The historical origin and the experimental basis of the concept of physical determinism indicate that this basis was removed with the acceptance of the kinetic theory of matter, while its difficulties are increased by the admission that human nature, in its entirety, is a product of natural causation. An indeterministic view of causation has the advantages (a) of unifying the concept of natural law in different spheres of human experience and (b) of a greater generality, which precludes the acceptance of (...) the special case of completely deterministic causation, so long as this is an unproved assumption. It is not inconsistent with the orderliness of the world, or with the fruitful pursuit of natural knowledge. It enriches rather than weakens the concept of of causation. It possesses definite advantages with respect to the one-sidedness of human memory, and to the phenomena of aiming and striving observable in man and other animals. Among biological theories it appears to be most completely in harmony with the theory of natural selection, which in its statistical nature resembles the second law of thermo-dynamics. In an indeterministic world natural causation has a creative element, and science is interested in locating the original causes of effects of special interest, and not merely in pushing a chain of causation backwards ad infinitum. These contrasting tendencies are illustrated by a critique of the mutation theory, and by an attempt more closely to define the sense in which indeterministic causation should be thought of as creative. (shrink)

Amit Sharma, Rajesh Ramanathan, Marc Posner, Robert A Fisher Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA: Pediatric kidney transplantation is the preferred treatment for children with end-stage renal disease. The most common indications for transplantation in children are renal developmental anomalies, obstructive uropathy, and focal segmental glomerulosclerosis. Living donor kidney transplants are often performed pre-emptively and offer excellent graft function. Policy changes in deceased-donor kidney allocation have increased the proportion of such transplants in pediatric recipients. Adequate pretransplant workup (...) along with evaluation of urologic abnormalities is imperative in achieving good outcomes. Overall, patient and graft outcomes after kidney transplantation have improved, with five-year deceased donor and living donor graft survivals of 78.8% and 84.3%, respectively. Improvements in induction and maintenance immunosuppression have contributed to the gradual improvement in outcomes. Unique challenges in pediatric recipients include increased graft thrombosis, adverse growth, and abnormal development relating to immunosuppression, increased rejection due to nonadherence, increased susceptibility to opportunistic infections, and post-transplant malignancy. This review focuses on the current practices and outcomes in pediatric kidney transplantation in North America. We discuss the indications for transplantation, the evaluation process, some key surgical and immunologic considerations, and the common risk factors for graft dysfunction. Keywords: pediatric kidney transplantation, end-stage renal disease, dialysis, organ donors, immunosuppression. (shrink)