The primary goal for organ replacement therapy, achieved by allografting,
should be to preserve life. Some transplantation procedures, such as those
for the heart, liver, and lung, are necessary to preserve life, while others
(eg, those for the cornea and pancreas) are not. Type 1 diabetes, a uniformly
fatal disease prior to the introduction of insulin therapy approximately 80
years ago, represents an interesting case for transplantation. Insulin therapy
reduced the occurrence of the metabolic catastrophe ketoacidosis and of death
by inanition that characterized diabetes in the preinsulin era; however, until
recently, insulin therapy also achieved grossly nonphysiologic metabolic control
that was associated with long-term complications, including vision loss, amputations,
and kidney failure.1
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