15.4K ⋅ Domain Authority 93 ⋅ Alexa Rank 619 View Latest Posts ⋅ Get Email Contact

30. Clinical and Translational Gastroenterology

About Blog Clinical and Translational Gastroenterology (CTG) is a peer-reviewed open-access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. Frequency 8 posts / month Blog journals.lww.com/ctg/pages/d..
Twitter followers 949 ⋅ Domain Authority 86 ⋅ Alexa Rank 6.3K View Latest Posts ⋅ Get Email Contact

31. United European Gastroenterology Journal

Vienna, Wien, Austria About Blog UEG Journal is an international forum for research in gastroenterology, publishing original articles which describe basic research, translational and clinical studies of interest to gastroenterologists and researchers in related fields. As of 2021, UEG Journal is now fully open access. Frequency 1 post / week Blog onlinelibrary.wiley.com/jour..
Twitter followers 3.5K ⋅ Domain Authority 93 ⋅ Alexa Rank 619 View Latest Posts ⋅ Get Email Contact

32. BMC Gastroenterology

London, England, United Kingdom About Blog BMC Gastroenterology is open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis, and management of gastrointestinal and hepatobiliary disorders, as well as related molecular genetics, pathophysiology, and epidemiology. Frequency 1 post / week Blog bmcgastroenterol.biomedcentr..
Twitter followers 19.2K ⋅ Domain Authority 88 ⋅ Alexa Rank 2.3K View Latest Posts ⋅ Get Email Contact

33. Expert Review of Gastroenterology & Hepatology

About Blog A MEDLINE-indexed journal focusing on the etiology, epidemiology, prevention, diagnosis, treatment, and development of new therapies relating gastrointestinal and liver diseases. It offers accelerated publication. Frequency 1 post / week Blog tandfonline.com/loi/ierh20
Twitter followers 20.2K ⋅ Domain Authority 89 ⋅ Alexa Rank 604 View Latest Posts ⋅ Get Email Contact

34. Gut Microbes

Abingdon, England, United Kingdom About Blog Gut Microbes publishes research on intestinal microbiota, gastrointestinal, liver, and cardiac disease, cancer, and irritable and inflammatory bowel conditions. Frequency 2 posts / week Blog tandfonline.com/toc/kgmi20/c..
Facebook fans 32K ⋅ Twitter followers 20.2K ⋅ Domain Authority 89 ⋅ Alexa Rank 604 View Latest Posts ⋅ Get Email Contact

35. Gastroenterology Research

Toronto, Ontario, Canada About Blog Gastroenterology Research is an international journal that concentrates on basic research and clinical practice of gastroenterology, hepatology, pancreas and biliary, alimentary metabolism, nutrition, oncology, translational gastroenterology, translational hepatology, and related fields. All articles are rigorously reviewed. Gastroenterology Research presents up-to-date coverage of physiology, pathophysiology, metabolic studies, and clinical reports on the etiology, diagnosis, and therapy of alimentary diseases. Frequency 10 posts / quarter Blog gastrores.org/index.php/Gast..
Twitter followers 2.2K ⋅ Domain Authority 39 ⋅ View Latest Posts ⋅ Get Email Contact

36. Gut Pathogens

London, England, United Kingdom About Blog Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals, and functional microbiota of the gut. The journal publishes basic, clinical, and cutting-edge research on all aspects of the above-mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology, and epidemiology of these microbes Frequency 2 posts / week Blog gutpathogens.biomedcentral.com
Twitter followers 684 ⋅ Domain Authority 88 ⋅ Alexa Rank 2.3K View Latest Posts ⋅ Get Email Contact

37. Evidence and Research

United Kingdom About Blog An international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews, and commentaries on all aspects of adult and pediatric hepatology in the clinic and laboratory. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE). Frequency 1 post / week Blog dovepress.com/hepatic-medici..
Twitter followers 2.7K ⋅ Domain Authority 71 ⋅ Alexa Rank 18K View Latest Posts ⋅ Get Email Contact

38. Clinical and Experimental Gastroenterology

Macclesfield, England, United Kingdom About Blog Clinical and Experimental Gastroenterology is an international, peer reviewed, open access journal focusing on all aspects of gastroenterology research, as well as clinical results in human, animal and in vitro studies that shed light on disease processes and potential new therapies. Frequency 3 posts / week Blog dovepress.com/clinical-and-e..
Twitter followers 2.7K ⋅ Domain Authority 71 ⋅ Alexa Rank 18.2K View Latest Posts ⋅ Get Email Contact

39. Clinical Endoscopy

Seoul, Republic of Korea About Blog Clinical Endoscopy is an open-access and peer-reviewed journal, helping researchers, technicians, and practicing physicians stay updated on global advances in experimental, diagnostic, and therapeutic endoscopic techniques used in the treatment of disorders of the gastrointestinal and pancreatico-biliary tract. CE publishes well-structured original articles, state-of-the art review articles, instructive case reports, brief reports, and letters to the editor on all subjects in the field of experimental, diagnostic, and therapeutic endoscopy as well as newer technologies. Frequency 9 posts / quarter Blog e-ce.org
Domain Authority 45 ⋅ Alexa Rank 9M View Latest Posts ⋅ Get Email Contact

40. Hepatobiliary Surgery and Nutrition

Hong Kong About Blog The Hepatobiliary Surgery and Nutrition is international, open access, a peer-reviewed journal indexed in PubMed and Science Citation Index Expanded (SCIE), covering the field of surgical techniques, clinical and basic researches, transplantation and other therapies, related imaging, biology, pathology, immunology, targeted drug, and molecular developments and technical advances, etc. Frequency 14 posts / quarter Blog hbsn.amegroups.com
Domain Authority 62 ⋅ Alexa Rank 79.5K View Latest Posts ⋅ Get Email Contact

41. The American College of Gastroenterology

About Blog AJG is published on behalf of the American College of Gastroenterology (ACG). As the leading clinical journal covering gastroenterology and hepatology, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Frequency 3 posts / month Blog journals.lww.com/ajg/pages/d..
Twitter followers 2.4K ⋅ Social Engagement 8 ⋅ Domain Authority 86 ⋅ Alexa Rank 6.3K View Latest Posts ⋅ Get Email Contact

42. World Journal of Gastrointestinal Surgery

California, United States About Blog World Journal of Gastrointestinal Surgery (WJGS, World J Gastrointest Surg) is a high-quality, online, open-access, single-blind peer-reviewed journal published by the Baishideng Publishing Group. WJGS accepts both solicited and unsolicited manuscripts. Articles published in WJGS are high-quality, basic and clinical, influential research articles by established academic authors as well as new researchers. The paramount objective of WJGS is to showcase and promote distinguished research in the field of gastrointestinal surgery, to help advance development of this field. Frequency 15 posts / month Blog wjgnet.com/1948-9366/index.htm
Twitter followers 28 ⋅ Domain Authority 65 ⋅ Alexa Rank 169.9K View Latest Posts ⋅ Get Email Contact

43. Case Reports in Hepatology

London, England, United Kingdom About Blog Case Reports in Hepatology is a peer-reviewed, Open Access journal that publishes case reports and case series related to the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas. Frequency 1 post / week Blog hindawi.com/journals/crihep
Twitter followers 16.4K ⋅ Social Engagement 1 ⋅ Domain Authority 81 ⋅ Alexa Rank 3.4K View Latest Posts ⋅ Get Email Contact

44. Annals of Coloproctology

Seoul, Seoul-teukbyeolsi, Korea, Republic of About Blog Annals of Coloproctology (Ann Coloproctol, ACP) is an official Journal of the Korean Society of Coloproctology (KSCP) and Asia Pacific Federation of Coloproctology (APFCP). It was launched in 1985 and was designated as an official journal of APFCP in 2019. The title of our journal was changed from Journal of the Korean Society of Coloproctology (abbreviated title-J Korean Soc Coloproctol) to Annals of Coloproctology (abbreviated title-Ann Coloproctol) in 2013. Frequency 7 posts / month Blog coloproctol.org
Domain Authority 40 ⋅ Alexa Rank 9.3M View Latest Posts ⋅ Get Email Contact

45. Canadian Journal of Gastroenterology and Hepatology

London, England, United Kingdom About Blog Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology. Frequency 2 posts / week Blog hindawi.com/journals/cjgh
Twitter followers 16.4K ⋅ Domain Authority 81 ⋅ Alexa Rank 3.4K View Latest Posts ⋅ Get Email Contact

46. Gastroenterology Research and Practice

London, England, United Kingdom About Blog Gastroenterology Research and Practice provide a forum for researchers and clinicians working in the areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. Frequency 3 posts / week Blog hindawi.com/journals/grp
Twitter followers 16.4K ⋅ Social Engagement 3 ⋅ Domain Authority 81 ⋅ Alexa Rank 3.4K View Latest Posts ⋅ Get Email Contact

47. Gastric Cancer

About Blog Gastric Cancer, a joint official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, publishes significant studies related to stomach neoplasms. The journal welcomes original articles, case reports, short communications, and technical notes, which will be peer-reviewed by the editorial board. Frequency 9 posts / month Blog springer.com/journal/10120
Twitter followers 54.9K ⋅ Domain Authority 92 ⋅ Alexa Rank 481 View Latest Posts ⋅ Get Email Contact

48. Journal of Gastroenterology

About Blog The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership. Frequency 5 posts / month Blog springer.com/journal/535
Twitter followers 54.9K ⋅ Domain Authority 92 ⋅ Alexa Rank 481 View Latest Posts ⋅ Get Email Contact

49. Journal of Neurogastroenterology and Motility

Seoul, Republic of Korea About Blog The aim of the Journal is to foster and promote research activities in the area of the motor, sensory and functional disorders of the gastrointestinal tract. The Journal provides researchers with accessible rooms for publication of their research results in the field of neurogastroenterology and motility. Frequency 12 posts / quarter Blog jnmjournal.org/main.html
Twitter followers 440 ⋅ Social Engagement 8 ⋅ Domain Authority 52 ⋅ Alexa Rank 1.8M View Latest Posts ⋅ Get Email Contact

50. Techniques and Innovations in Gastrointestinal Endoscopy

About Blog Techniques and Innovations in Gastrointestinal Endoscopy (TIGE) provides a comprehensive overview of clinical conditions and gastrointestinal endoscopic procedures. Each issue of TIGE focuses on the pathophysiology of select conditions and technical performance of gastrointestinal procedures for the management of these conditions, in combination with best practices, expert opinion, and innovations. Frequency 8 posts / quarter Blog sciencedirect.com/journal/te..
Twitter followers 65.8K ⋅ Domain Authority 93 ⋅ Alexa Rank 272 View Latest Posts ⋅ Get Email Contact

51. Best Practice & Research Clinical Gastroenterology

About Blog Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology. Frequency 5 posts / month Blog sciencedirect.com/journal/be..
Twitter followers 65.8K ⋅ Domain Authority 93 ⋅ Alexa Rank 272 View Latest Posts ⋅ Get Email Contact

52. World Journal of Hepatology

California, United States About Blog World Journal of Hepatology (WJH, World J Hepatol) is a high-quality, online, open-access, single-blind peer-reviewed journal published by the Baishideng Publishing Group. WJH accepts both solicited and unsolicited manuscripts. Articles published in WJH are high-quality, basic and clinical, influential research articles by established academic authors as well as new researchers. Frequency 8 posts / month Blog wjgnet.com/1948-5182/index.htm
Twitter followers 28 ⋅ Social Engagement 11 ⋅ Domain Authority 65 ⋅ Alexa Rank 169.9K View Latest Posts ⋅ Get Email Contact

53. Gastroenterology Clinics

About Blog A perfect source to consult for those in the fields of gastroenterology and hepatology, Gastroenterology Clinics provides answers to clinical questions, information on the latest diagnostic methods and treatments, and numerous clinical images. Published quarterly in March, June, September, and December each issue offers state-of-the-art reviews on everything from the alimentary tract, liver, and pancreas, to endoscopic procedures (including diagnosis and biopsy) and therapeutics. Frequency 7 posts / quarter Blog gastro.theclinics.com
Twitter followers 1.9K ⋅ Domain Authority 56 ⋅ Alexa Rank 121.8K View Latest Posts ⋅ Get Email Contact

54. Case Reports in Gastrointestinal Medicine

London, England, United Kingdom About Blog Case Reports in Gastrointestinal Medicine publishes case reports and case series focusing on gastroenterology, hepatology, pancreas and biliary, and related cancers. Case Reports in Gastrointestinal Medicine publishes case reports and case series focusing on gastroenterology, hepatology, pancreas and biliary, and related cancers. Frequency 2 posts / day Blog hindawi.com/journals/crigm
Twitter followers 16.4K ⋅ Domain Authority 81 ⋅ Alexa Rank 3.4K View Latest Posts ⋅ Get Email Contact

55. International Journal of Hepatology

London, England, United Kingdom About Blog International Journal of Hepatology publishes research related to medical, surgical, pathological, biochemical, and physiological aspects of hepatology and management of disorders affecting the liver, gallbladder, biliary tree and pancreas. Frequency 1 post / week Blog hindawi.com/journals/ijh
Twitter followers 16.4K ⋅ Domain Authority 81 ⋅ Alexa Rank 3.4K View Latest Posts ⋅ Get Email Contact

56. World Journal of Gastroenterology - Baishideng Publishing Group

California, United States About Blog World Journal of Gastroenterology (WJG, World J Gastroenterol) is a high-quality, online, open-access, single-blind peer-reviewed journal published by the Baishideng Publishing Group. WJG accepts both solicited and unsolicited manuscripts. Articles published in WJG are high-quality, basic and clinical, influential research articles by established academic authors as well as new researchers. The paramount objective of WJG is to showcase and promote distinguished research in the field of gastroenterology and hepatology, to help advance development of this field. Frequency 10 posts / day Blog wjgnet.com/1007-9327
Twitter followers 28 ⋅ Domain Authority 65 ⋅ Alexa Rank 169.2K View Latest Posts ⋅ Get Email Contact

57. Digestive Diseases and Sciences

About Blog Digestive Diseases and Sciences journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology. Frequency 1 post / day Blog springer.com/journal/10620
Twitter followers 54.9K ⋅ Domain Authority 92 ⋅ Alexa Rank 481 View Latest Posts ⋅ Get Email Contact


Getting a Bilateral Salpingectomy at the age of 23

I have thinking about not having kids for a long, long time. I started researching sterilization when I was 18. Unfortunately my parents found out about this and got very angry at me not wanting kids. I never stopped believing that I didn't want kids, I just hid it from my parents.

In my research, I decided the surgery I wanted was a bilateral salpingectomy or a complete removal of the fallopian tubes. This is a form of permanent birth control. I would no longer able to have children. I frequently get asked "why" and I have a bunch of reasons. I'm a really independent person, I plan to dedicate my time to loved ones and a career I can be proud of. The thought of pregnancy also terrifies me. To the point that it is a phobia for me. If I got pregnant, I would be extremely emotional. Once I get a handle on my emotions, I'd call Planned Parenthood. I also have a lot of family physical and mental health issues I don't want to pass on. I wouldn't date a guy that has or wants kids. I have lost a lot of potential dating relationships because of it.

I have been asking for a bilateral salpingectomy for a while now. I wanted to ask when I was 20. I didn't feel comfortable with the gynecologist I had at that time. On my first appointment with her, she slut shamed me because my now ex boyfriend and I had started having sex a month into our relationship. Not that it matters to her, but that was an abusive relationship and not all the sex we had consentual. It took me a while to realize that what happened in that relationship was abuse.

The first time I actually asked was to my primary care for a referral for a sterilization. She just asked if I was sure. I said yes, and she didn't question me. The referral was sent to a gynecologist and my appointment was a few months away. In those months waiting, I put together a 'sterilization binder.' I filled it with studies like a bilateral salpingectomy will reduce the risk of ovarian cancer, I have a small cervix so I added a study saying that if I did give birth the baby will be born premature enough that they will have to stay in NICU for a while, the various medications I take every day has an affect on a growing fetus, and a study about how women who don't have kids and don't plan on having kids are the least likely to change their mind about sterilization. Having this binder made me feel more confident and I could refer back to something if a doctor brought up something.

Once my appointment came up, I put together my binder and dressed professionally so I'd be taken seriously. Unfortunately this doctor was very arrogant and acted as though he was doing me a favor by saying no. He even told me to come back in a year and a half if I didn't change my mind, and he'd agree to it. I almost cried in the doctors office. I didn't want to wait around for a year and a half. Plus I don't trust him to do a thorough job. Once I got out to my car I couldn't cry. I just didn't have it in me because I was mostly frustrated. Also I knew I had to get work finding a new gynecologist. I messaged my primary care provider, she comforted me and said she will reroute the referral any place I wanted to go. I plan to send a letter to that doctor saying I found a phenomenal doctor and got the surgery.

As a medical professional and as a woman it makes me incredibly disappointed and upset that physicians deny individuals these types of procedures purely based on the assumption that "you'll regret it later" or "want children later". I'll give two examples of two people, one had endometriosis to the point that she was in constant pain and had to struggle to get her procedure done, the other is my cousin who has had 7 children. Her doctor refuses to do it because she is "only 30 years old". It's something that shouldn't happen but it does. This is a part of healthcare where this needs to change and I hope some day it does.

After that appointment, I posted in facebook about how frustrated I was trying to find a doctor for this surgery. An acquaintance I went to high school with reached out to me and recommended a doctors office. I had the referral rerouted there. The first doctor I talked to at that office said he felt uncomfortable doing my surgery but that he has already recommended me to a coworker of his, and she agreed to do the surgery without meeting me yet. I scheduled an appointment to see her the next day. She was so kind. I didn't have to beg or plead my case. She didn't question my decision although we did talk about the decisions and circumstances that led to me not wanting kids. We scheduled the surgery and I signed my consent forms.

Unfortunately, due to covid-19 my surgery was delayed. It was rescheduled a month after I was originally told I was getting it. I wasn't upset though. I was just happy that it was actually going to happen. With the surgery being delayed, I had time to work extra hours, arrange who will drive me to and from the surgery, go grocery shopping keeping in mind good things to eat/drink after surgery, and get my FMLA approved.

My FMLA was approved pretty quickly and I was set to have two weeks off. It was my boss that insisted I go on FMLA. I'm happy she suggested that because I'm such a lightweight when it comes to pain meds and anesthesia. Local anesthesia knocked me on my ass for hours when I had a cyst removed and when I did wake up, I was very disoriented.

I worked a bunch of hours so I would have better peace of mind while being on FMLA. I also took myself on a shopping trip to celebrate my surgery. During my pre-op appointment, she gave me the okay to have clear liquids up until two hours before surgery. I told her about me being a lightweight so I wanted some narcotics, but mostly ibuprofen. She explained to have a friend drive me to and from surgery. We talked about the kind of stitches I'd have and that I would be under general anesthesia and a paralytic, I would also have an intubation tube to help me breath. She felt bad about my family not supporting me, so she asked me if I wanted her to talk to my family and ease their minds. I know my parents aren't going to change their minds about this, so I told her it was okay. Also I don't want to drag her into my family drama. I had labs drawn and a covid test. I truly, truly didn't care for the covid test but it's a small price to pay for an elective surgery during a pandemic.

The night before my surgery, I had a big dinner at about ten o'clock at night. I went to bed right after. I wish I didn't go to bed so early so I could I sleep in because I couldn't eat all day. I think it's better to sleep through the times you can't eat. I could have clear liquids but I couldn't have more than 16 ounces.

My roommate dropped me off at the hospital for my surgery. I checked in and I paid for my surgery then. It was $250 for everything. Once I was all ready to go to surgery, my surgeon and anesthesiologist came to see me. I told my surgeon that I was so ready for this surgery and she said she had a feeling I've been ready for a while. They then wheeled me down to the operating room. I was talking to the nurses and I could hear the anesthesiologist say that it's time for the anesthesia. They put a large oxygen mask over me and that's all I remember. I don't even remember drifting off to sleep.

I then woke up in recovery, and this time I cried out of happiness. It's like a dream come true. The nurse said I had slept for two hours after surgery and the surgery went very well. She kept asking if I felt okay and she gave me two doses of fentanyl. I looked at my vital signs on the monitor and realized my pulse was at 140, which is why I got such strong pain meds. I took another short nap and drank some water. I had a ton of messages from friends, my boyfriend, and my roommates asking if I was okay. The nurse said she had already called and told everyone that I was okay and surgery went well.

My pulse went down and once the nurse saw that I could swallow okay and that I could go to the bathroom by myself, I was good to go. My roommates and boyfriend came to pick me up. We picked up my prescriptions. I had a prescription for ibuprofen and percocet. I do wish I picked up cough drops though. My throat is still scratchy because of the intubation tube.

After picking up my prescriptions, we got tacos to celebrate. I hadn't eaten all day so I was more hungry than in pain. Once I got home, I took an ibuprofen and went to bed. I woke up in quite a bit of pain so I took a percocet in the morning. The awesome nurse I had in recovery was nice enough to call me and ask how I was doing. She suggested taking either ibuprofen or percocet and then waiting three hours to take the other pain med. That has helped control my pain a lot. I am on day two post op. My ribs and shoulder still hurt sometimes because of the gas they gave me to blow up my organs. I was told walking helps with that, so I go on walks everyday. My stomach still kind of hurts like when I cough or sneeze, but I'm trying to save my pain meds for when I am in a lot of pain. My stomach still feels tender and sore, so I'm taking it easy. I have another 12 days of FMLA, and I think I'll be able to work. If I could give one piece of advice, it would be to never stop advocating for yourself. I'm so still happy this was done. I've already added my doctor the Reddit's list of Childfree Doctors.


Ethical Implications Of Genetic Engineering

Cell, tissue, and organ engineering are many major benefits of genetic engineering because new tissues and organs can and are being grown and produced to replace ones that are not working properly. This is very beneficial because there are 100,000 people on the waiting list for an organ transplant in the United States, and in one year only around 12,000 organ transplants take place (Olson, 2007, para. 4). There is a large shortage of organs for transplant with so many people waiting&hellip


ELI5:Why can't stem cells cure cancer right now?

Yes, there's potential, but I'm taking about right now as of today. Had a discussion on this with my friends the other day. The way of thinking is that if stem cells can be made to grow body parts, why not just get rid of the cancerous body part and grow in a new one? Obviously if your cancer is something that's everywhere, you're screwed. But if it's something localized like your lung for example, why not put in new lungs? I guess now in hindsight, infinite organ transplants too. Why not have infinite organ transplants?

Some points brought up by them that might or might not be accurate:

You can grow an arm (as in replacing a whole arm), but the not the fingers since it won't grow correctly.

Also, after you grow the arm, the arm will eventually die because the stem cells can't replace themselves like normal cells can.


Getting a Bilateral Salpingectomy at the age of 23

I have thinking about not having kids for a long, long time. I started researching sterilization when I was 18. Unfortunately my parents found out about this and got very angry at me not wanting kids. I never stopped believing that I didn't want kids, I just hid it from my parents.

In my research, I decided the surgery I wanted was a bilateral salpingectomy or a complete removal of the fallopian tubes. This is a form of permanent birth control. I would no longer able to have children. I frequently get asked "why" and I have a bunch of reasons. I'm a really independent person, I plan to dedicate my time to loved ones and a career I can be proud of. The thought of pregnancy also terrifies me. To the point that it is a phobia for me. If I got pregnant, I would be extremely emotional. Once I get a handle on my emotions, I'd call Planned Parenthood. I also have a lot of family physical and mental health issues I don't want to pass on. I wouldn't date a guy that has or wants kids. I have lost a lot of potential dating relationships because of it.

I have been asking for a bilateral salpingectomy for a while now. I wanted to ask when I was 20. I didn't feel comfortable with the gynecologist I had at that time. On my first appointment with her, she slut shamed me because my now ex boyfriend and I had started having sex a month into our relationship. Not that it matters to her, but that was an abusive relationship and not all the sex we had consentual. It took me a while to realize that what happened in that relationship was abuse.

The first time I actually asked was to my primary care for a referral for a sterilization. She just asked if I was sure. I said yes, and she didn't question me. The referral was sent to a gynecologist and my appointment was a few months away. In those months waiting, I put together a 'sterilization binder.' I filled it with studies like a bilateral salpingectomy will reduce the risk of ovarian cancer, I have a small cervix so I added a study saying that if I did give birth the baby will be born premature enough that they will have to stay in NICU for a while, the various medications I take every day has an affect on a growing fetus, and a study about how women who don't have kids and don't plan on having kids are the least likely to change their mind about sterilization. Having this binder made me feel more confident and I could refer back to something if a doctor brought up something.

Once my appointment came up, I put together my binder and dressed professionally so I'd be taken seriously. Unfortunately this doctor was very arrogant and acted as though he was doing me a favor by saying no. He even told me to come back in a year and a half if I didn't change my mind, and he'd agree to it. I almost cried in the doctors office. I didn't want to wait around for a year and a half. Plus I don't trust him to do a thorough job. Once I got out to my car I couldn't cry. I just didn't have it in me because I was mostly frustrated. Also I knew I had to get work finding a new gynecologist. I messaged my primary care provider, she comforted me and said she will reroute the referral any place I wanted to go. I plan to send a letter to that doctor saying I found a phenomenal doctor and got the surgery.

As a medical professional and as a woman it makes me incredibly disappointed and upset that physicians deny individuals these types of procedures purely based on the assumption that "you'll regret it later" or "want children later". I'll give two examples of two people, one had endometriosis to the point that she was in constant pain and had to struggle to get her procedure done, the other is my cousin who has had 7 children. Her doctor refuses to do it because she is "only 30 years old". It's something that shouldn't happen but it does. This is a part of healthcare where this needs to change and I hope some day it does.

After that appointment, I posted in facebook about how frustrated I was trying to find a doctor for this surgery. An acquaintance I went to high school with reached out to me and recommended a doctors office. I had the referral rerouted there. The first doctor I talked to at that office said he felt uncomfortable doing my surgery but that he has already recommended me to a coworker of his, and she agreed to do the surgery without meeting me yet. I scheduled an appointment to see her the next day. She was so kind. I didn't have to beg or plead my case. She didn't question my decision although we did talk about the decisions and circumstances that led to me not wanting kids. We scheduled the surgery and I signed my consent forms.

Unfortunately, due to covid-19 my surgery was delayed. It was rescheduled a month after I was originally told I was getting it. I wasn't upset though. I was just happy that it was actually going to happen. With the surgery being delayed, I had time to work extra hours, arrange who will drive me to and from the surgery, go grocery shopping keeping in mind good things to eat/drink after surgery, and get my FMLA approved.

My FMLA was approved pretty quickly and I was set to have two weeks off. It was my boss that insisted I go on FMLA. I'm happy she suggested that because I'm such a lightweight when it comes to pain meds and anesthesia. Local anesthesia knocked me on my ass for hours when I had a cyst removed and when I did wake up, I was very disoriented.

I worked a bunch of hours so I would have better peace of mind while being on FMLA. I also took myself on a shopping trip to celebrate my surgery. During my pre-op appointment, she gave me the okay to have clear liquids up until two hours before surgery. I told her about me being a lightweight so I wanted some narcotics, but mostly ibuprofen. She explained to have a friend drive me to and from surgery. We talked about the kind of stitches I'd have and that I would be under general anesthesia and a paralytic, I would also have an intubation tube to help me breath. She felt bad about my family not supporting me, so she asked me if I wanted her to talk to my family and ease their minds. I know my parents aren't going to change their minds about this, so I told her it was okay. Also I don't want to drag her into my family drama. I had labs drawn and a covid test. I truly, truly didn't care for the covid test but it's a small price to pay for an elective surgery during a pandemic.

The night before my surgery, I had a big dinner at about ten o'clock at night. I went to bed right after. I wish I didn't go to bed so early so I could I sleep in because I couldn't eat all day. I think it's better to sleep through the times you can't eat. I could have clear liquids but I couldn't have more than 16 ounces.

My roommate dropped me off at the hospital for my surgery. I checked in and I paid for my surgery then. It was $250 for everything. Once I was all ready to go to surgery, my surgeon and anesthesiologist came to see me. I told my surgeon that I was so ready for this surgery and she said she had a feeling I've been ready for a while. They then wheeled me down to the operating room. I was talking to the nurses and I could hear the anesthesiologist say that it's time for the anesthesia. They put a large oxygen mask over me and that's all I remember. I don't even remember drifting off to sleep.

I then woke up in recovery, and this time I cried out of happiness. It's like a dream come true. The nurse said I had slept for two hours after surgery and the surgery went very well. She kept asking if I felt okay and she gave me two doses of fentanyl. I looked at my vital signs on the monitor and realized my pulse was at 140, which is why I got such strong pain meds. I took another short nap and drank some water. I had a ton of messages from friends, my boyfriend, and my roommates asking if I was okay. The nurse said she had already called and told everyone that I was okay and surgery went well.

My pulse went down and once the nurse saw that I could swallow okay and that I could go to the bathroom by myself, I was good to go. My roommates and boyfriend came to pick me up. We picked up my prescriptions. I had a prescription for ibuprofen and percocet. I do wish I picked up cough drops though. My throat is still scratchy because of the intubation tube.

After picking up my prescriptions, we got tacos to celebrate. I hadn't eaten all day so I was more hungry than in pain. Once I got home, I took an ibuprofen and went to bed. I woke up in quite a bit of pain so I took a percocet in the morning. The awesome nurse I had in recovery was nice enough to call me and ask how I was doing. She suggested taking either ibuprofen or percocet and then waiting three hours to take the other pain med. That has helped control my pain a lot. I am on day two post op. My ribs and shoulder still hurt sometimes because of the gas they gave me to blow up my organs. I was told walking helps with that, so I go on walks everyday. My stomach still kind of hurts like when I cough or sneeze, but I'm trying to save my pain meds for when I am in a lot of pain. My stomach still feels tender and sore, so I'm taking it easy. I have another 12 days of FMLA, and I think I'll be able to work. If I could give one piece of advice, it would be to never stop advocating for yourself. I'm so still happy this was done. I've already added my doctor the Reddit's list of Childfree Doctors.


ELI5: Why can't you live for ever if you replace organs when they start to fail.

I have been thinking on this for the last month and shouldent it be possible to live for a extended period of life if you keep on replacing organs when they start failing? And also in the future if we continue devoloping new ways to make skin and so forth we should be able to creat organs aswell right?

Your body counts on cell replacement. Cell replacement comes from cell division. Cell division counts on DNA replication. DNA has a finite number of replications, enforced by chipping away at a terminator called telomere. When the telomere gets too short, the DNA can't replicate any more. This flags things in the cell that say Time's up, time to give it up, and the cell commits biochemical suicide. When we get very old, a lot of our cells have short telomeres. So the trick isn't organ replacement, it's telomere preservation.

So the trick isn't organ replacement, it's telomere preservation.

Hypothetically, what would it take to stop senescence? Nanorobot's that replaced telomeres? Transdifferentiation trickery?

If DNA has a half-life of 512 years, how is it that an animal like the immortal jellyfish can theoretically live forever? Does the half-life of DNA only kick in after death?

Are there any promising advances/theories in science which might one day provide for the elimination or slowing of telomere loss?

edit: After reading about this:

but understanding very little of it, I wonder. Could we make non-cancerous cells immortal using Telomerase without making those cells harmful to us? Would that be absolutely impossible to do, or is it simply beyond our current understanding and technology?

In another study, introducing the TERT gene into healthy one-year-old mice using an engineered adeno-associated virus led to a 24% increase in lifespan, without any increase in cancer.

So you're telling us that our body basically commits suicide after a certain period of time?

A lot of people believe that when you die of old age, it has to do with a failure of a certain organ or mechanism. This isn't completely true. Over time, your DNA becomes weaker and weaker due to constant multiplication of cells. In order for something like this to truly work, you would need to replace/repair the genetic code itself as well as all of the organs in one's body.

one possible way is to find a way to download our consciousness, and move it to another body, whether organic, or robotic. But since no one really truly understands what consciousness is, as a scientifically caclulable factor. this is still beyond our reach.

How would you go about replacing the brain?

Brain transplants have been done on monkeys although not on humans yet, as i guess its kind of a taboo for people

People who are in very poor overall health are poor candidates for the kind of major surgery a transplant requires.

Not if your brain began to fail. And you can't replace that.

I'm going to add a little bit about the difference between switching up the transmission of your truck and a liver transplant. Right now we don't have the ability to grow complete transplanted organs spesified for the individual, at least its not commonly publicized and available for us. With your transmission you just switch out the metal there's a lot of plugging things in but essentially the truck just uses whatever transmission is there. With your body every cell has receptors on it which identify who it belongs to. When you go doing transplants as we currently have them you have to take tons of anti rejection drugs and the high end life span of a transplanted organ is about 10 years. Your body is always trying to reject cells that don't belong to it and as always fighting that new organ because it perceives that as an enemy invader. There is also some trauma and getting it out of the original host to some extent. Tissue is a living thing when we try to extend the pre programmed life span of a cell by manipulating or eliminating the telomeres on the ends of the cells we create cancer. I think the immortal jellyfish is a bit of a misnomer however, it probably lives for quite a while. We have quite a number of cells in our body that are perpetually regenerating with each copy of those cells we run into increased risk for bad copies. Many of those bad copies turn into cancer. the elastic properties of all tissues do degenerate over time cells are also not made at as high a rate as they were when one was young. People's bodies where out throughout their lives all of it from your hair to your skin to your brain. Its not like switching out the transmission of a truck and then one body panel at a time. We kind of have a pre-programmed expiration date cell by cell.


ELI5: Why do we spend so much time, research and time on organ transplants? ( Lung, heart, liver, kidney etc..) Has no one considered a better alternative?

I had a thought, maybe it's a little ahead of our time, but what is stopping us from completing full on brain transplants? So instead of adding a healthy organ into an aging body, we put the brain into a healthy body? These bodies could be produced in laboratories, or something similar, maybe kept in suspended animation, (In my mind I kind of picture it like a big warehouse of bodies waiting to be used for these brain transplants) waiting for a brain to be transplanted into it? I know it sounds far-fetched, but surely it should be considered in terms on scientific advancement? I mean, if we put in a lot of time, effort, money and research, surely it's not implausible?

Also I know there would be a lot of moral issues, i just think in the long run, if conducted properly, it would be beneficial to 'simply' transfer a brain into a ɿresh' body, rather than potential carrying out multiple organ transplants into the same aging body.

In a sense, this could create immortality, if the brain is capable of living forever if the environment it is in (the body) is healthy.

I've had this thought/idea for a year or two now, I just finally got around to posing the question to see what other people think of it.

EDIT 1: I'm not saying people who need organ transpalnts don't deserve them, what I'm saying it's better to transfer 'them' (their brain) into a body with all of the organs in perfect condition, kind of like a reset button.

Brain transplants, though they sound simple enough, are waaaaaayyyyy more complicated than other organ transplants. At this time, we still have pretty much no idea how to reconnect nerves that have been severed. Stem cells are promising, but still too unpredictable. For example, this lady grew a nose in her spine as a result of stem cell therapy, instead of her paralysis being cured.

Lots of your internal organs don't have nearly as many nerves through/around them. This is why you can't really feel your internal organs, and when they do get injured, it's usually a dull spread-out pain instead of being localized at the damaged site. This is why there aren't the same issues with transplanting lungs, kidneys, etc. as there would be with a whole brain.

I get that a brain transplant is a lot more complex. You say we have no idea on how to reconnect the nerves that have been severed, but why is that? Are we researching how to reattach severed nerves?

Do you think we should increase funding for this, and the whole brain transplant concept? I imagine in 100 years it could be a reality, like 100+ years ago organ transplants were non existent, our technology advances and I think this could be the next major breakthrough in the years/decades to come.

I think you might want to check out r/transhumanism - this is one of their big things.

I'll check this out, thank you. I have never met someone that has had this idea before, I've mentioned it to people before, but they've just shot me down as it being futuristic and unrealistic, but I still think it's a possibility.

I won't tackle the question why brain transplants aren't possible yet, but I'll talk about your initial question:

Why do we spend so much time, research and time (sic) on organ transplants? (Lung, heart, liver, kidney etc. ) Has no one considered a better alternative?

First off, organ transplantation in its current state is a makeshift solution at best and most transplant surgeons would agree that it represents only be a bridge technology until better methods are available. But not for the reasons you seem to think.

I feel I should mention that most medical research tries to battle disease and suffering and improve the lifes of those affected by it, not to make everyone immortal. Transplant medicine is aimed at saving those who are suffering from lifethreatening illnesses and injuries. It hopes to give those terminally ill at least a chance of life, not a way to make ordinary people immortal. Most patients waiting for an organ will be lucky to survive just a few more months, they aren't concerned with immortality just yet.

What makes todays transplant medicine so flawed is a) the need for organ donors and the growing organ shortage and b) the need for constant immunosuppression and its often devasting long-term effects.

Research into regenerative medicine therefore is trying to understand how we can restore and repair damaged organs, avoiding the need for donors, invasive surgery and life-long immunosuppression.

The same goes for artificially growing individual organs from patient's own tissue which is another field or research this would also render organ donation and immunosuppression irrelevant.

Future full-body transplants/brain transplants aren't implausible but for the foreseeable future they not only aren't the better alternative, they aren't an alternative at all. And since we've only limited resources and manpower, stopping all other transplant research in favour of brain transplants would be madness. At best we would end up with the ability to transplant brains but with a society so fed up with science and medicine that no further research is possible, at worst we sacrifice hundreds of thousands of lifes that could've been saved and can show nothing at all for it.

Even if we believe in extraterrestrial life we don't suddenly stop all science and education in the hopes that aliens will descend and grant us omniscience one day, do we? That would only reduce our chances of making contact in the first place.

Same goes for full-body transplants. Achieving it would make much of our current problems obsolete, but prioritizing it above more realistic goals will only make it less likely to happen. You can't start building spaceships if you haven't even learned to tame fire.

if the brain is capable of living forever if the environment it is in (the body) is healthy.

Sadly (or perhaps luckily) the brain isn't capable of that. It will age and wither no matter the environment. We may be able to one day extend its lifespan a few decades but eventually it will degenerate and die, so youɽ need to replace that aging brain as well.

it would be beneficial to 'simply' transfer a brain into a ɿresh' body, rather than potential carrying out multiple organ transplants into the same aging body.

Saying that full-body transplants would be a better solution than infinte organ transplants to cheat death may be right, but it is as silly as proclaiming that interdimensional teleportation outperforms conventional time-travel. Science needs lofty goals and being mortal sucks, but making "immortality" the goal of any medical research would only show both hubris and a lack of reality in my opinion.


ELI5: What determines a match for Organ Donor Transplant Surgery

Peoples cells have a special protein that lets their immune system recognize them. It’s like wearing a security badge. When the white blood cells come in contact with the cells, they will “read” the protein to determine if this is should be there or not. If your white blood cells don’t match with the protein it will trigger an immune response and your body will violently destroy the new organ.

Matching is based on blood and tissue matching. Blood matching is based on ABO typing (proteins on the red blood cell surface). Tissue typing is based on HLA (Human Leukocyte Antigens) proteins. These are used by the immune system to recognize the body's own cells. Without matching the recipient immune system will attack the donor cells, especially without immune suppressing drugs. Unfortunately, it is very difficult to find perfect matches as there are multiple different proteins and people can have very unique combinations.

For those curious, I am aware of two methods for testing tissue compatibility. The original method was based on sampling a person's blood, separating out the immune cells, and then exposing these to a panel of HLA antigens to find which ones caused an immune reaction (thus not matching properly). The newer method is using PCR to isolate the actual DNA of the HLA antigens and compare them based on the components of the DNA.