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Skin grafting is a surgical procedure that involves removing skin from one area of the body and moving it, or transplanting it, to a different area of the body. This surgery may be done if a part of your body has lost its protective covering of skin due to burns, injury, or illness.

Skin grafts are performed in a hospital. Most skin grafts are done using general anesthesia, which means you'll be asleep throughout the procedure and won't feel any pain.

A skin graft is placed over an area of the body where skin has been lost. Common reasons for a skin graft include:

skin infections

large, open wounds

bed sores or other ulcers on the skin that haven't healed well

skin cancer surgery

There are two basic types of skin grafts: split-thickness and full-thickness grafts.

Split-thickness grafts

A split-thickness graft involves removing the top layer of the skin - the epidermis - as well as a portion of the deeper layer of the skin, called the dermis. These layers are taken from the donor site, which is the area where the healthy skin is located. Split-thickness skin grafts are usually harvested from the front or outer thigh, abdomen, buttocks, or back.

Split-thickness grafts are used to cover large areas. These grafts tend to be fragile and typically have a shiny or smooth appearance. They may also appear paler than the adjoining skin. Split-thickness grafts don't grow as readily as ungrafted skin, so children who get them may need additional grafts as they grow older.

Full-thickness grafts

A full-thickness graft involves removing all of the epidermis and dermis from the donor site. These are usually taken from the abdomen, groin, forearm, or area above the clavicle (collarbone). They tend to be smaller pieces of skin, as the donor site from where it's harvested is usually pulled together and closed in a straight-line incision with stitches or staples.

Full-thickness grafts are generally used for small wounds on highly visible parts of the body, such as the face. Unlike split-thickness grafts, full-thickness grafts blend in well with the skin around them and tend to have a better cosmetic outcome.

Your doctor will likely schedule your skin graft several weeks in advance, so you'll have time to plan for the surgery. Tell your doctor ahead of time about any prescription or over-the-counter medications you're taking. Certain medicines, such as aspirin, can interfere with the blood's ability to form clots. Your doctor may instruct you to change your dosage or stop taking these medications before the surgery. Additionally, smoking or tobacco products will impair your ability to heal a skin graft, so your doctor will likely ask you to stop smoking ahead of your surgery.

Your doctor will also tell you not to eat or drink anything after midnight on the day of the procedure. This is to prevent you from vomiting and choking during the surgery if the anesthesia nauseates you.

You should also plan on bringing a family member or friend who can drive you home after the surgery. General anesthesia may make you drowsy after the procedure, so you shouldn't drive until the effects have fully worn off.

It's also a good idea to have someone stay with you for the first few days after the surgery. You may need help performing certain tasks and getting around the house.

A surgeon will begin the operation by removing skin from the donor site. If you're getting a split-thickness graft, the skin will be removed from an area of your body that's usually hidden by clothing, such as your hip or the outside of your thigh. If you're getting a full-thickness graft, preferred donor sites are the abdomen, groin, forearm, or area above the clavicle (collarbone).

Once skin is removed from the donor site, the surgeon will carefully place it over the transplant area and secure it with a surgical dressing, staples, or stitches. If it's a split-thickness graft, it may be "meshed." The doctor may punch multiple holes in the graft to stretch out the piece of skin so that he or she may harvest less skin from your donor site. This also allows fluid to drain from under the skin graft. Fluid collection under the graft may cause it to fail. In the long term the meshing may cause the skin graft to take a "fish-net" appearance.

The doctor also covers the donor area with a dressing that will cover the wound without sticking to it.

The hospital staff will watch you closely after your surgery, monitoring your vital signs and giving you medications to manage the pain.

If you've had a split-thickness graft, your doctor may want you to stay in the hospital for a few days to make sure the graft and the donor site are healing well.

The graft should start developing blood vessels and connecting to the skin around it within 36 hours. If these blood vessels don't begin to form shortly after the surgery, it could be a sign that your body is rejecting the graft.

You may hear your doctor say that the graft "hasn't taken." This may happen for several reasons including infection, fluid or blood collecting under the graft, or too much movement of the graft on the wound. This may also happen if you smoke or have poor blood flow to the area being grafted. You may need another surgery and a new graft if the first graft doesn't take.

When you leave the hospital, your doctor will give you a prescription for painkillers to help minimize the pain. They'll also instruct you on how to care for the graft site and the donor site so they don't get infected.

The donor site will heal within one to two weeks, but the graft site will take a bit longer to heal. For at least three to four weeks after the surgery, you'll need to avoid doing any activities that could stretch or injure the graft site. Your doctor will tell you when it's safe to resume your normal activities.

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Skin Graft: Purpose, Types, and Procedure

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Skin grafting is a surgical procedure that involves removing skin from one area of the body and moving it, or transplanting it, to a different area of the body. This surgery may be done if a part of your body has lost its protective covering of skin due to burns, injury, or illness.

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Medical Breakthrough: Gene Therapy Skin Grafts Restore 80% of EB Patient's Skin

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Skin graft successfully replaces 80% of boy's skin.

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4 Things You Shouldn't Do When Taking A Wound Swab

Some wounds get infected and require a wound swab, and there are different methodologies for taking the samples. Infected wounds that are hard to diagnose...

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3 Innovative Alternatives to Skin Grafts

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4 Things You Shouldn't Do When Taking A Wound Swab Some wounds get infected and require a wound swab, and there are different methodologies for taking the samples. Infected wounds that are hard to diagnose...

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Medical breakthrough could eliminate need for painful skin grafts

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Sketch, surveillance video released in search for Jazmine Barnes' killer Houston Rodeo releases 2019 entertainment lineup Mother of 14-year-old boy charged with murder in deadly crash speaks Shaquille O'Neal, Houston officer cover cost of Jazmine Barnes' funeral "You may all go to hell, I am going to Texas."

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U.S. Government Information on Organ Donation and Transplantation

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Soon there may be no need to wait weeks or months for an organ transplant. Meet the new bodybuilders - tissue engineers who hope to make ready-made organs

WHEN the tracheal cancer reappeared, doctors agreed that Andemariam Teklesenbet Beyene's golf ball-sized tumour was inoperable. So one of them suggested a treatment that was rather different&colon; building him a new windpipe, from scratch.

Researchers around the world are making groundbreaking progress in engineering replacement organs. Since the first successes with bioengineered skin - which can be used for grafts to treat people with burns, for example - tissue engineers have created lab-grown cartilage, bone and, most recently, whole organs such as bladders.

"Scientists genuinely believe that in years to come, labs will be filled with rows of hearts and livers that can be taken off the shelf and tailored to you," says Lindsey Dew, who has just started a PhD in tissue engineering at the University of Sheffield. "Tissue engineering is the future of medicine."

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"In years to come, labs will be filled with rows of hearts and livers that can be taken off the shelf"

Building organs

Engineering an organ usually means starting with a scaffold to supply the basic structure. This is often donated. The team behind the world's first bioengineered windpipe transplant, for example, started this way, stripping the donor's cells from the structure before seeding it with stem cells from the recipient's bone marrow. Stem cells can be encouraged to develop almost any type of cell, given the right environment, and once the recipient's cells had populated the scaffold, it could be transplanted.

Unlike donated organs, those custom-made in this way are not rejected by the body. That means recipients are spared a lifetime of taking immune-suppressing drugs.

Tissue engineers now hope to bypass lengthy waits for donor organs by using synthetic scaffolds. One of the first successes came two years ago, when a team at Karolinska University Hospital in Stockholm, Sweden, transplanted a synthetic windpipe for the first time. Beyene was the lucky recipient.

The trachea was developed by Alexander Seifalian and his colleagues at University College London. With a background in nuclear physics, Seifalian also studied nuclear medicine and biochemistry before settling on tissue engineering. "It's the next generation of medical treatment," he says. "When you're developing organs, you're saving lives and improving people's lives. That got me excited."

His team built the organ in just 10 days. Seifalian first crafted a glass mould of Beyene's windpipe based on a CT scan, then the team used the mould to create a replica made from porous polymers. They coated this scaffold with growth factors - chemical cues to goad stem cells into becoming specific cell types - then soaked the structure in a solution of stem cells extracted from Beyene's bone marrow. During this time, the cells take hold in the scaffold's millions of tiny holes. Today, Beyene remains in good health. "It was the highlight of my life," says Seifalian.

Since then, Seifalian's team has built tear ducts and bypass grafts from similar materials. Lab-grown urethras, coronary arteries, heart valves and stents are next.

Other groups are creating new organs by printing them. Ben Shepherd and colleagues at Organovo, a bioengineering company based in San Diego, California, used a 3D printer loaded with human cells to build a functional "mini-liver". Although only a few millimetres wide and a mere half a millimetre thick, it produced detoxification enzymes just like a full-sized liver.

Body shop

Seifalian's long-term ambition is to scale up production. "It would be virtually like having a shop," he says. "People could order an organ and I would make it and send it to them." Organs such as windpipes, ears or noses would ideally still be made to measure, but blood vessels or heart valves could be manufactured in various standard sizes.

One of the main challenges is ensuring these newly built organs have enough of a blood supply to keep them alive. For her PhD project, Dew is developing experimental and computational models to look for ways to accelerate blood vessel growth in skin grafts.

"With tissue engineering, there's a real push to take research out of the lab and into the clinic," says Dew. "I love the idea that my work will have an impact on patients' lives."

A truly multidisciplinary subject, tissue engineering requires the skills of chemists and materials engineers to design and build organ scaffolds, physicists and mathematicians to model tissue growth, and biologists to monitor and control cell growth. "Sitting in my team now we have physicists, engineers, mathematicians, pharmacologists, biologists and surgeons, and we collaborate with other clinical staff," says Seifalian.

At the moment, most UK tissue engineering research takes place in universities, and much of the funding comes from organisations supporting the development of bioengineered organs for drug testing, including the National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) and the EU's Innovative Medicines Initiative. NC3Rs provides PhD studentships and early career fellowships at UK universities.

The biggest UK employers in industry are Smith & Nephew, a research company focused on wound care, and drug company Pfizer, whose research includes developing stem cell therapies for Crohn's disease.

Postdocs can get in on the action by creating their own opportunities, says Jamie Davies, who is attempting to engineer kidneys at the University of Edinburgh. "Find a really strong group that has not yet got tissue engineering and be the one who starts it," he suggests.

"It's a great time to pitch in," says Shepherd. "You're starting to see things happen that people have been talking about the last 10 to 15 years. It's really exciting."

Build your own food, too

Mark Post's burger recipe is somewhat unconventional. He starts by collecting stem cells from cow muscle. Post's team at Maastricht University in the Netherlands then coaxes them into multiplying to form small strips of muscle tissue. "If you make sufficient numbers of those, you have enough to make a hamburger," he says.

It may seem far-fetched, but in-vitro meat offers a solution to some pressing global issues, notably feeding hungry mouths as the world's population rises. "Meat production has met its maximum, but demand is going to double in the next 20 to 40 years," says Post. Swapping livestock for test tubes would also slash the emission of greenhouse gases belched out by the animals, and avoid the welfare issues associated with farming.

Post's first burger took three months to manufacture and cost an indigestion-inducing €260,000, but he hopes to refine the procedure until it is more cost-effective than rearing animals for food.

"It's really promising as a first step for the future of cultured meat," says Marianne Ellis, a biochemical engineer at the University of Bath. Her team is developing devices called bioreactors that aim to provide the ideal conditions for tissue growth. These systems could scale up the production of in-vitro meat, she says.

Current opportunities for aspiring meat engineers are few and far between, but Post hopes that the publicity generated by his burger will whet the appetites of other research groups and funding bodies. "I'm pretty sure that five years from now, it'll be pretty big," he says. By then, in-vitro meat might already have hit supermarket shelves, says Ellis.
This article appeared in print under the headline "Grow your own"

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Grow your own organs as a tissue engineer

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Soon there may be no need to wait weeks or months for an organ transplant. Meet the new bodybuilders - tissue engineers who hope to make ready-made organs WHEN the tracheal cancer reappeared, doctors agreed that Andemariam Teklesenbet Beyene's golf ball-sized tumour was inoperable.

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With the recent launch of MIT's Institute for Medical Engineering and Science, MIT News examines research with the potential to reshape medicine and health care through new scientific knowledge, novel treatments and products, better management of medical data, and improvements in health-care delivery.

In the 1970s and 1980s, tissue engineers began working on growing replacement organs for transplantation into patients. While scientists are still targeting that goal, much of the tissue engineering research at MIT is also focused on creating tissue that can be used in the lab to model human disease and test potential new drugs.

This kind of disease modeling could have a great impact in the near term, says MIT professor Sangeeta Bhatia, who is developing liver tissue to study hepatitis C and malaria infection.

Like other human tissues, liver is difficult to grow outside the human body because cells tend to lose their function when they lose contact with neighboring cells. "The challenge is to grow the cells outside the body while maintaining their function after being removed from their usual microenvironment," says Bhatia, the John and Dorothy Wilson Professor of Health Sciences and Technology and Electrical Engineering and Computer Science.

Bhatia recently developed the first stem-cell-derived liver tissue model that can be infected with the hepatitis C virus. She has also designed thin slices of human liver tissue that can be implanted in mice, enabling rapid studies of potential drugs.

In a large-scale project recently funded by the Defense Advanced Research Projects Administration, several MIT faculty members are working on a "human-on-a-chip" system that scientists could use to study up to 10 human tissue types at a time. The goal is to create a customizable system of interconnected tissues, grown in small wells on a plate, allowing researchers to analyze how tissues respond to different drugs.

"If they're developing a drug for Alzheimer's, they may want to examine the uptake by the intestine, the metabolism by the liver, and the toxicity on heart tissue, brain tissue or lung tissue," says Linda Griffith, the S.E.T.I. Professor of Biological and Mechanical Engineering at MIT and leader of the research team, which also includes scientists from the Charles Stark Draper Laboratory, Zyoxel and MatTek.
Regeneration
Another near-term goal for tissue engineers is developing regenerative therapies that help promote wound healing.

"Healthy cells sitting adjacent to diseased tissues can influence the biology of repair and regeneration," says MIT professor Elazer Edelman, who has developed implantable scaffolds embedded with endothelial cells, which secrete a vast array of proteins that respond to injury.

Endothelial cells, normally found lining blood vessels, could help repair damage caused by angioplasty or other surgical interventions; smoke inhalation; and cancer or cardiovascular disease. The implants are now in clinical trials to treat blood-vessel injuries caused by the needles used to perform dialysis in patients with kidney failure. Better repair of those injuries could double the time that such patients can stay on dialysis, which is now limited to about three years, says Edelman, the Thomas D. and Virginia W. Cabot Professor of Health Sciences and Technology.

Similar scaffolds could also help heal serious injuries such as smashed bones, which are very difficult to repair. Griffith and George Muschler, an orthopedic surgeon at the Cleveland Clinic, have developed ceramic scaffolds coated with immature blood cells taken from a patient's bone marrow, which are now being tested in animals.
Replacement
One of the earliest successes of implantable tissues was the development of artificial skin, which is now commonly used to treat burn victims. Skin was a good place to start because its function is easier to mimic than that of more complex organs such as the heart or liver, says Robert Langer, the David H. Koch Institute Professor at MIT, who was one of the pioneers of the technology behind tissue engineering, along with Ioannis Yannas, MIT professor of mechanical engineering.

Langer is now working on more complex tissues, such as cardiac-tissue scaffolds that include electronic sensors and a synthetic polymer that could restore vocal-cord function in people who have lost their voices through overuse or other types of damage.

One major challenge for designing implantable organs is that the tissues need to include blood vessels that can connect to the patient's own blood supply. In Langer's lab, researchers are working on inducing blood vessels to form by growing cells on nanopatterned surfaces.

In Bhatia's lab, where tissue-engineering research is evenly divided between modeling diseases and working toward implantable organs, researchers recently developed 3-D liver tissues that include their own network of blood vessels. In a recent paper in Nature Materials, Bhatia and Christopher Chen of the University of Pennsylvania described how they built the tissues by printing a 3-D network of sugar molecules, then growing liver tissue around it. After dissolving the sugar, they stimulated blood vessels to fill in the space left behind.

Though still a long-term goal, being able to regenerate new organs could have a great impact on the future of health care, Langer says. "It's the kind of thing that can transform society," he says. "You can't have a drug that will grow a new liver or a new heart, so this could be huge."

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institute for medical engineering and science (imes)

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Tissue engineering: Growing new organs, and more

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With the recent launch of MIT's Institute for Medical Engineering and Science, MIT News examines research with the potential to reshape medicine and health care through new scientific knowledge, novel treatments and products, better management of medical data, and improvements in health-care delivery.

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NIBIB's 60 Seconds of Science explains what tissue engineering is and how it works. Music by longzijun 'Chillvolution.' For more information on Tissue Engineering: http://www.nibib.nih.gov/science-education/science-topics/tissue-engineering-and-regenerative-medicine For NIBIB's Copyright Policy: http://www.nibib.nih.gov/policies#copyright

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3D printing human tissue: where engineering meets biology | Tamer Mohamed | TEDxStanleyPark

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A record amount of money is spent developing new drugs, but drug approval rates are declining and many fatal diseases are left untreated. A big reason behind this is often times current drug testing methods including animal testing don't accurately predict the human response to drugs.

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Although organ donation is vital to our health care system, many individuals still feel unnerved when they first receive the organ donation form. For many, this is when they get their first driver's license and subsequently with every license renewal thereafter. However, because most individuals are not properly educated on how organ donation works, whom it benefits, what the benefits are, and what the negatives are, many don't opt-in.

Rather, the form often elicits a passive response of consideration but then gets tossed aside and often forgotten. Namely, this is due to the topic being a tricky one to talk about or consider because of the implications it has. With this said, read on to find out who can donate and what the benefits and negatives of organ donation entail.

Who Is a Good Candidate For Organ Donation

Almost anyone can become an organ donor, but for those who are under the age of eighteen, must have a parent present when giving their permission or else they must have guardian consent. Generally, anyone is a good candidate, permitting that he or she does not have actively spreading cancer, a severe infection, or HIV/AIDS. When going to donate an organ, one must go through a testing and evaluation before getting the green light.

Typically, the donor should have a similar blood type and tissue type, and when possible be an exact match. However, most recipients will receive a special treatment to prevent their body from rejecting the organ, tissue, or donated blood. Organs and tissues that can be donated include the liver, kidney, skin, bone marrow, bone, lungs, intestines, heart, pancreas, heart valves, middle ear, cornea, and connective tissue.

Pros:

1. Saving lives

There are hundreds of thousands of people who are waiting for an organ donation and one organ donor can end up saving up to eight of these lives as critical organs like the heart, kidneys, and liver can be matched to those in need.

2. It provides family consolation/closure

If an individual passes away unexpectedly or dies out of a tragedy, them being an organ donor can actually provide their family with some closure and consolation. In knowing that your family member or friend has donated a part of themselves to someone else, there can be an understanding that their life was not lost in vain. It also helps connect the family to new individuals who have been saved because of the passing of their loved one.

3. You contribute to medical research opportunities

If for some reason an organ cannot be helpful to someone straight away, the organ or the body can be donated to scientific research. This is especially helpful in understanding rare diseases, genetic conditions, and illnesses that are rarely seen. An organ of someone who has an ailment as such can also help others who are suffering from the same condition.

4. You Give Someone a Second Chance

Those who are waiting on an organ transplant are often on treatment plans that help them extend their life. These can be costly, require multiple treatments and trips to the doctor and may require them to have constant medical attention. When an organ is donated, you give them a second chance at living a relatively normal life, one that possibly doesn't have costly procedures and multiple trips to the doctor.

5. You Can Help Someone Right Now

If you are an exact match for someone on the transplant list, you may become a living donor and help them right now. Living donations can be done for portions of the liver, the kidneys, portions of the lung, pancreas, and intestinal tissues. If you would prefer to not donate an organ but still want to be a living donor, choose to donate blood.

Cons:

1. It Can Extend the Family's Grieving Period

Unfortunately, for an organ donation to be successful, the family of the organ recipient may need to keep them on extended life support, which can prolong the grieving period. When a family member or friend is kept on life support, it can provide a false sense of hope or presence of life which can make the grieving process stronger and harder to go through. Organs are not donated until an individual has been pronounced as brain dead.

2. Not everyone is an eligible organ donor

Although anyone can go through the process of becoming an organ donor, not everyone will be eligible to provide specific organs as there are age restrictions in place. For instance, someone who wants to donate a heart valve, cannot if they are not younger than sixty years of age. Someone who is over the age of eighty cannot donate their corneas. Individuals who have actively spreading cancer within the past year cannot donate at all, as is the same for those who are HIV positive.

3. Organ donation can cause health problems

Not only can organ donations cause complications with surgery but for some people, surgery will require a lifestyle change. If that lifestyle change is not followed, this can cause other health problems. For instance, those who donate a kidney will no longer be able to consume alcohol, or those who donate bone marrow may be restricted from participating in certain activities.

4. Not every organ will be accepted

Unfortunately, organs do get rejected by the body and it can be tough knowing that one must take immunosuppressants for the rest of their life just to stop their body from rejecting the organ that has saved their life.

5. Employers do not always have donor leave policies

When considering donating an organ, knowing employee policies around paid and unpaid leave is critical since being an organ donor is expensive. Some U.S states do not have donor leave policies which may heavily sway your decision to become an organ donor.

All in all, the best thing you can do if you are considering becoming an organ donor is to learn more about how the system works and what the benefits are. By becoming educated on the subject, you can make an informed decision on whether you would like to donate your body to medical research, provide your organs for donation, or opt out completely.

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10 Pros and Cons of Organ Donation - organdonation.com

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Although organ donation is vital to our health care system, many individuals still feel unnerved when they first receive the organ donation form. For many, this is when they get their first driver's license and subsequently with every license renewal thereafter.

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We never know when tragedy might strike. We never known when an illness may develop. Some people may even be born with a genetic disorder or disease and require help. That is why the current system of organ donations is such an integral part of our healthcare system.

Thanks to modernizing technologies, it is possible for more people to become living donors than ever before. It is also very easy to list yourself as an organ donor should something happen to you, allowing you to save multiple lives with one final act of caring and grace.

There are some organ donation pros and cons that should be thought about if you're wondering if becoming an organ donor is the right decision for you.

Here Are the Pros of Organ Donation

1. It is possible for one organ donor to save up to 8 lives.
More than 100,000 people just in the United States are waiting for an organ transplant right now. This includes critical organs, such as the heart, the liver, and the kidneys. When a person registers as an organ donor, it becomes possible to help save lives in ways that you may have never thought possible before.

2. It offers people a second chance at life.
People who are waiting for an organ transplant are often dependent on costly treatments to survive. A person waiting for a kidney transplant, for example, may need to visit a dialysis clinic multiple times per week to have their blood cleaned. By being able to donate an organ, it becomes possible for that individual to return to a somewhat normal lifestyle that doesn't have the same costly procedures that need to happen on a regular basis.

3. It can offer a sense of closure.
For organ donations which occur out of tragedy, the process of organ donation can help families to find a sense of closure that wouldn't happen otherwise. Knowing that the heart of a son, daughter, father, or mother continues to beat on in the chest of someone else can be a comforting experience. It won't eliminate the grief that comes from losing a loved one, but it does communicate the idea that their loss is not in vain. Letting someone continue with their life is a gift that really does keep on giving.

4. It is possible to help someone right now.
If someone is a direct match for an individual on the organ transplant list, then it is possible to help a person in need right now. You can donate certain organs while you are still alive. Living donations right now include a kidney, portions of the liver, portions of the lung or pancreas, and some intestinal tissues as well. If you are not comfortable with this type of living donation, then consider donating blood.

5. There are no age restrictions on being an organ donor.
Anyone can be an organ donor, including children. The only restrictions in place are related to the age of certain organs for some individuals and that children under the age of 18 must have the consent of a parent or guardian to provide a donation.

6. It allows for the potential of medical research advances.
Organ donation may not always be possible to help someone else live a normal life, but that doesn't completely exclude the ability to donate to help others. People can make donation to benefit science and medical research. This may include donating a specific organ, such as a heart or their brain. It can even include donating their entire body. For those who may have a rare disease or genetic condition, a donation such as this offers the potential of saving more lives through the knowledge gained.

7. Living donations are free.
If you are approved as a match and make a living donation for someone in need, then the medical procedure and recovery needs you have are free of charge. The costs related to you are usually not passed on to the organ recipient either, as many physicians will provide their services free of charge. Even if there are recovery complications, your medical costs are covered.

8. More organ transplants are happening today than ever before.
In 2016, there were more than 33,500 organ transplants that occurred in the United States. That set a new record for completed transplants. Thanks to improvements in medical procedures and technology innovations, there has been a 20% increase in successful transplants from 2012-2016. With more than 8,000 transplants completed in the first quarter of 2017, that is a trend which looks to be continuing.

Here Are the Cons of Organ Donation

1. It can prolong the grieving period of a family.
For an organ donation to be successful, it may be necessary to keep a loved one on life support for an extended period. This helps to keep the tissues which will be donated in a healthy state. Organ donations do not occur unless a person is declared to be brain dead, but the process of life support can make it feel like a loved one is still alive. When there is the presence of life, there is often hope, and having that hope can make the grief even stronger.

2. There is not always a choice for the donation.
Many families do not have a choice in who gets the organs that are being donated by a loved one through tragedy. They are simply given to the person who is on the organ donation list who is a match and in the direst of need. This means someone of a different faith, a different political position, or different culture may receive the organ and that can be difficult for some families to accept. Living donations are often matched to other family members, while direct matches for humanitarian purposes are also possible, so this key point doesn't always apply.

3. Not everyone can become an organ donor.
Although many people can become an organ donor through a simple authorization process, not everyone is eligible. There are age-related restrictions on certain organs. You cannot be over 80 years old to make a cornea donation and must be younger than 60 to donate heart valves or tendons. People with certain existing medical conditions, such as being HIV-positive, having metastasized cancer in the last 12 months, or being diagnosed with Creuzfeldt-Jacob Disease will also prevent a donation.

4. Organ donations can lead to other health problems.
To become a living donor, a surgery or medical procedure is required. Any surgery offers a risk to the person that may include death. Other health problems can develop after a surgery that requires a lifestyle change. People who donate bone marrow, for example, may be restricted in the future activities for a lifetime. Those who donate a kidney may be prohibited from consuming alcohol. For those who receive an organ, there is a 10% risk of diabetes development.

5. Not every organ which is donated will be accepted.
Organ rejection is a very real possibility for those who receive a transplant. Even when there is a direct match, there is always the chance that the transplant will be rejected. Those who receive a transplant will often be required to take immunosuppressant medications for the rest of their lives to reduce the chances of this issue from occurring.

6. Employers do not always have leave policies for living donations.
Only 12 states in the US currently have organ or bone marrow donor leave policies that impact private sector employees. Federal government employees receive 30 days of paid leave for an organ donation and 7 days of paid leave for a bone marrow donation that is over and above the employee's sick and annual leave. Most states have similar donor leave laws for state employees, but some offer the 30 days of leave unpaid.

7. Organ transplants are incredibly expensive.
In the United States, the cost of a liver transplant is $71,000, plus an additional $25,000 for every 30 days of care pre-transplant. For those who need a heart-lung transplant, the cost is $130,000, with an additional $56,000 for every 30 days of care pre-transplant. For many organ recipients, their total care cost exceeds $1 million, with heart-lung transplant recipients facing a cost of $2.3 million. Part of this cost is due to the wait time to receive an organ transplant. For some organs, the average wait time can be 3-5 years in some regions of the United States.

The pros and cons of organ donation show that you can get involved in some way right now. You can register to become an organ donor. You can register your children. You can also be tested to see if you could become a living donor for someone who is in need right now. Someone is added to the national organ transplant waiting list every 10 minutes, on average, in the United States. Since one organ donor can save up to 8 lives, the time to act is now.

Blog Post Author Credentials
Louise Gaille is the author of this post. She received her B.A. in Economics from the University of Washington. In addition to being a seasoned writer, Louise has almost a decade of experience in Banking and Finance. If you have any suggestions on how to make this post better, then go here to contact our team.

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We never know when tragedy might strike. We never known when an illness may develop. Some people may even be born with a genetic disorder or disease and require help. That is why the current system of organ donations is such an integral part of our healthcare system.

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The perfect tan in a bottle, but at what cost? The increasingly popular self-injecting "Barbie doll drug" Melanotan II is unregulated and, say doctors, could be dangerous.

It is a treatment which promises to leave you tanned, thin and stimulated. Melanotan II is said to suppress your appetite and increases your libido while leaving you bronzed regardless of the season, writes Science Reporter . But this synthetic hormone is an unlicensed drug so its quality, safety and efficacy has not been tested. This means it is illegal to sell in the UK - but not to buy online.

And this loophole means the illicit global trade of online pharmaceuticals is flooding the UK and the country's medicines regulator says the internet is "impossible to police" because these websites could be based anywhere in the world.

Melanotan II can only be injected with needles. It is designed to stimulate the pigment cells in your body to produce more melanin, which gives you a tan. After several injections and exposure to the sun or a sun-bed to kickstart the process, your skin tone is claimed to change from the inside out.

There have been no long-term clinical trials and the side effects of this chemical are unknown. Doctors say it could potentially be very dangerous because it has the ability to change the shape and colour of moles. Reactions to the drug vary from person to person ranging from acute allergic reactions, to dizziness, sickness and acne. There is no way of knowing what is actually in the bottle or how it will react to other medicines.

'I get a tan in one quick step'

And it is cheap to buy. The attraction, says Nichola Hill, a user from Hove says, "I get a tan in one quick and easy step. It's like anything, I do it in moderation."

Dr Patrick Bowler, a Harley Street dermatologist, told Channel 4 News that vanity is powerful force, which means even people afraid of needle overcome their fears. People, it seems, will do anything for the body beautiful. Following the explosion of non-surgical procedures on the cosmetic surgery market we appear to have become less squeamish about the use of needles. Women now pop out at lunchtime to get a Botox fix and anyone from hairdressers to dentists can administer the jab for you.

One woman from Sheffield, who wanted to remain anonymous, told us that she regularly used Melanotan 2 but hid it from her family. When I asked her why, she said they wouldn't understand "because only junkies inject".

Self-injecting also highlights other concerns about needle safety issues. There is the risk of blood-borne diseases such as hepatitis and HIV. One national health and social care charity, the Crime Reductions Initiatives (CRI) told Channel 4 News that almost half of users at its needle exchanges in England and Wales are injecting image-enhancing drugs, not opiates like heroine. At Stockton CRI, on Teesside, staff have noticed a sharp increase in the use of Melanotan 2 over the last two years.

There are no national figures for Melanotan 2 use or steroids, weight loss drugs or any other image enhancing drug. Staff at CRI's needle exchange say the proportion of non-illegal drug users could be far higher because it remains unknown whether needles collected are shared with other users too.

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Rise in use of 'dangerous' tanning injection

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The perfect tan in a bottle, but at what cost? The increasingly popular self-injecting "Barbie doll drug" Melanotan II is unregulated and, say doctors, could be dangerous. It is a treatment which promises to leave you tanned, thin and stimulated.

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What lengths would you go to to achieve a darker tan?

While some people apply fake tanning products to avoid excess time in the sun, others choose a more extreme method to gain their ideal complexion.

It involves injecting melanotan into your body.

Spokeswoman for Cancer Council Queensland Katie Clift says melanotan mimics the activity of a natural skin hormone.

"It stimulates skin cells to secrete melanin, which is a pigment that gives skin its colour," Ms Clift said.

But she warns there are health risks involved with using melanotan, as it has not been approved for sale by the Therapeutic Goods Administration in Australia and it is illegal for Australians to buy it overseas or online.

"At the moment people are illegally importing it into Australia and injecting it into their skin in order to tan," Ms Clift said.

Users notice change in moles and freckles

Dr Robert Miller is a specialist dermatologist in Townsville, and has treated people who have used melanotan.

He says when people inject melanotan it can change the appearance of their moles and freckles.

"Whether that is a permanent change in the structure we don't know, but it will make them look different - and of course one of the signs of melanoma is a mole or a freckle that has changed its appearance," Dr Miller said.

He says using melanotan could cause people to have unnecessary surgery.

"I suppose as a dermatologist my main concern with this drug is what effect in the long-term does it have on melanoma risk, and in the short-term if people are using it - are people going to have to get their moles and freckles looked at fairly closely, and perhaps even some of them excised unnecessarily," he said.

Dr Miller says he hasn't diagnosed a melanoma in someone using melanotan yet, but he says it is concerning that we have such a high instance of melanoma to start with in Australia.

"For example in the Mackay region the risk for a male getting a melanoma is 100 cases per 100,000 population per year, which is huge compared to the UK where it is about six per 100,000 per year," Dr Miller said.

"Townsville is about 87 for males, a little bit less for females, but I think Mackay wins the prize for the highest instance in the world."

Words of advice

Dr Miller does not endorse using melanotan for cosmetic purposes.

"We have no idea what effects it has really in the long-term," he said.

"Now in 10 or 15 years' time it might be proved to be a fantastic drug, it might prevent skin cancers and melanomas, so in the future maybe this drug has a huge market or area of use.

"But until that has been researched and recognised I tell people to stay away from it."

Editor's note: This story has been updated to clarify that melanotan has not been approved by the TGA and is not available on prescription in Australia. Text which suggested it can accelerate cancers has also been removed. The long-term effects of the drug are unknown.

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Dermatologist warns against tanning injections

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What lengths would you go to to achieve a darker tan? While some people apply fake tanning products to avoid excess time in the sun, others choose a more extreme method to gain their ideal complexion. It involves injecting melanotan into your body.

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Scientists make drug that creates a natural tan and prevents skin cancer

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Many people love having a tan, even though we know full-well that UV damage is extremely dangerous and harmful. We slather on sun-cream to protect our skin, and then apply the fake stuff to achieve a safe glow. But what if there was a way to get a real tan whilst staying safe in the sun?

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On March 3 the cover story of the New York Daily News trumpeted a simple imperative to "Design Your Baby." The screaming headline related to a service that would try to allow parents to choose their baby's hair, eye and skin color. A day later the Fertility Institutes reconsidered. The organization made an "internal, self regulatory decision" to scrap the project because of "public perception" and the "apparent negative societal impacts involved," it noted in a statement.

The change of heart will do nothing to stymie the dawning era of what the article called "Build-A-Bear" babies. The use (and abuse) of advanced fertility technology that evokes fears of Gattaca, Brave New World and, of course, the Nazis' quest for a blonde, blue-eyed race of Aryans continues apace. A recent survey found that about 10 percent of a group who went for genetic counseling in New York City expressed interest in screening for tall stature and that some 13 percent said they would be willing to test for superior intelligence. The Fertility Institutes is still building the foundation for a nascent dial-a-trait catalogue: it routinely accepts clients who wish to select the sex of their child.

The decision to scrap the designer baby service came just a few weeks after Nadya Suleman, a single, unemployed California mother living on food stamps, gained notoriety after giving birth to octuplets through in vitro fertilization. The Suleman brouhaha showed that even routine uses of reproductive technologies can be fraught with issues that bear on ethics and patient safety.

The preimplantation genetic diagnosis (PGD) technique used by the Fertility Institutes to test embryos before implantation in the womb has enabled thousands of parents to avoid passing on serious genetic diseases to their offspring. Yet fertility specialists are doing more than tiptoeing into a new era in which medical necessity is not the only impetus for seeking help. In the U.S., no binding rules deter a private clinic from offering a menu of traits or from implanting a woman with a collection of embryos. Physicians who may receive more than $10,000 for a procedure serve as the sole arbiters of a series of thorny ethical, safety and social welfare questions. The 33-year-old Suleman already had six children, and her physician implanted her with six embryos, two of which split into twins. American Society for Reproductive Medicine (ASRM) voluntary guidelines suggest that, under normal circumstances, no more than two embryos be transferred to a woman younger than 35 because of the risk of complications.

Of course, any office consultation with a fertility doctor will likely neglect the nuances of more encompassing ethical dilemmas. Should parents be allowed to pick embryos for specific tissue types so that their new baby can serve as a donor for an ailing sibling? For that matter, should a deaf parent who embraces his or her condition be permitted to select an embryo apt to produce a child unable to hear? Finally, will selection of traits perceived to be desirable end up diminishing variability within the gene pool, the raw material of natural selection?

In the wake of the octuplets' birth, some legislators made hasty bids to enact regulation at the state level-and one bill was drafted with the help of antiabortion advocates. The intricacies of regulating fertility technology requires more careful consideration that can only come with a measure of federal guidance. As part of the push toward health care reform, the Obama administration should carefully inspect the British model.

Since 1991 the U.K.'s Human Fertilization and Embryology Authority (HFEA) has made rules for in vitro fertilization and any type of embryo manipulation. The HFEA licenses clinics and regulates research: it limits the number of embryos implanted and prohibits sex selection for nonmedical reasons, but it is not always overly restrictive. It did not object to using PGD to pick an embryo that led to the birth of a girl in January who lacked the genes that would have predisposed her to breast cancer later in life.

HFEA may not serve as a precise template for a U.S. regulatory body. But a close look at nearly two decades of licensing a set of reproductive technologies by the country that brought us the first test-tube baby may build a better framework than reliance on the good faith of physicians who confront an inherent conflict of interest.
This story was originally published with the title "Designing Rules for Designer Babies"

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On March 3 the cover story of the New York Daily News trumpeted a simple imperative to "Design Your Baby." The screaming headline related to a service that would try to allow parents to choose their baby's hair, eye and skin color. A day later the Fertility Institutes reconsidered.

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Genetic Engineering Will Change Everything Forever – CRISPR

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The ethical dilemma of designer babies | Paul Knoepfler

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Benedikt Luft

At first, Matthew assumed the weakness in his knee was the sort of orthopedic nuisance that happens when you turn 30. It was weeks before he consulted a doctor, and months before it occurred to him that there could be a connection between his worsening limp and a cousin's shoulder problem when they were kids. DNA testing confirmed it: Matthew, like his cousin, had a genetic form of dystonia, a condition where muscles contract uncontrollably. Their grandfather most likely had dystonia as well.

I'd met Matthew only a few months earlier, when he'd married my friend's daughter, Olivia, in one of those hip old New York hotels with an elegant downtown vibe. Since I was the only genetic counselor of their acquaintance, they brought their questions to me. With their permission, I am sharing their story. I have changed their names to preserve their privacy.

Matthew was lucky. His was a mild version of DYT1 dystonia, and injections of Botox in his knee helped. But the genetic mutation can cause severe symptoms: contractures in joints or deformities in the spine. Many patients are put on psychoactive medications, and some require surgery for deep brain stimulation.

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Their kids, Matthew and Olivia were told, might not be as lucky. They would have a 50-50 chance of inheriting the gene variant that causes dystonia and, if they did, a 30% chance of developing the disease. The risk of a severely affected child was fairly small, but not insignificant.

My friends learned there was an alternative. They could undergo in vitro fertilization and have their embryos genetically tested while still in a laboratory dish. Using a technology called pre-implantation genetic testing, they could pick the embryos that had not inherited the DYT1 mutation.

It would be expensive-costs for IVF in the US average over $20,000 for each try, and testing can add $10,000 or more. And it would require an unpleasant two-week process of ovarian stimulation and egg harvesting. "It wasn't the way I saw myself making a baby," Olivia told me. But they wanted what the procedure could offer them: a guarantee that dystonia was eliminated for the next generation, and beyond.

Matthew and Olivia don't think of themselves as having a "designer baby." That term has negative associations, suggesting something trivial, discretionary, or unethical. They weren't choosing eye color or trying to boost their kid's SAT score. They were looking out for the health and well-being of their future child, as parents should.

We risk creating a society where some groups, because of culture or geography or poverty, bear a greater burden of genetic disease.

Public opinion on the use of assisted reproductive technology consistently draws a distinction between preventing disease and picking traits. The Johns Hopkins Genetics and Public Policy Center, which contacted over 6,000 people through surveys and focus groups from 2002 to 2004, summed up its findings this way: "In general, Americans approve of using reproductive genetic tests to prevent fatal childhood disease, but do not approve of using the same tests to identify or select for traits like intelligence or strength." The dystonia gene is in a gray zone-some people born with it live perfectly healthy lives-yet presumably few parents would criticize Matthew and Olivia's choice to weed it out.

All embryo testing does fit the "designer" label in one important way, however: it is not available to everybody.

Matthew and Olivia opted in to what is a quiet but significant trend. Although the number of couples using this technology remains small, it is growing rapidly. According to the Society for Assisted Reproductive Technology, the number of US IVF attempts with single-gene testing rose from 1,941 in 2014 to 3,271 in 2016, an increase of almost 70%.

This is only the beginning. As the price of genetic testing of all kinds drops, more adults are learning about their genetic makeup as part of routine medical care and discovering specific genetic risks before pregnancy. But these people are still most likely to be affluent and educated, like Olivia and Matthew. While they consulted with IVF clinics, Olivia's own brother and his wife got news of a gene that increased risk for cancer in their kids. "If you could get rid of it, why wouldn't you?" he asked.

Cost was not a concern for these couples, but it is an obstacle for many Americans. The Centers for Disease Control and Prevention (CDC) estimates that 1.7% of babies born in the US today are conceived using IVF. It's much higher in countries that publicly fund assisted reproductive technology: 4% in Belgium, 5.9% in Denmark. A 2009 study found that 76% of the medical need for assisted reproduction in the US is unmet.

Insurance doesn't normally cover IVF in the US, except for a handful of states where coverage is mandated. Even policies that cover fertility treatment are inconsistent in what they reimburse. Coverage for pre-implantation genetic testing is downright Kafkaesque. Under many policies, testing the embryos is covered, but the IVF procedure itself is not, because the couples are not infertile.

"The analogy I like to use," says James Grifo, director of the Division of Reproductive Endocrinology and Infertility at NYU Langone Health, "is if you were having coronary bypass surgery and they didn't pay for cracking the chest."

At least part of the reason the IVF industry is growing is not that more people can afford it but that those who can are paying for new kinds of services. Egg banking, for example, is now aggressively marketed to younger women as an insurance policy against age-related infertility. In 2011, egg banking did not even exist as a category in the CDC's annual report on IVF; by 2016, storing eggs or embryos was the purpose of 25% of all IVF cycles. Elite companies like Facebook offer egg freezing as a perk, but for most people it remains a luxury.

Cost isn't the only barrier. Reproductive technology is less acceptable in racial, ethnic, and religious groups where being seen as infertile carries a stigma. Language barriers can reduce awareness and referrals. Geography also plays a role, since IVF clinics cluster in areas of greatest demand.

Presumably, many people would make the same decision as Matthew and Olivia if given the option, but many don't have that choice. Our discomfort around designer babies has always had to do with the fact that it makes the playing field less level-taking existing inequities and turning them into something inborn. If the use of pre-implantation testing grows and we don't address these disparities, we risk creating a society where some groups, because of culture or geography or poverty, bear a greater burden of genetic disease.

What could change society more profoundly than to take genetic disease-something that has always epitomized our shared humanity-and turn it into something that only happens to some people?

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Designer babies aren't futuristic. They're already here.

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Benedikt Luft At first, Matthew assumed the weakness in his knee was the sort of orthopedic nuisance that happens when you turn 30. It was weeks before he consulted a doctor, and months before it occurred to him that there could be a connection between his worsening limp and a cousin's shoulder problem when they were kids.

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Controversial scientist says he feels “unease” about the future of children whose genes he edited as embryos

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A blogger was stealing my ideas.

And it made me very, very angry. Like foot stomping, slobbery snarling, pirate cursing angry.

Let me back up...I give a slice of my heart and thumb every time I write for this blog. (Don't worry they regrow pretty fast). Basically, I LOVE writing for the Science of People-and am so grateful to you for reading!

I am constantly looking for ideas, pictures and article topics in my daily life and have pages and pages of notes for possible posts. I spend weeks honing topics, finding research and coming up with titles to make sure that everything we put up is extremely relevant (and of course anti-boring!).

So I was more than miffed when I noticed a fellow blogger was poaching our blog topics. About 2 or 3 weeks after we would come out with a post, we would see a strikingly similar post go up on their blog-citing the same research and quotes!

Bah! It made me so mad!!!! He was stealing all of our hard work and watering down the topic. My first instincts:

I wanted to rain farts upon his brand.

I wanted to shoot arrows at his articles.

I wanted retribution.

It was such a powerful feeling that I began to research the psychology of revenge and discovered the scientific seeds of this article. Before I get into how I dealt with this blogging monster, here's what I found about the science and psychology of retribution.

What Is Revenge?

Revenge (n): the action of inflicting hurt or harm on someone for an injury or wrong suffered at their hands; the desire to inflict retribution.

It's the juice of so many TV dramas and movie sagas, but should it play an important role in our real lives?

I want to explore the dark, secretive and mysterious science and psychology of revenge. As much as we hate to admit it, revenge is one of those intense feelings that comes up for every single human being.

Have you ever been wronged and wished you could punish the perpetrator? This desire is wired within us. Revenge is a powerful internal force we must seek to understand.

And to understand it better, it helps to understand ourselves. That's why learning about our own goals (and setting better ones) can really help our self-awareness. Learn the best tips how:

The Science of Revenge

A group of Swiss researchers wanted to know what happens in the brain when someone reaps revenge.

1. They scanned the brains of people who had just been wronged during a game in the lab.

2. The researchers then gave the wronged participant a chance to punish the other person, and for a full minute as the victim's contemplated revenge, the activity in their brain was recorded.

3. Immediately, researchers noticed a rush of neural activity in the caudate nucleus. This is the part of the brain known to process rewards.

Big Idea: This study found that revenge, in the moment, is quite rewarding.
However, they wanted to know one more thing: Does revenge keep rewarding?

The Long-Term Effects of Revenge

We often believe that exacting revenge is a form of emotional release and that getting retribution will help us feel better. Movies often portray the act of revenge as a way of gaining closure after a wrong. But in fact, revenge has the opposite effect.

Even though the first few moments feel rewarding in the brain, psychological scientists have found that instead of quenching hostility, revenge prolongs the unpleasantness of the original offense.

Instead of delivering justice, revenge often creates only a cycle of retaliation.

"A man that studieth revenge, keeps his own wounds green, which otherwise would heal." -Francis Bacon

What to Do with Revenge

Revenge re-opens and aggravates your emotional wounds. Even though you might be tempted to punish a wrong, you end up punishing yourself because you can't heal.

But what do you do if you were wronged? How can you deal with the intense emotional feelings of retribution? What do you do if you feel an intense need for revenge?

There is a healthy way to deal with these feelings that can help you heal and give your brain the same amount of rewards without the consequences.

Healthy Revenge

Are you ready for it? This one comes from the amazing, prolific, Frank Sinatra. In his words:

"The best revenge is massive success." -Frank Sinatra

The next time you feel the dark tendrils of revenge creeping into your soul, I want you to take that intensity and put it towards succeeding.
Put it towards your goals. Put it towards hustling to get what you want. Put it towards growth.
Get the reward center of your brain pumping by thinking about how sweet it will feel when you meet your goals. This shifts the focus onto you and your mission and makes your perpetrator irrelevant-which is exactly where they should be.

A Happy Non-Revenge Ending

As you might have guessed, I did not rain farts upon my competitor's blog. I did not shoot arrows at his articles. I did not seek retribution. After reading this study, I decided to completely turn away from what he was doing and focus all of my energy into making our blog even better.

His content stealing actually gave us one of the best insights we could have ever had about our blog:

We had to make our content un-stealable.

Anyone can write about studies. Anyone can make bullet points. But not everyone can share stories. Not everyone can do original research. Not everyone can have cool videos.

This poacher inspired me to level-up our posts. Instead of posting basic steps and bullets, I pushed our team to come up with creative graphics, film and edit cool videos and not post articles until we had really good real life examples.

Yes, this made it much harder for him to steal our posts (and now he only does it occasionally) but more important, it made our blog better for our readers. We started getting more shares, comments and likes. Hoorah!

So here we go:
Thank you for stealing our content. You made us work harder.

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The Psychology of Revenge: Why It's Secretly Rewarding

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I wanted revenge. It was such a powerful feeling that I began to research the psychology of revenge and discovered the scientific seeds of this article.

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My mother with whom I went no contact three years ago has waged an outright war against me. Never mind that what she says about me is packed with lies and exaggeration; she seems committed to ruining my life and reputation. She's managed to win my siblings over to her side but that doesn't seem to be enough. She's even taken to social media and she's 66! What makes someone that motivated to hurt someone?

We're are seven years post- divorce and it never stops. I've remarried and he's living with someone in what appears to be a committed relationship but I swear he wakes up every morning and the first thought that comes to his mind is how he can somehow make me pay. He drags me into court every chance he can. Does this make him happy? What would motivate him to hurt me and our children in this way?

Apart from a few saintly types, most of us have for a few minutes or perhaps longer fantasized about playing tit for tat-wreaking revenge on someone who has wronged, hurt, or betrayed us deliberately. For most of us, acting vengefully never gets past the fantasy stage; our rational minds kick in, along with our moral compasses, and perhaps our fear of continued reprisal. While we still may be angry, we choose instead to move on with our lives, either in full stride or with a noticeable limp. We don't send an email to his boss about all the lies he's told or that his expenses are bogus. We decide against getting word to her new boyfriend about what a scheming, faithless, manipulator she is. We give up on elaborate plans like rounding up his former disgruntled clients so we can try to get him disbarred or lose his realtor license. Revenge may be sweet, as the saying going, but most of us settle for eating bon bons or perhaps buying a voodoo doll to stick pins in.

But not everyone stops at the fantasy stage. What motivates that mother with her slash-and-burn campaign? The ex who keeps taking you to court? What's the skinny on those focused on revenge?

It's no surprise that scientists have wondered about that too.
The psychology of revenge
Revenge as a response to injustice has a long literary history, and doubtless dates to pre-historical times. Whether it's Odysseus slaughtering the suitors who've taken over his house or the Old Testament intoning "an eye for an eye, a tooth for a tooth," the theme of revenge has never lost its luster as countless contemporary variations in movies and books from high-brow to low attest. From Hamlet to The Count of Monte Cristo to Carrie and Gone Girl, the pulsing energy of revenge keeps us spellbound. But revenge doesn't just animate fiction, of course, but real-life interactions. Killing is often justified by murderers as necessary revenge, along with other heinous acts which are supposedly given more gravitas by their history of provocation.

As Katrina Schumann and Michael Ross point out, revenge is an action provoked by a wrong, unlike aggression which requires no provocation. Similarly, revenge and punishment are distinguished by motivation and goals: revenge seeks to have the transgressor suffer while punishment looks to improve the transgressor's behavior or to deter future bad behavior. Finally, they point out something important about acts we label as revenge when the motivation is unclear: the labeling is based on inference and our attributions of the act.

Some theorists believe that the threat of revenge may actually have helped our forebears build social bonds by promising swift retribution if rules or boundaries were transgressed. Additionally, those known to be vengeful were much less likely to be victimized or attacked.
Is there an upside to revenge?
As Kevin M. Carlsmith, Timothy D. Wilson, and Daniel T. Gilbert report, anecdotally people tend to believe that retribution of some kind effectively releases the tension and anger someone feels toward the transgressor and his action, and that payback helps to assuage negative emotions, supplanting them with positive ones. But, in their own studies, while participants thought they'd feel better after exacting revenge, the researchers found the very opposite. It wasn't just that punishing the transgressor didn't provide a release but, in fact, made participants focus on and ruminate about both the transgressor and the transgression more, especially if the person had taken revenge himself rather than simply witnessing it!

Their findings expanded other research that showed that the supposed cathartic effect of revenge is largely a fiction. The researchers attribute the mistaken notion of what revenge would deliver to a much more generalized truism about how humans aren't very good at affective forecasting or predicting how both future actions (and inactions) will make them feel.

That said, it turns out that revenge can deliver a jolt of pleasure-to men at least. Tania Singer and her colleagues had male and female participants engage in an economic game in which confederates either played fairly or unfairly, and then measured the activity in the participants' brains with MRI as they watched the cheating players and the fair players receive an electric shock. Men and women reacted to the punishment of the fair player in the same way, with the parts of the brain associated with empathy being activated, But-and it's a big but- when the bad guy was shocked, even though the women disliked and disapproved of him, nonetheless the empathy centers in their brains lit up. Not so for the dudes; not only did the empathy centers stay quiet but the reward-centers of the brain, associated with revenge, were activated big-time! This doesn't mean that there are no vengeful women, of course, and the studies were conducted in a lab setting but still.

Are women higher in empathy and men higher in revenge? You draw your own conclusions because the jury is still out.
Who's more likely to be vengeful?

I wish someone had given me a field guide to narcissists before my divorce so I could have been prepared for the years of game-playing. But no; I totally didn't get who he was until I wanted out. Low-key guy, not a braggart, and not very social but, boy oh boy, did he love being vindictive and vengeful. Since he drank himself out of our marriage, I'm still not sure what he was avenging other than his own rationalizations and lies but he did.

Not surprisingly, not everyone is inclined to vengeance and some are much more inclined than others as research shows; additionally, certain emotions such as anger are much likely to up the possibility of revenge as well. People who set great store by their reputations, for example, are more likely to seek revenge if they feel they and their honor have been unfairly impugned. But the clear winner on the vengeful scale is the person high in narcissistic traits. Up next? The one high in neuroticism.
The narcissist and revenge
One study by Ryan P. Brown explored the link between lack of forgiveness and vengefulness; was being unforgiving a guarantee of revenge? It was true enough that people high in forgiveness were low in vengefulness but being unforgiving per se didn't predict vengefulness. The deciding factor? Narcissism. The people most hell-bent on revenge were both low in forgiveness and high in narcissistic traits. As the researchers wrote: "Both the narcissist's inflated social confidence and the narcissist's sense of entitlement could produce a desire to retaliate against wrong-doers and could reduce constraints on acting on this desire."

In his book The Narcissist You Know, Joseph Burgo actually identifies The Vindictive Narcissist as a type. Burgo attributes the narcissist's vengefulness to his unconscious shame and his need to defend himself against that shame being revealed, leaving him thin-skinned and vulnerable to anything that looks vaguely like an attack. When he feels attacked, he reacts with no holds barred.

Alas, as Burgo points out, we rarely anticipate how vengeful the narcissist can be until we're in the thick of it.
Insecurity, worry, and revenge
According to researchers, those high in neuroticism are also likely to seek revenge. At a glance, that seems counterintuitive because revenge is an aggressive act and these people worry and ruminate much of the time, are prone to self-criticism, and have trouble setting goals and achieving them. But their vengefulness is a product of their inability to manage negative emotions, particularly anger. A longitudinal study by John Maltby and others showed that individuals high in neuroticism and who experienced continued anger and hostility were still inclined to seek revenge two-and-a-half years after the original transgression! So, if you're dealing with someone who has trouble managing anger, watch out!

A more recent study by David S. Chester and C. Nathan DeWall suggests that revenge and aggression are prompted by the need to self-regulate after social rejection. Interestingly, the researchers measured aggression by having participants stab a voodoo doll after simulated rejection scenarios; the number of stabs permitted was one to fifty-one. What they found was that social rejection did significantly increase aggression, reflecting on the strength of the human need to belong and that exclusion can "elicit powerful and sometimes maladaptive responses." Tellingly, believing in the catharsis of revenge mattered; those participants who consciously perceived aggression and revenge as ineffective ways of coping with social pain didn't experience an increase in aggressive behavior. Still, counter to other studies, Chester and DeWall found that retaliation did lower negative affect after simulated rejection.

Conclusion? The effectiveness of revenge depends on your beliefs about its working.

As for me, I am pretty much committed to the thought, attributed to George Herbert and highly dubious since I studied 17th-century poetry, but quotable as needlepoint pillows in many corners prove: Living well is the best revenge. And maybe a voodoo doll is a good investment.

Copyright © 2017 Peg Streep

Visit me on Facebook: http://www.Facebook.com/PegStreepAuthor

Photo by Kadres. Copyright free. Pixabay

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The Psychology of Revenge (and Vengeful People)

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My mother with whom I went no contact three years ago has waged an outright war against me. Never mind that what she says about me is packed with lies and exaggeration; she seems committed to ruining my life and reputation. She's managed to win my siblings over to her side but that doesn't seem to be enough.

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5 Most Incredible & Brutal Acts Of Revenge in History

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In 1954, the kidney was the first human organ to be transplanted successfully. Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s.

Until the early 1980s, the potential of organ rejection limited the number of transplants performed. Medical advances in the prevention and treatment of rejection led to more successful transplants and an increase in demand.

UNOS' beginnings

On March 21, 1984, UNOS was incorporated as an independent, non-profit organization, committed to saving lives through uniting and supporting the efforts of donation and transplantation professionals. Learn more >

Also in 1984, the National Organ Transplant Act (NOTA) called for an Organ Procurement and Transplantation Network (OPTN) to be created and run by a private, non-profit organization under federal contract. The federal Final Rule provides a regulatory framework for the structure and operation of the OPTN.

UNOS was first awarded the national OPTN contract in 1986 by the U.S. Department of Health and Human Services. UNOS continues as the only organization ever to operate the OPTN. As part of the OPTN contract, UNOS has:

established an organ sharing system that maximizes the efficient use of deceased organs through equitable and timely allocation

established a system to collect, store, analyze and publish data pertaining to the patient waiting list, organ matching, and transplants

informed, consulted and guided persons and organizations concerned with human organ transplantation in order to increase the number of organs available for transplantation

Many facets of organ donation and transplantation have changed since UNOS' founding. Our dedication and mission have not changed. We continually seek to meet the needs of transplant candidates by maintaining a fair and effective national transplant network. Yet ultimately, every transplant is made possible by someone's decision to help another through organ donation.

The following highlights show how UNOS has grown and developed over the years. The history of our organization is still being written; this illustrates the progress of our community thus far.

1968
First successful isolated pancreas transplant performed.

First successful heart transplant performed.

The Southeast Organ Procurement Foundation (SEOPF) is formed as a membership and scientific organization for transplant professionals.

1983
First successful single-lung transplant performed.

Cyclosporine, the first of a number of drugs that effectively treat organ rejection by suppressing the human immune system, introduced.

1984
National Organ Transplant Act (NOTA) passed.

United Network for Organ Sharing (UNOS) separates from SEOPF and is incorporated as a non-profit member organization.

1986
First successful double-lung transplant performed.
UNOS receives the initial federal contract to operate the Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients.

1992
UNOS helps found Donate Life America to build public support for organ donation.

UNOS prepares first-ever comprehensive report on transplant survival rates for all active U.S. transplant centers.

1999
UNOS launches UNet sm, a secure, Internet-based transplant information database system for all organ matching and management of transplant data.

2006
UNOS launches DonorNet sm, a secure, Internet-based system in which organ procurement coordinators send out offers of newly donated organs to transplant hospitals with compatible candidates.

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In 1954, the kidney was the first human organ to be transplanted successfully. Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s. Until the early 1980s, the potential of organ rejection limited the number of transplants performed.

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It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device.

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New prosthetic invention lets users reclaim their sense of touch

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Two years ago, Melissa Loomis, age 43, was in her house in Ohio when she heard her two dogs barking and scuffling outside. She discovered her pets in a tussle with a raccoon and ran to intercede. The wild animal bit her right ...

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The Mind-Controlled Bionic Arm With a Sense of Touch

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Carolina Impact: Medical Breakthroughs - Prosthetic Hands Responding to Electrodes (April 3, 2018)

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Awesome innovations that you must see | artificial organs | medical breakthrough

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Medical Breakthroughs We Will See In The Next 50 Years

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Grow a Baby in your Living Room in a Pod - Artificial Womb Incubator

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Are Artificial Wombs the Future of Birth?

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We are approaching a biotechnological breakthrough. Ectogenesis, the invention of a complete external womb, could completely change the nature of human reproduction. In April this year, researchers at the Children's Hospital of Philadelphia announced their development of an artificial womb. The "biobag" is intended to improve the survival rates of premature babies and is a significant step forward from conventional incubators. Their results show that lambs (at the equivalent of a premature human foetus of 22-24 weeks) are able to successfully grow in the biobag, with the oldest lamb now more than one year old.

Researchers at Cambridge University, meanwhile, have also kept a human embryo alive outside the body for 13 days using a mix of nutrients that mimic conditions in the womb. The embryo survived several days longer than previously observed and research only stopped because they were approaching the 14-day legal limit for the length of time an embryo can be kept in a lab. In other words, our ethics rather than our technology are now the limiting factor.

The key to survival through ectogenesis is reproducing the conditions of the womb. As scientists become better at that, the gap between the longest time embryos can survive and the earliest time a foetus is viable will narrow. When the two timescales meet, we will have the technology for a complete external womb.

It is exactly this kind of scientific discovery that I imagined for my novel, The Growing Season. In a world that is still similar to present day, the recent invention of an external womb known as the "baby pouch" is changing society. For some, it has brought equality, freedom and choice, while for others the implications are much more frightening. This world is perhaps only decades away from our own; what will happen when our version of the baby pouch arrives?

The Growing Season by Helen Sedgwick.

There will be amazing medical benefits: it could save the lives of premature babies, help infertile couples, give gay and trans people new fertility options and enable older parents to have children. It could offer a safer alternative to traditional pregnancy and childbirth and provide a healthier environment for the foetus by eliminating the risks of drugs or alcohol and providing an ideal balance of nutrients, temperature, movement and sound. But where do we draw the line between ensuring healthy development and only having children deemed to be the "healthiest"? Who decides which type of pregnancy is "best" - women or men? Doctors? Religious leaders? Employers?

There is a danger that whoever pays for the technology behind ectogenesis would have the power to decide how, when and for whose benefit it is used. It could be the state or private insurance companies trying to avoid the unpredictable costs of traditional childbirth. Or, it could become yet another advantage available only to the privileged, with traditional pregnancies becoming associated with poverty, or with a particular class or race. Would babies gestated externally have advantages over those born via the human body? Or, if artificial gestation turns out to be cheaper than ordinary pregnancy, could it become an economic necessity forced on some?

But an external womb could also lead to a new equality in parenthood and consequently change the structure of our working and private lives. Given time, it could dismantle the gender hierarchies within our society. Given more time, it could eliminate the differences between the sexes in our biology. Once parental roles are equal, there will be no excuse for male-dominated boardrooms or political parties, or much of the other blatant inequality we see today.

Women's rights are never more emotive than when it comes to a woman's right to choose. While pregnancy occurs inside a woman's body, women have some control over it, at least. But what happens when a foetus can survive entirely outside the body? How will our legislation stand up when viability begins at conception? There are fundamental questions about what rights we give to embryos outside the body (think of the potential for harvesting "spare parts" from unwanted foetuses). There is also the possibility of pro-life activists welcoming this process as an alternative to abortion - with, in the worst case, women being forced to have their foetuses extracted and gestated outside their bodies.

One thing we can know for sure is that society will be greatly changed by ectogenesis. Growing humans outside women's bodies raises various risks but may at the same time offer hope for new forms of equality and healthcare - and the debate is only just getting started. It is likely that we will have the ability to create an artificial womb within a generation or two. How will we choose to use it?
The Growing Season by Helen Sedgwick (Harvill Secker, £12.99) is published on 7 September. To order a copy for £11.04, go to bookshop.theguardian.com or call the Guardian Bookshop on 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min. p&p of £1.99.

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Artificial wombs could soon be a reality. What will this mean for women?

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Technology is well on the way to realising ectogenesis, improving premature baby survival and increasing fertility options. But it also has other, more frightening, implications

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E arlier this year, researchers at Children's Hospital of Philadelphia (CHOP) revealed that they had developed an artificial womb capable of sustaining a premature lamb during a period of development roughly equivalent to 23 to 24 weeks' gestation in humans. That's a critical time. In the United States, an estimated 30,000 babies are born extremely premature each year. Weighing about one pound, their survival is uncertain. Those who do survive have a much higher likelihood of lifelong health problems such as lung disease, cerebral palsy, and hearing and vision impairments.

The new device, the researchers suggested, could one day dramatically improve outcomes for this particularly vulnerable group.

Such were the very narrow and targeted goals of the CHOP team. The public response among bioethicists and the media, however, was far more elaborate. In the weeks following the paper's publication, a wide range of speculative narratives painted the development with a dystopian air. In an interview with NPR, Dena Davis, a bioethicist at Lehigh University, invoked Aldous Huxley's "Brave New World," in which human conception and gestation occur entirely outside the body - a concept known as "ectogenesis" - under the control of an autocratic state. In that same NPR segment, Scott Gelfand, a bioethicist at Oklahoma State University, worried that employers could require female employees to use artificial wombs to avoid maternity leave.

The U.K.'s New Statesman magazine ran an article with the title "Artificial wombs are only three years away - how scared should women be?" The author provided a feminist perspective on the question of whether an artificial womb will make women obsolete. And an article from Gizmodo declared that the technology could threaten a woman's right to an abortion. In response, the conservative National Review magazine accused the Gizmodoauthor of wanting "a constitutional right to a dead baby."

Discussions about where technology is taking us are surely warranted, though in the case of artificial wombs, the publication of one scientific paper became an occasion for speculation that left the particulars of physiology - and technology - in the dust. For example, the structural integrity of tiny blood vessels, the physical limits of synthetic tubing, the complex molecular exchange between fetus and placenta, and the often-poor outcomes of premature infants (despite receiving today's most cutting-edge interventions) all speak to the immeasurably complex science attending fetal viability outside the human womb. Furthermore, the sometimes-sci-fi speculation potentially distracts from the murky ethical terrain that already exists in neonatal intensive care units across the country, where parents and physicians face a vexing question: Should they resuscitate an extremely premature infant with a high likelihood of death and severe disability?

A handful of groups worldwide are working on devices that would allow infants at this tenuous threshold of viability to survive. I became aware of the media conjecture while writing an article for the University of Michigan, where researchers are working to develop an artificial placenta. In the press, the lead researchers at CHOP and the University of Michigan have commented - not always favorably - on each other's devices. But one thing both agree on: They are nottrying to lower the age of viability, which is currently around 22 to 24 weeks' gestation.

Dr. Alan Flake, a fetal surgeon and the corresponding author for CHOP's Nature Communications paper, suggests that the ethical objections appearing in the press reflect a "lack of insight into the clinical context and the science that we're doing." Speaking about bioethicists in particular, he says, "It would be nice if they even just wanted to call me up and we could discuss it. It might add to their insight before they start raising these highly sensationalistic ethical objections."

I. Glenn Cohen, a bioethicist and legal scholar, offers a different take. In an email interview, he writes that by staying ahead of the science - contemplating its possible trajectory and consequences - bioethicists can motivate the scientific community, laypeople, or legislators to change direction. "In my view," Cohen says, "this is one of the most important contributions bioethicists make."

While not completely discounting the thought experiments that accompanied the CHOP announcement (and which have followed analogous efforts elsewhere), a variety of scientists and medical practitioners suggest that the challenges and limits of technology are too often being overlooked. For anyone agonizing over (or hoping for) an imminent "Brave New World," the scientific realities are likely to prove eye opening.

I t's worth noting that the term "artificial womb" never appears in CHOP's research paper. The text, which describes how eight premature lambs survived four weeks without breathing air through their lungs, uses terms like "system" and "device."

In photographs, that device appears otherworldly: A lamb is sealed inside a clear bag filled with synthetic amniotic fluid. Three small tubes, called cannulas, connect the umbilical cord to an oxygenator located outside of the bag, creating a circuit. Blood flows through the tubing from the lamb to the oxygenator, which provides nutrients and oxygen, while removing carbon dioxide. The replenished blood then flows back to the lamb.

In July, the Hastings Center, a bioethics research institute in Garrison, New York, provided a shot of adrenalin to the abortion debate when it published a report by Cohen that imagines a scenario in which an infant could be sustained in an artificial womb at 18 weeks' gestation. That's a tiny being, just over four months into a pregnancy and less than half a pound. Such a device, Cohen suggested, might lead courts to ban abortion at that age.

What would happen if doctors tried to connect this infant to CHOP's artificial womb? There's a vast difference in size and development between an 18-week-gestation fetus and a 23-week-gestation fetus, says Flake. The size difference matters because a smaller infant doesn't pump as much blood. If there isn't enough blood flow through the artificial womb's tubing, the blood will clot. "At the present time, there's nothing made or manufactured that can function adequately with those [lower] blood flows," says Flake.

Even if a device could support a lower blood flow, it would be impossible to connect it to such a small infant, says Jutta Arens, a biomedical engineer working on artificial placenta technology at RWTH Aachen University in Germany. An artificial womb's cannulas must connect with an infant's blood vessels, but the smaller the baby, the smaller its vessels. If the blood vessels aren't thick enough, they won't be able to stabilize a cannula. "There really is a physical limit to everything that we do regarding the diameter of the vessels of the baby," she says. The German group's current target is 24 weeks' gestation. "Perhaps we could go down to 23 or 22," she says, but "I don't think we could push the limits further down."

Similar devices already exist that take over heart and lung function for adults and children recovering from organ failure. But they are only a last resort because complications can arise from long-term use. These technologies save thousands of lives, but their effectiveness is time-limited. This is one of the reasons Flake considers it "very unlikely" that a device like his could support an infant as long as 5 or 6 weeks.

"We're trying to optimize the benefit-to-risk ratio here," says Flake. "By going back to 18 weeks, you increase the risks dramatically and really negate the benefit." I sense that Flake is tiring of these hypotheticals, but I press on: What about speculation that artificial wombs could provide a desirable alternative to pregnancy?

"That's all pure fantasy stuff," he says. "They're making this stuff up just for the sensationalist value of it. It's ridiculous. You're never going to have a zero-risk system."

A rtificial wombs and placentas are being developed with the goal of treating infants who are already receiving intensive care in NICUs across the country.

"In the United States, children born at 23 or 24 weeks' gestation - most of them are going to receive attempts at aggressive care," says Dr. Mark Mercurio, chief of neonatology and director of the program for biomedical ethics at Yale School of Medicine. This includes measures such as mechanical ventilation, fluid and electrolyte management, and surgical procedures.

Despite these interventions, outcomes for this group of infants are so poor that they exist in what's called the " gray zone" of viability, when survival is uncertain and chances of severe disability are high. Among infants born at 23 weeks' gestation, only about a third survive. At 24 weeks, the odds of survival double. Among survivors in both groups, the likelihood of disability is extremely high due to long-term health issues such as chronic lung disease, neurodevelopmental problems, and impairments of hearing and vision.

Mercurio believes a technology that improves outcomes for these children "would receive a great deal of interest." He sees that as a better focus than the question, "Couldn't we get them even smaller?"

Sandra Bellini, director of the Neonatal Nurse Practitioner Track at the University of Connecticut School of Nursing, has spent 30 years working in neonatal intensive care. She is skeptical about the notion of lowering the current age of viability because while neonatology has made great strides in treating premature infants, "every single thing we do can carry risks of short- and long-term damage" to the baby. "We are all about saving babies, but we want to save babies who are going to go on to have a happy, healthy life," Bellini says. She mentions data showing that families whose babies received a high degree of medical intervention in the NICU have "huge incidences of [post-traumatic stress disorder], divorce, and financial ruin." Some families have medical insurance policies with a lifetime cap. Daily NICU costs exceed $3,000 per infant, and a prolonged stay can top one million dollars. NICU children can hit their cap before they ever leave the hospital.

All of this means that parents of infants born at 23 weeks' gestation must make a difficult decision about whether to pursue aggressive, uncomfortable, and often ineffective care for their premature baby. A successful artificial placenta, by improving outcomes for these infants, would eliminate the decision. "My device doesn't introduce huge ethical questions if it's applied appropriately, meaning to a 23-weeker to improve outcome," says Flake.

For its part, the CHOP team is not against bioethical input on these technologies. In fact, they're collaborating with some bioethicists to identify the best way to introduce artificial wombs into the clinic once the technology is ready. Describing his artificial womb, Flake says, "I think it needs an ethical framework that is based on its capabilities and the science and the clinical context that it will be used in."

Even if CHOP's artificial womb isn't capable of lowering the current age of viability, isn't it possible that once in place, it might allow other research groups to create a device that could?

"Not a chance, no. Not good," says D. Michael Nelson, an obstetrician at Washington University School of Medicine in St. Louis, who has been researching the placenta for over 30 years. He is editor emeritus of the journal Placenta, and recently gave an inaugural address at the International Federation of Placenta Associations.

"There are a lot of programming things that go into babies," he explains. In this case, he isn't referring to genetic programming, but to programming that comes from interactions with the environment to which the baby is exposed in the mother's womb. The maternal placenta provides a complex and changing mixture of proteins, lipids, carbohydrates, minerals and growth factors. "You start putting [babies] in an artificial environment, and it changes everything," says Nelson. Machines and artificial sources of nutrition are not as good as the placenta and the mother's blood supply.

Nelson believes that researchers will make significant advances in prematurity prevention before they perfect an artificial womb. He cites research at the March of Dimes Prematurity Research Centers, a network of researchers based at major medical centers, including his own, studying how factors such as the microbiome, circadian rhythms, and genes might contribute to prematurity.

"Our goal is to avoid premature birth," he adds in an email message, "rather than putting our preterm babies in a bag."

T hat's certainly a brusque way to describe the technological advances being made at the frontiers of infant viability. But in its brusqueness, it also serves to underscore the vast distance between the science of human gestation as it now stands, and the faraway horizons where it would need to go to breathe real life into the ethical worries - boxed pregnancies, valueless women, and other Brave New Worlds - that the CHOP innovation recently set in motion.

Of course, to bioethicists, the gap between what we can do now and what we might be able to do in the future is precisely where all the potential consequences ought to be fully considered. "By the time a breakthrough is here and widespread," Cohen says, "it is often hard to have a real conversation about 'where to go' because we are already there."

By most measures, scientists suggest, we won't be there for quite some time.

"Reproduction is very complex and it's taken millions and millions of years to create the systems we have and there are still huge amounts that we just don't understand about it all," says Dr. David Adamson, a reproductive endocrinologist and CEO of Advanced Reproductive Care, a national network of fertility clinics.

Adamson believes that ectogenesis might one day be possible, but in the distant future: decades at least, perhaps even a century. He also points out that this will likely require technologies other than those currently available to us. He mentions big data, and a better understanding of gene expression, and perhaps stem cells to create special types of placental tissues that aren't currently available. "If we look over 40 years, because IVF's not 40 years old yet, we see that there's been a lot of progress in terms of our being able to do in vitro growth of embryos on the one hand, and, on the other side, to reduce the gestational period at which viability can occur," he says.

But just as IVF and surrogacy are supplemental procedures today, he envisions ectogenesis as an assisted reproductive technology, akin to IVF but much more complex - and far, far in the future.

In the meantime, many scientists agree with Jutta Arens, the German engineer:

"There's no way," she told me, "of substituting the womb."
Sara Talpos is a freelance writer whose recent work has been published in Mosaic and the Kenyon Review's special issue on science writing. Sara has an MFA in creative writing (poetry) and is interested in the connections between science and literature. She taught writing classes at the University of Michigan for ten years.

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Nurturing Controversy: The Real Science Behind the Artificial Womb

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E arlier this year, researchers at Children's Hospital of Philadelphia (CHOP) revealed that they had developed an artificial womb capable of sustaining a premature lamb during a period of development roughly equivalent to 23 to 24 weeks' gestation in humans. That's a critical time.

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rik Gatenholm first saw a 3D bioprinter in early 2015. His father, Paul, a professor in chemistry and biopolymer technology at Chalmers University of Technology in Gothenburg, had bought one for his department. It cost somewhere in the region of $200,000. "My father was like, 'This thing can print human organs,'" Gatenholm recalls, still awestruck. "I said, 'Bullshit!' Then it printed a little piece of cartilage. It wasn't cartilage, but it was like, this could be cartilage. That was the moment when it was like, 'This is frickin' cool!'"

Gatenholm, who had long owned a regular 3D printer, decided then that he wanted to do something in 3D bioprinting. His language might be a bit Bill & Ted - he grew up between Sweden and the US, where his father is a visiting professor - but his intent and ambitions are very serious. Gatenholm had started his first biotech company aged 18 and he realised that if this machine had the potential to print organs, like his father said, then it had the potential to radically change the world of medicine.

There is a global shortage of organs available for lifesaving transplants. In the UK, for example, you can now expect to wait an average of 944 days - more than two-and-a-half years - for a kidney transplant on the NHS. There's a similar shortage of liver, lungs and other organs. The lack of transplanttissues is estimated to be the leading cause of death in America. Around 900,000 deaths a year, or around one-third of all deaths in the US, could be prevented or delayed by organ or engineered tissue transplants. The demand, simply, is endless.

Gatenholm's father introduced him to Héctor Martínez, one of his students who was doing a PhD on tissue engineering, and early on another student, Ivan Tournier, was also involved in the brainstorming. "We were talking about doing some experiments," says Gatenholm, who is 27, tall and handsome even by Swedish standards.

"So I said, 'Why don't we just go online and buy the ink we need?' And Ivan said, 'Well, there's no ink. You can't buy it.' And I was like, 'What do you mean?' It was the dumbest thing I ever heard. There's a bunch of printers on the market, just buy the ink. And he said, 'No, you don't understand, there is no ink. You have to make it yourself, you have to mix something.' So I was like, 'Just make an ink then!'"

Cellink was born from this lightbulb moment in January 2016. Although the technology is the stuff of science fiction, the business principle is classic "razor and blades". In this model, which is as old as the inventor King Gillette, at the turn of the last century, you practically give away the razor and you make the money on the disposable blades. And repeat, for ever. Or inkjet printers: everyone knows the serious returns are in the replacement ink cartridges.

In bioprinting, Gatenholm and Martínez developed and brought to market the world's first standardised bioink: it is made primarily from a material called nanocellulose alginate, which is extracted in part from seaweed. If you owned a 3D bioprinter, here, finally, was a product you could effectively buy off the shelf.

The impact of Cellink, especially considering its tender years, has been remarkable. The company has already won a slew of awards: for innovation and entrepreneurialism, as well as the rapturous backing from Sweden's version of Dragons' Den. Ten months after its launch, Gatenholm went to the stock market, becoming listed on Nasdaq First North. The initial public offering was oversubscribed by 1,070%.

When I meet Gatenholm in Gothenburg, he still seems to be coming to terms with his company's newfound liquidity. The office, frankly, is chaotic: there's an iron on the floor and suit jackets on a peg, in case he's called on to attend an impromptu client meeting. He and 32-year-old Martínez are working 16-hour days as standard. "The couch is nice to sleep on," laughs Gatenholm. His office doesn't actually have anywhere to sit. Cellink is taking on staff so quickly that Gatenholm and Martínez had to give up their chairs to new employees. "We donated them to science," says Gatenholm wryly.

But Gatenholm is clear: bioprinting's time is now. "As an entrepreneur, you're always looking for a blue ocean," he says. "Entrepreneurs are always asking, 'Where's a new area that you become the name of it? And you can claim it?' I guess I saw bioink and bioprinting to be one of those."

He shakes his head in disbelief: "No one was doing the ink!"

You die because your organs break. If we can start replacing them, we can extend life. That's really neat!

Erik Gatenholm, Cellink

Bioprinting, as Gatenholm cheerily accepts, is something of a trippy idea and one that raises some ethical concerns. The principles are very similar to conventional 3D printing: you start by using a computer program to make a virtual representation of what you'd like to make and then a printer builds it slice by slice - sometimes around a pre-prepared scaffold - until you have the finished object. But instead of jewellery, little statues or parts for cars, bioprinters offer the potential to create living tissue.

In the beginning, this might mean printing skin or cartilage, which are relatively simple structures and are more straightforward to grow outside the body. Eventually, however, the pioneers of this technology believe they will be able to create complex organs, such as hearts and livers, from scratch. These could then be used in human transplants.

Scientists and commercial companies around the world are working on the project. In fact, something of a race is on. San Diego-based Organovo has been around since 2007 and has had some success in printing parts of lung, kidney and heart muscle. In 2015, it announced a partnership with the cosmetics behemoth L'Oréal on a plan to supply 3D-printed skin. Ultimately, the goal is to eradicate the need for animal trials.

L'Oréal is committing massive resources to bioprinting. In September last year, the company revealed that its scientists were also working with the France-based startup Poietis. The aim this time was to produce synthetic hair follicles. This, it turns out, is devilishly complex: there are more than 15 different cell types in each follicle and there is a cyclical process of fibre production that needs to be stimulated in vitro.

Many have tried, all have failed, but L'Oréal and Poietis are confident they are close to cracking it. The key is the bioprinter that Poietis has developed: most machines push bioink through a nozzle; theirs uses a laser that deposits cells one by one, at a rate of 10,000 drops per second, without damaging the cells. "The way it works is actually quite simple and is similar to inkjet printing," Fabien Guillemot, the CEO and chief scientific officer of Poietis, explained in the video announcing the collaboration. "It prints 3D structures, in this case, biological tissues, by successively layering microdrops of cells on a surface."

Poietis calls its innovation 4D bioprinting. "The fourth dimension is time," said Guillemot. "Because our laser-assisted bioprinting technology can print the cells basically one at a time, it enables us to guide the interaction between the cells and their environment until they produce the biological functions we are looking for."

In the short to medium term, L'Oréal hopes that its sunscreens and age-defying serums will work more effectively because it can now endlessly test products on a material that reacts exactly like human skin. Perhaps your hair will look more lustrous after using its shampoo, but it's obvious that the impact of such technology could reach far beyond the cosmetics aisle of the supermarket.

If skin can be printed in a lab, then it's not a stretch to imagine it being used to treat severe burns. At present, skin grafts, which can lead to bleeding and infection and typically involve a long recovery time, are the most common form of treatment for such burns.

Meanwhile, the developments in synthetic hair follicles appear to open the way for commercial products that reduce hair loss or even implants. "Obviously, our objective for the future is to be able to test innovative molecules using systems of follicles created in vitro," says José Cotovio, of L'Oréal's research and innovation department, "but also to increase our understanding of the key processes behind phenomena such as hair ageing, hair loss and hair growth."

This is just the tip of it - other researchers are working on how to create human organs. "There's enormous human benefit in bioprinting," says Gatenholm. "You die because your organs break. That's why you die. If we can start replacing them, maybe we can extend the human lifespan... That's really neat!"

We are a little way off from these developments being a reality. But not too far: bioprinted skin could be five years away, thinks Gatenholm. "Within 10 years, we'll start seeing some implants in the cartilage field, either partial or full," he says. "Replacement organs, it's our lifetime." He adds, smiling: "It's in our lifetime."

Already, inevitably, there are some ethical concerns. These range from fears over the quality and the efficacy of artificial skin and implants to the accusation that bioprinting will allow humans to "play God". Perhaps the most thorough investigation of these issues has been undertaken by a team at the Science, Technology and Innovation Studies department at the University of Edinburgh.

The researchers, led by Dr Niki Vermeulen and Dr Gill Haddow, are unfazed by the horror-movie fantasy of a bioprinted Frankenstein's monster. "Assuming that God exists, and is someone who can create and influence life, there are already lots of technologies that allow human beings to play God, such as genetics," says Haddow. "Bioprinting allows people to make small parts of the body and is used for medical applications."

A much bigger hurdle that 3D bioprinting needs to overcome, they believe, are the costs. Although it is tempting to hope that the ability to make artificial organs will solve the problem of waiting lists, that is unlikely to be the case. "This is an extremely expensive technology that, if it is realised, only a few will be able to afford," warns Vermeulen. "There is a risk that the health inequalities and postcode lottery that currently exist will also make it unavailable for most people."

In short, they conclude, the problems and delays that patients experience in the NHS, the US healthcare system and elsewhere "will persist in the context of bioprinting".

"Ideally, you'd like to think that exporting a relatively cheap bioprinter to a country or region with a non-optimal healthcare structure would enable people to have access to the therapies such a machine could provide. In reality, these printers can only work within an existing healthcare infrastructure that has the capacity to make use of it."

Cost has certainly been a prohibitive barrier in these early days of 3D bioprinting. The best machines, such as EnvisionTEC's 3D Bioplotter and RegenHU's 3DDiscovery, are priced in excess of £150,000 and, as a result, are usually only found in labs at universities. However, here, too, Cellink is keen to shake things up a little. Although it started out supplying bioink, the company soon moved into hardware. On the table next to us in Gatenholm's office is "Bob", his pet name for the Inkredible+ 3D bioprinter that Cellink developed and which he carts around trade shows.

The Inkredible+ is an attractive machine: a little smaller than a hotel room minibar, it is clean and white and has blue LEDs. But what really catches the eye is the price. Cellink makes three 3D bioprinters, which cost from just £7,600 to £29,900. The savings, Gatenholm explains, come in part from using cost-effective 3D printer components instead of super-expensive motor rail systems. Also, again in the spirit of the razors and blades business model, Cellink knows that the more people own 3D bioprinters, the more bioink it will sell.

Gatenholm is proud that his company is driving down the costs of 3D bioprinting. While Cellink's clients include MIT, Harvard and University College London, the company is also making the new technology available to hobbyists. Gatenholm doesn't know how these people will use their machines and inks - perhaps for printing tissues to test drugs or taking cells from a cancerous tumour and using multiple versions to work out how best to treat it - but that is what makes the new technology so exciting.

"Many of those big bioprinting companies are really pissed off," says Gatenholm. "But to be honest, the consumers are the ones who drive the market and the consumers want to do this. And for us, I don't know where the cure for cancer is going to come from. I don't know if it's India, or Japan, or South America, or New York, but we want to give everybody a chance to work on it."

Why would we want to bioprint a heart?
Apart from its geometry, the heart is one of the least complicated organs in the body. It doesn't perform complicated biochemistry like the liver and kidneys and it is well understood by science, unlike other organs such as the brain. For this reason, the heart could theoretically be one of the easiest organs to bioprint and therefore a good place for the bioprinting industry to start. There are 3,500 people in Europe on the waiting list for a heart transplant, many of whom have needed a new heart for more than two years.

How would you bioprint a heart?
The most promising method could prove to be bioprinted cell scaffolds. Instead of printing layer upon layer of living cells to form a 3D structure, like a conventional 3D printer would do with plastic or metal, the bioprinter would first be used to print a biodegradable scaffold structure of the heart, a kind of skeleton for cells. This scaffold would mimic the heart's extracellular matrix that provides structural support to cells and helps direct them to where they should be. Heart cells could then be printed into the scaffold, where they would interact and link to form the structure of the heart. After the cells mature into the full structure of the heart, the scaffold could be broken down, leaving a fully functioning heart ready for transplantation. This technique does already exist, albeit on a smaller scale. A scaffold was used to bioprint a small patch of working heart muscle, which was shown to be able to repair a mouse heart that had been damaged by a heart attack.

Why can't we bioprint a heart already?
Bioprinting a small patch of muscle and bioprinting a whole heart are very different feats. But why is this? There is one problem with creating whole organs that has to be overcome: blood vessels. All blood vessels have proved difficult to create with bioprinting, but creating capillaries, which can be smaller in diameter than the smallest cell, has been nearly impossible. Manufacturing a working vascular system would be such a huge achievement that Nasa is offering a $500,000 prize for the first research team that can do it. The Vascular Tissue Challenge will award the prize for a 1cm thick piece of human tissue with a fully working blood system that can survive for 30 days in vitro.

How far away are we from bioprinting our organs?
Estimates for a date when organ bioprinting will be viable vary wildly, with one team claiming that they will be able to bioprint a heart within six years. No one knows for certain when these techniques will be approved as safe to use for human transplants. However, the sheer number of research scientists working in the 3D bioprinting field, coupled with developments in an industry that is predicted to be worth more than $1.3bn by 2021, means that we can be sure that it isn't too far away. Agnes Donnelly

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Could 3D printing solve the organ transplant shortage?

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rik Gatenholm first saw a 3D bioprinter in early 2015. His father, Paul, a professor in chemistry and biopolymer technology at Chalmers University of Technology in Gothenburg, had bought one for his department. It cost somewhere in the region of $200,000. "My father was like, 'This thing can print human organs,'" Gatenholm recalls, still awestruck.

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Soon, Your Doctor Could Print a Human Organ on Demand

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At a laboratory in North Carolina, scientists are working furiously to create a future in which replacement organs come from a machine

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Incredible breakthrough in medicine: 3D printed organs are a real thing now!

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Social Justice and Fairness | National Association of Scholars

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William Young examines the notion of social justice and

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Society has many rules about how to behave, but not all of the social expectations are in the realm of morality. We need an independent way of evaluating which conventions are ethical and which are not. Just as ethics is independent of religious rules, so it is independent of social convention.

The work of Larry Nucci, a psychologist at the University of Illinois at Chicago, is helpful in understanding the distinction between social convention and morality. In his book Education in the Moral Domain, Nucci posits that there are three areas that encompass social behavior: the personal domain, the domain of social conventions, and the moral domain. The first area is subjective in that individuals have preferences for one thing or another that has no objective standard of measurement. For example, there is nothing objectively better about liking sofas over armchairs. The second domain is arbitrary in that the rules could have been different and it wouldn't make any difference, such as driving on the left side of the road instead of the right. In the third domain, behaviors are intrinsically right or wrong.

Nucci finds that children instinctively distinguish between these three domains. Children identify morality with those actions that have an intrinsic effect on the welfare of others. They understand that harming another as being wrong and acting fairly as being right. No one needs to tell them this is the case; they know it as a matter of course. The inherent nature of morality (defined in this narrow sense) is underscored by the finding that children everywhere make these same distinctions and do so without rules telling that it is so. Nucci's conclusion is that morality is independent of social rules regarding proper behavior.

Drawing the difference between these two domains-the moral and the conventional-allows us to better understand the ways in which children comprehend the world and how they understand their own actions. At the same time, the distinction helps to reveal the underlying and universal nature of morality. Nucci's research indicates that concepts of human welfare, fairness, and rights are inherent, not socially conditioned or constructed. In both domains, some behaviors are deemed "right" and others "wrong."

Nucci gives this example, taken from an interview with a four-year-old girl. In the first interview, the girl is operating in the area of social conventions. Something is wrong because there is a rule that says it is wrong. Without the rule, it would no longer be wrong.

"Did you see what just happened?"

"Yes. They were noisy."

"Is that something you are supposed to do or not supposed to do?"

"Not do."

"Is there a rule about that?"

"Yes. We have to be quiet."

"What if there were no rules, would it be all right to do then?"

"Yes."

"Why?"

"Because there is no rule."

Contrast the interview, which is an illustration of thinking in the social domain, with the one that follows.

"Did you see what happened?"

"Yes. They were playing and John hit him too hard."

"Is that something you are supposed to do or not supposed to do?"

"Not so hard to hurt."

"Is there a rule about that?"

"Yes."

"What is the rule?"

"You're not to hit hard."

"What if there were no rules about hitting hard, would it be all right to do then?"

"No."

"Why not?"

"Because he could get hurt and start to cry."

Here the girl is operating in the moral domain. There is no rule that told her it is wrong to hit hard. It is wrong because hurting others is wrong in and of itself. Without a rule, it would still be wrong.

Not all schools require the same degree of quiet from their pupils. In some schools, quiet is a sign of respect. In other schools, it is taken as a sign of a lack of creativity. There are also some families that are vocal, boisterous, and demonstrative, while others are verbally restrained, orderly, and proper. In both cases, acceptable behavior is governed by rules and expectations

On the other hand, hitting hard is not acceptable whether or not there are rules governing the action. There are an infinite number of ways that people can determine how to make a social system function; this explains the cultural differences that we see. But since we are all human, there are harms and benefits that are universal. Being punched hurts wherever you live, whereas a child calling an adult by his or her first name offends only some people. Being treated unfairly causes resentment everywhere, whereas belching when eating is socially acceptable only in some cultures.

Children distinguish between rules that are in the moral domain and those that are social conventions. They identify moral issues as those having to do with welfare and physical harm (pushing, shoving, hitting, killing), psychological harm (hurting others' feelings, ridiculing, name calling), fairness and rights (stealing, breaking promises, not sharing, destroying others' property), and positive behaviors (helping another in need, sharing, donating to a charity).

In justifying moral behavior, the criteria refer to the benefit or harm or the fairness or unfairness that the action would cause. For conventional issues, they turn to the norms and expectations of authority. What emerges from the work of cognitive psychologists is that, at young ages, children know the difference between social convention and morality, and they know it without being taught. You might say that they understand very well the point made by Socrates in his conversation with Euthyphro: Social conventions don't make for morality. It is morality that judges social conventions.

Religious commandments, social conventions, and codes of conduct can assist you in making moral decisions, but they are no substitute for ethical judgments. They do not pre-empt the need to make ethical decisions that have no obvious answers or present conflicts in ethical values. Codes, laws and ethical regulations can only suggest a course of action, not mandate a good, moral, and just one.

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Society Doesn't Create Morality and Neither Do Individuals

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Society has many rules about how to behave, but not all of the social expectations are in the realm of morality. We need an independent way of evaluating which conventions are ethical and which are not. Just as ethics is independent of religious rules, so it is independent of social convention.

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Morals are the prevailing standards of behavior that enable people to live cooperatively in groups. Moral refers to what societies sanction as right and acceptable.

Most people tend to act morally and follow societal guidelines. Morality often requires that people sacrifice their own short-term interests for the benefit of society. People or entities that are indifferent to right and wrong are considered amoral, while those who do evil acts are considered immoral.

While some moral principles seem to transcend time and culture, such as fairness, generally speaking, morality is not fixed. Morality describes the particular values of a specific group at a specific point in time. Historically, morality has been closely connected to religious traditions, but today its significance is equally important to the secular world. For example, businesses and government agencies have codes of ethics that employees are expected to follow.

Some philosophers make a distinction between morals and ethics. But many people use the terms morals and ethics interchangeably when talking about personal beliefs, actions, or principles. For example, it's common to say, "My morals prevent me from cheating." It's also common to use ethics in this sentence instead.

So, morals are the principles that guide individual conduct within society. And, while morals may change over time, they remain the standards of behavior that we use to judge right and wrong.

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Morals are the prevailing standards of behavior that enable people to live cooperatively in groups. Moral refers to what societies sanction as right and acceptable. Most people tend to act morally and follow societal guidelines. Morality often requires that people sacrifice their own short-term interests for the benefit of society.

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We've moved! Formerly at Bryn Mawr College, Serendip is now an independent site partnering with faculty at multiple colleges and universities around the world. Please update your bookmarks, and happy exploring.

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Meet Your Master - Getting to Know Your Brain: Crash Course Psychology #4

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Donner Party - Survivors, Timeline & Facts | HISTORY

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The Donner Party was a group of 89 emigrants from Illinois who purportedly turned to cannibalism to survive after getting trapped by snowfall while on a westward journey in 1846. Forty-two members of the party died.

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I saw a patient of mine recently whose appearance in my office always makes me smile. He's challenging-not because he's a difficult person (quite the opposite), but because he has so many serious medical problems about which I can do so little.

Why, then, does seeing him so consistently lighten my mood? Because it reminds me that for all the terrible things that go on-the abuse, the discrimination, the injustice, the downright nastiness-good still exists in the world. Because, you see, he's a hero.

What makes him a hero isn't the consistent good cheer with which he faces the discomfort his illnesses cause him on a daily basis. What makes him a hero is that fifteen years ago, before he got sick, he donated one of his kidneys to his brother who had AIDS. He told me about it the first day we met when he came to see me, reporting it the same way he did that he lived alone and worked at a large retail chain-in a tone that attached to it no particular significance.

Whatever ego boost he may or may not have ever felt from doing it had long since faded. I paused in my history taking, looked up at him from the notes I was making with eyebrows raised as I, at least, thought this remarkable. But in response, he only smiled self-consciously and nodded once to confirm it.

Around the same time, a professional football player (whose name I can't recall now) was being promoted by the media as a hero, and I remember thinking how strange it was that the entire nation was celebrating him when only a handful of people knew about my patient.
A HERO DEFINED
Not to take away from that football player's accomplishments in any way-I'm a great admirer of excellence in any form-but I found nothing about him even remotely heroic. I wondered if he was ever introduced to my patient if he wouldn't find the label a bit embarrassing himself.

What actually makes a hero? I'd argue it's the willingness to make a personal sacrifice for the benefit of others. If you don't find yourself having to resist a voice inside your head urging you to save yourself instead of whatever action you're contemplating, my heart, at least, will refuse to recognize your actions-however legitimately compassionate or courageous they may be-as heroic. Serving others while simultaneously serving oneself can be noble, certainly, but a special kind of nobility attaches itself to those who serve others at a cost to themselves. That's the nobility that tugs at my heart. That's the the kind of behavior I find heroic.
WHO QUALIFIES?
This definition implies the number of genuine heroes we have is at once smaller and larger than we all think. Smaller, because many of those people held up by the media as heroes, while undoubtedly wonderful in many ways, don't qualify as heroes. Certainly not famous sports figures-even those who quietly provide free game tickets to underprivileged children as Michael Jordan did or volunteer their time and money to charity as numerous pro football players do.

In fact, what sparked my thinking about this topic was a Facebook posting by a friend of mine who wrote, "...on a plane talking to an interesting passenger before take off about his job...will be an interesting flight sitting next to American hero Captain Sullivan..." I found myself reflecting that while Sully does indeed for me represent the epitome excellence, commitment, humility, and grace under pressure, the actions he took in the particular circumstance that made him famous weren't, in my view, heroic. Strictly speaking, he risked losing nothing personal in what he did on that day he and his crew (let's not forget his crew) saved the lives of all the passengers of Flight 1549. He may have been thinking more about his passengers' safety than his own-a characteristic of heroes to be sure-and, in fact, I strongly suspect that had circumstances been different and he'd needed to put himself in personal jeopardy to save those passengers, he would have had done so without hesitation. But those circumstances didn't exist the day he glided that plane safely into the Hudson. He had to make many choices but none that put him in more jeopardy than anyone else. While it seems to me likely that he does, in fact, possess the character of a hero, on that particular day no opportunity presented itself for him to display it. Leadership, courage, decisiveness, and technical expertise-yes. But heroism-no.

And I think he'd agree. Few people consider themselves heroes when doing something they have no choice about doing. This includes, I've discovered, most patients who find themselves facing potentially terminal diseases like cancer. Most such patients, in fact, bristle at the notion that "fighting" their disease makes them heroic. They certainly don't feel like heroes, they tell me. How they feel is tired, discouraged, and sick. They do what they need to do to survive. What's heroic, they want to know, about that? There's no other person whom they hope to save by fighting, no personal sacrifice they're making that another may live. They "fight" to save themselves-a worthy and noble goal certainly, one that requires enormous courage in the face of the painful treatments they must often endure-but not a goal, most of them seem to feel, that in any way deserves to be called heroic. Most of them even refuse to see the keeping of a stiff upper lip in the face of their fear as heroic, even when it's done-as it so often is-in an attempt to ease the burden their loved ones feel in watching them go though their illness.

So how, then, using this definition, are there more heroes around than we think? To find the answer, look at your neighbors and friends. You'll often find, if you bother to ask, that they're making sacrifices for others-sometimes enormous ones-all around you. Single mothers who deny themselves vacations, clothes, and even food to send their children to college. Couples who come to their doctors with forms to be filled out to qualify them to become foster parents. Children who put their careers on hold or even abandon them altogether to care for their sick parents, or to keep them out of nursing homes.

And my patient, who donated a kidney to save his brother. A brother who unfortunately died anyway (this was back when most AIDS patients died no matter what we did-a fact my patient knew himself when he gave him his kidney).

"That's how it goes sometimes," was all he said to me when I asked him about his brother's death during that first visit all those years ago.

He'd come to see me because his one remaining kidney had started to fail. I subsequently diagnosed him with sarcoidosis and was able to save it, only to flounder at sparing him from further complications of the disease later, complications that have since forced him to go on disability and significantly compromised the quality of his life.

I'm sure he feels bitter about it on some days and rails against his fate on others. He never complains to me about it, though.

He's one of my heroes. Who are some of yours?

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I saw a patient of mine recently whose appearance in my office always makes me smile. He's challenging-not because he's a difficult person (quite the opposite), but because he has so many serious medical problems about which I can do so little. Why, then, does seeing him so consistently lighten my mood?

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Hero means everything and nothing. It encompasses the firefighters who rushed into the burning twin towers, long-distance runners who compete through chronic disease, and the wag on Twitter who makes a point you agree with. The highly specific, armor-bright figure of classical myth has grown a thousand faces. We still want him around (DC Comics recently announced 10 new superhero films to unspool over the next six years, including one about a her: Wonder Woman), but his omnipresence makes him easy to mock. Part of our ambivalence may also stem from the suspicion that his noble deeds are not as selfless as they seem, motivated instead by a thirst for attention, rational egotism, or even masochism.

What's the psychology of heroism? Is extreme self-sacrifice the result of a pained calculus, a weighing of desire and obligation, or an instinct? (Which would be more heroic? Does it matter?) In a study out last week in the journal PLOS ONE, Yale researchers recruited more than 300 volunteers to read statements by 51 contemporary "heroes." These men and women had all received the Carnegie Hero Medal for "civilians who risk their lives to save strangers"; the experimenters wanted to know whether they had acted without thinking or after exerting "conscious self-control" in order "to override negative emotions like fear."

The volunteers-and a computer algorithm, for safesies-analyzed the medal winners' statements for evidence of careful thought, or of unpremeditated action. Overwhelmingly, they found that day-savers rescue first and reflect second. As Christine Marty, a 21-year-old student who wrested a trapped senior citizen from her car during a flash flood, said, "I'm thankful I was able to act and not think about it." Study author David Rand noted that people playing economic games are similarly less likely to share resources when they ruminate about their moves, but more generous when they don't take time to consider strategy. Perhaps human nature is reflexively pure and kind (and corrupted by our hyper-rational, transactional society)-or perhaps, as Rand speculated, cooperation becomes an intuitive habit only after we see it paying off. (Quoth Zazu: Cheetahs never prosper.)

The Yale study adds to a rich tradition of scientific inquiry into altruism, generosity, and the better angels/cannily perceptive salespeople of our nature. Before diving in, though, it's worth noting that the hero and the altruist are made of slightly different stuff. While both act admirably, only one has, by definition, a superhuman, preternatural aura. That distinction raises the question of whether what we value in heroism is a kind of transcending of what we take to be our frail or selfish wiring. Generosity might retain its gleam if it's innate-but does heroism count as heroism if we're predisposed to it?

We may indeed be built for acts of kindness. Children engage in prosocial behavior early on, helping, giving, and empathizing. One-year-olds will comfort an experimenter in feigned distress. And a 2009 study by German psychologists revealed that 18-month-old toddlers often provide "spontaneous, unrewarded" help to adults, retrieving a dropped clothespin, for instance, or opening a cabinet for a researcher whose hands are full. It isn't just that the kids like feeling useful or picking up clothespins. When the experimenter seemed unruffled by the fallen pin or the closed cabinet, rates of helping declined.

Of course, it doesn't cost a lot to pick up an object from the floor (especially when you are 2 feet tall). So next, the researchers strewed obstacles between the clothespin and the child-complex motor movement is hard at that age!-and got the same results. Phase 4 was giving the child enticing toys to play with in one corner of the room and positioning the closed cabinet in the opposite corner. In order to do a mitzvah for the researcher, the toddlers had to leave behind the toys and walk precariously across the room. Many did. Nor did rewards for helping motivate them to help more. (In fact, suddenly introducing an extrinsic motivation can undermine the internal glow of doing good-and drive subsequent helping rates down. This overjustification effect is the bane of helicopter parents everywhere.)

Once we're older, research finds, the impulse to be nice doesn't go away. Brain scans show the activation of neural regions that process pleasure when we give to charity. Some people experience more activation-they find giving more pleasurable-than others. They are the ones who voluntarily donate the most in an experimental setting. (Stroke victims who suffer from lesions to selected brain areas may also exhibit pathological generosity.) But the question remains: Why do these so-called altruists take such joy in acting kindly?

One study, by researchers at Georgetown University, implies that the world's givers and helpers simply possess more empathy. Psychologist Abigail Marsh and her team recruited 19 people who had donated their kidneys to total strangers, and 20 people who had not. They flashed images of fearful, upset, or angry human faces at the volunteers while recording their brain activity with an fMRI machine. The donors and the control group generated similar scans, except for two details: In donors, the right amygdala, which governs emotional response, was 8 percent larger, and it showed enhanced activity. Previous tests had already revealed the opposite finding for psychopaths. These empathy-impaired subjects had amygdalae that fired less when distressed faces were presented. Though fMRI studies are in their infancy, this one implied that altruists just give more shits than do the rest of us.

Yet perhaps they pursue generous deeds for craftier reasons. In 2012, psychologists from Knox College in Illinois divided 78 students into 26 groups of three-some with two men and one woman, and some with two women and one men. The groups were asked to complete a task that would result in a financial reward, and one facet of the job was that a team member would need to plunge his or her forearm into a bucket of icy water for 40 seconds. Within each group, the volunteer who elected to "sacrifice" him- or herself to the bucket ("This hurts a lot more than people think it will, and ... even more after you remove your arm from the ice," intoned the experimenter) was judged as more likeable and admirable than everyone else. That group member was also awarded more money when the teams decided how to split up their prize.

Perhaps predictably, intense rivalry broke out, especially between the men in male-male-female groups. Guys really wanted to wear the heroic, ice bucket-conquering mantle, gain social status, and impress the lady. The researchers concluded that engaging in "self-sacrifice" is "a profitable long-term strategy." "Competition ... and 'showing off' are key factors in triggering altruistic behavior," they wrote.

Which brings us back to heroes. Despite all the prestige, money, and adoring lookers-on, at a certain point altruism no longer represents any kind of long-term strategy. Rather, its risks and sacrifices overwhelm its benefits.

The morbid, unspoken problem with studying real-life heroes is that they have a tendency to die. The three men who leapt in front of their girlfriends when a gunman opened fire in an Aurora, Colorado, movie theater can't tell us what they were thinking and feeling. Nor can the Sikh temple president who lost his life shielding worshippers from a skinhead's bullets. Nevertheless, a few papers shed some light. In 2005, researchers ran personality tests on 80 Gentiles who risked their lives to shelter Jewish refugees during the Holocaust, as well as 73 bystanders. Two interesting commonalities arose among the "heroes": First, they were more likely to embrace, or at least tolerate, danger. Second, they were more likely to say they interacted frequently with friends and family. These findings expanded on a classic 1970 study of 37 Holocaust rescuers, in which researchers determined that the helping Gentiles were animated in part by "a spirit of adventurousness." (Related but more prosaic: Studies suggest that " sensation-seeking" is positively correlated with the willingness to give blood.) In 1984, scientists John P. Wilson and Richard Petruska determined that "high-esteem" college students-those who believed they were worthy and competent- more often rushed to aid an experimenter during a simulated explosion, while "high-safety" students, driven by a need for security and the desire to avoid anxiety, were less likely to lend a hand. In the realm of smaller, but still substantial, risk, 74 percent of kidney donors interviewed for a 1977 study said they put great faith and trust in people, compared with only 43 percent of non-donors.

The heroic picture that emerges here-confident, risk-taking men and women who believe in others and value their relationships-looks familiar. It's idealistic Peter Parker and grinning, goodhearted Indiana Jones. It's Buffy, Wildstyle from The Lego Movie, and Law & Order: SVU's Olivia Benson. Meanwhile, for show-offy altruists, there are philanthropic golden boys Bruce Wayne and Tony Stark, or that one male ally in your Twitter feed who always blurs the line between feminist support and benevolent sexism.

What about you or me? Will we be heroes when the moment calls? Maybe, if we don't overthink it.

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There's a Huge Difference Between Being a Hero and Being an Altruist

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Hero means everything and nothing. It encompasses the firefighters who rushed into the burning twin towers, long-distance runners who compete through chronic disease, and the wag on Twitter who makes a point you agree with. The highly specific, armor-bright figure of classical myth has grown a thousand faces.

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What makes people have prospects in such dire and needy situations? 

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What makes people have prospects in such dire and needy situations? 

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Would a lack of expectation make us more or less motivated?

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Would a lack of expectation make us more or less motivated?

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Why do adults sometimes keep things from kids? 

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Why do adults sometimes keep things from kids? 

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How does who we think we are effect who we become?

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How does who we think we are effect who we become?

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Are some lives more valuable than others? Why do we sometimes treat them like they are? What do we associate with value? 

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Are some lives more valuable than others? Why do we sometimes treat them like they are? What do we associate with value? 

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What is Stockholm Syndrome? (Mental Health Guru)

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Forty years ago, the term Stockholm Syndrome was coined at the end of a six-day bank siege. What is it and why is it cited time and again in hostage situations?

Most people know the phrase Stockholm Syndrome from the numerous high-profile kidnapping and hostage cases - usually involving women - in which it has been cited.

The term is most associated with Patty Hearst, the Californian newspaper heiress who was kidnapped by revolutionary militants in 1974. She appeared to develop sympathy with her captors and joined them in a robbery. She was eventually caught and received a prison sentence.

But Hearst's defence lawyer Bailey claimed that the 19-year-old had been brainwashed and was suffering from "Stockholm Syndrome" - a term that had been recently coined to explain the apparently irrational feelings of some captives for their captors.

More recently the term was applied in media reports about the Natascha Kampusch case. Kampusch - kidnapped as a 10-year-old by Wolfgang Priklopil and held in a basement for eight years - was reported to have cried when she heard her captor had died and subsequently lit a candle for him as he lay in the mortuary.

While the term is widely known, the incident that led to its coinage remains relatively obscure.

Outside Sweden few know the names of bank workers Birgitta Lundblad, Elisabeth Oldgren, Kristin Ehnmark and Sven Safstrom.

It was 23 August 1973 when the four were taken hostage in the Kreditbanken by 32-year-old career-criminal Jan-Erik Olsson - who was later joined at the bank by a former prison mate. Six days later when the stand-off ended, it became evident that the victims had formed some kind of positive relationship with their captors.

Stockholm Syndrome was born by way of explanation.

Patricia "Patty" Hearst

19-year-old American newspaper heiress Patty Hearst was kidnapped and held hostage by little-known group the Symbionese Liberation Army (SLA) in 1974

She was apparently brainwashed into accepting their ideas

In April 1974 she was caught on CCTV helping the group to rob a bank

She went on the run, but was caught by the FBI

Hearst was sentenced to seven years in prison, but was released after three years

She was pardoned in January 2001 by President Bill Clinton

1974: Newspaper heiress kidnapped
The phrase was reported to have been coined by criminologist and psychiatrist Nils Bejerot. Psychiatrist Dr Frank Ochberg was intrigued by the phenomenon and went on to define the syndrome for the FBI and Scotland Yard in the 1970s.

At the time, he was helping the US National Task Force on Terrorism and Disorder devise strategies for hostage situations.

His criteria included the following: "First people would experience something terrifying that just comes at them out of the blue. They are certain they are going to die.

"Then they experience a type of infantilisation - where, like a child, they are unable to eat, speak or go to the toilet without permission."

Small acts of kindness - such as being given food - prompts a "primitive gratitude for the gift of life," he explains.

"The hostages experience a powerful, primitive positive feeling towards their captor. They are in denial that this is the person who put them in that situation. In their mind, they think this is the person who is going to let them live."

But he says that cases of Stockholm Syndrome are rare.

So, what went on in the bank on Stockholm's Norrmalmstorg square that enabled the captives to experience positive feelings towards their captors, despite fearing for their lives?

In a 2009 interview with Radio Sweden, Kristin Ehnmark explained: "It's some kind of a context you get into when all your values, the morals you have change in some way."

It was Ehnmark that, according to reports, built up the strongest relationship with Olsson. There were even erroneous reports afterwards that the pair had become engaged.

In one phone call from the bank's vault to the country's prime minister Olof Palme, Ehnmark begged to be allowed to leave the bank with the kidnappers. One of Olsson's demands had been the delivery of a getaway car in which he planned to escape with the hostages. The authorities had refused.

Telling Palme that she was "very disappointed" with him, Ehnmark said: "I think you are sitting there playing chequers with our lives. I fully trust Clark and the robber. I am not desperate. They haven't done a thing to us. On the contrary, they have been very nice. But you know, Olof, what I'm scared of is that the police will attack and cause us to die."

American journalist Daniel Lang interviewed everyone involved in the drama a year later for the New Yorker. It paints the most extensive picture of how captors and captives interacted.

The hostages spoke of being well treated by Olsson, and at the time it appeared that they believed they owed their lives to the criminal pair, he wrote.

On one occasion a claustrophobic Elisabeth Oldgren was allowed to leave the vault that had become their prison but only with a rope fixed around her neck.

She said that at the time she thought it was "very kind" of Olsson to allow her to move around the floor of the bank.

Safstrom said he even felt gratitude when Olsson told him he was planning to shoot him - to show the police understood he meant business - but added he would make sure he didn't kill him and would let him get drunk first.

"When he treated us well, we could think of him as an emergency God," he went on to say.

Stockholm Syndrome is typically applied to explain the ambivalent feelings of the captives, but the feelings of the captors change too.

Olsson remarked at the beginning of the siege he could have "easily" killed the hostages but that had changed over the days.

"I learned that the psychiatrists I interviewed had left out something: victims might identify with aggressors as the doctors claimed, but things weren't all one way," wrote Lang.

"Olsson spoke harshly. 'It was the hostages' fault,' he said. 'They did everything I told them to do. If they hadn't, I might not be here now. Why didn't any of them attack me? They made it hard to kill. They made us go on living together day after day, like goats, in that filth. There was nothing to do but get to know each other.'"

The notion that perpetrators can display positive feelings toward captives is a key element of Stockholm Syndrome that crisis negotiators are encouraged to develop, according to an article in the 2007 FBI Law Enforcement Bulletin. It can improve the chances of hostage survival, it explained.

But while Stockholm syndrome has long been featured on police hostage negotiating courses, it is rarely encountered, says Hugh McGowan, who spent 35 years with the New York Police Department.

McGowan was commanding officer and chief negotiator of the Hostage Negotiation Team, which was set up in April 1973 in the wake of a number of hostage incidents that took place in 1972 - the bank heist that inspired the film Dog Day Afternoon, an uprising that came to a violent end at Attica prison in New York and the massacre at the Munich Olympics.

"I would be hard pressed to say that it exists," he says. "Sometimes in the field of psychology people are looking for cause and effect when it isn't there.

"Stockholm was a unique situation. It occurred at around the time when we were starting to see more hostage situations and maybe people didn't want to take away something that we might see again."

He acknowledges that the term gained currency partly because of the bringing together of the fields of psychology and policing in the field of hostage negotiating.

There are no widely accepted diagnostic criteria to identify the syndrome, which is also known as terror-bonding or trauma bonding and it is not in either of the two main psychiatric manuals, The Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems (ICD).

But the underlying principles of how it works can be related to different situations, say some psychologists.

"A classic example is domestic violence, when someone - typically a woman - has a sense of dependency on her partner and stays with him," says psychologist Jennifer Wild, a consultant clinical psychologist at the University of Oxford.

"She might feel empathy rather than anger. Child abuse is another one - when parents emotionally or physically abuse their children, but the child is protective towards them and either doesn't speak about it or lies about it."

Forty years on and the term is evoked nearly every time an abductee is found after many years out of public sight. Some argue that its very nature implies a criticism of the survivor - a weakness perhaps.
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In a 2010 interview with the Guardian, Kampusch rejected the label of Stockholm Syndrome, explaining that it doesn't take into account the rational choices people make in particular situations.

"I find it very natural that you would adapt yourself to identify with your kidnapper," she says. "Especially if you spend a great deal of time with that person. It's about empathy, communication. Looking for normality within the framework of a crime is not a syndrome. It is a survival strategy."

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Forty years ago, the term Stockholm Syndrome was coined at the end of a six-day bank siege. What is it and why is it cited time and again in hostage situations? Most people know the phrase Stockholm Syndrome from the numerous high-profile kidnapping and hostage cases - usually involving women - in which it has been cited.

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