Opinion Review
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World J Stem Cells. Aug 26, 2022; 14(8): 577-586
Published online Aug 26, 2022. doi: 10.4252/wjsc.v14.i8.577
Pancreatic transplant surgery and stem cell therapy: Finding the balance between therapeutic advances and ethical principles
Martina Padovano, Matteo Scopetti, Federico Manetti, Donato Morena, Davide Radaelli, Stefano D’Errico, Nicola Di Fazio, Paola Frati, Vittorio Fineschi
Martina Padovano, Federico Manetti, Donato Morena, Nicola Di Fazio, Paola Frati, Vittorio Fineschi, Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome 00185, Italy
Matteo Scopetti, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome 00189, Italy
Davide Radaelli, Stefano D’Errico, Department of Medicine, Surgery and Health, University of Trieste, Trieste 34149, Italy.
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting, critical revision, and approval of the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vittorio Fineschi, MD, PhD, Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy. vittorio.fineschi@uniroma1.it
Received: March 18, 2022
Peer-review started: March 18, 2022
First decision: May 11, 2022
Revised: May 24, 2022
Accepted: August 1, 2022
Article in press: August 1, 2022
Published online: August 26, 2022
Processing time: 160 Days and 20.3 Hours
Abstract

The latest achievements in the field of pancreas transplantation and stem cell therapy require an effort by the scientific community to clarify the ethical implications of pioneering treatments, often characterized by high complexity from a surgical point of view, due to transplantation of multiple organs at the same time or at different times, and from an immunological point of view for stem cell therapy. The fundamental value in the field of organ transplants is, of course, a solidarity principle, namely that of protecting the health and life of people for whom transplantation is a condition of functional recovery, or even of survival. The nature of this value is that of a concept to which the legal discipline of transplants entrusts its own ethical dignity and for which it has ensured a constitutional recognition in different systems. The general principle of respect for human life, both of the donor and of the recipient, evokes the need not to put oneself and one’s neighbor in dangerous conditions. The present ethical reflection aims to find a balance between the latest therapeutic advances and several concepts including the idea of the person, the respect due to the dead, the voluntary nature of the donation and the consent to the same, the gratuitousness of the donation, the scientific progress and the development of surgical techniques, and the policies of health promotion.

Keywords: Pancreas transplantation; Multi-organ transplants; Stem cell therapy; Ethical principles; Donor; Recipient

Core Tip: Recent research in pancreatic transplantation is involving many branches of medicine. The objective is represented by the achievement of euglycemia and the anatomo-functional restoration of the β-cells, avoiding exogenous insulin administration. Transplantation of the pancreas or pancreatic islets (eventually associated with renal transplantation) and stem cell therapy constitute the new frontiers in this field. However, such rapid scientific growth must be followed by an extensive discussion on the ethical implications to make experimental and clinical practices adequate and sustainable.