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In the period following the Carnation Revolution of 25 April 1974 that put an end to Caetano's dictatorship, Guterres became involved in Socialist Party leadership and held the following offices: Head of Office of the Secretary of State of Industry (1974 and 1975) Deputy for Castelo Branco in the Portuguese National Parliament (1976–1995) Leader of the parliamentary bench of the Socialist Party, succeeding Jorge Sampaio (1988) Guterres was a member of the team that negotiated the terms of Portugal's entry into the European Union in the late 1970s. He was a founding member of the Portuguese Refugee Council in 1991.
In 1992, after the Socialists' third consecutive defeat in Parliamentary elections, Guterres became secretary-general of the Socialist Party and leader of the opposition during Aníbal Cavaco Silva's government. At the time, he was the party's third leader in six years. He was also selected as one of the 25 vice-presidents of the Socialist International in September 1992. His election represented a break with tradition for the Socialists: not only was Guterres not associated with either the faction around then-president and former prime minister Mário Soares or the party's left wing led by Guterres' predecessor Sampaio, but he was also a devout Catholic, running counter to the party's historical secularism.
He sought to consult with Portugal's civil society in formulating policy, meeting a range of intellectuals, scientists and entrepreneurs from across the country and the political spectrum in the run-up to the next general election. Prime Minister of Portugal Cavaco Silva did not seek a fourth term as prime minister of Portugal (in order to run for the 1996 Presidential election) and the Socialist Party won the 1995 parliamentary election. President Soares appointed Guterres as prime minister and his Cabinet took the oath of office on 28 October that year.
Guterres ran on a platform of keeping a tight hold on budget spending and inflation in a bid to ensure that Portugal met the Euro convergence criteria by the end of the decade, as well as increasing rates of participation in the labor market, especially among women, improving tax collection and cracking down on tax evasion, increased involvement of the mutual and non-profit sectors in providing welfare services, a means-tested guaranteed minimum income (known as the Rendimento Minimo Garantido), and increased investment in education. He was then one of seven Social Democratic prime ministers in the European Union, joining political allies in Spain, Denmark, Finland, Sweden, Greece and the Netherlands.
First term (1995–1999) With a style markedly different from that of his predecessor, and based on dialogue and discussion with all sections of society, Guterres was a popular prime minister in the first years of his office. Portugal was enjoying a solid economic expansion which allowed the Socialists to reduce budget deficits while increasing welfare spending and creating new conditional cash transfer programs. His government also accelerated the program of privatizations which had been undertaken by Cavaco Silva's government: a total of 29 companies were privatized between 1996 and 1999, with proceeds from privatizations in 1996–1997 being greater than those of the previous six years, and the public sector's share of GDP being halved from 11 percent in 1994 to 5.5 percent five years later.
Share ownership was also widened, with 800,000 people investing in Portugal Telecom upon its privatization in 1996 and 750,000 applying for shares in Electricidade de Portugal. In 1998, Guterres presided over Expo 98 in Lisbon, commemorating the 500th anniversary of the voyage of Vasco da Gama. Also in 1998, two nationwide referenda were held. The first one was held in June, and asked the voters whether abortion rules should be liberalized. The Socialist Party split over the issue of liberalization, and Guterres himself led the pro-life side, which eventually won the referendum. A second referendum was held in November, this time over the regionalization of the mainland.
In this referendum, both Guterres and his party supported the approval of such an administrative reform. In this second referendum, Guterres suffered a political defeat, as the proposal was rejected by the voters. Contrary to his party stance and following the removal of homosexuality from the list of mental illnesses by the World Health Organization in 1990, Guterres said, in 1995, that "he did not like homosexuality" and that he considered it "something that bothered him". On foreign policy, Guterres campaigned for United Nations intervention in East Timor in 1999, after the former Portuguese colony was virtually destroyed by Indonesian-backed militias when it voted for independence.
He also finalized the 12-year-long negotiations on the transfer of sovereignty over Macau, which had been a Portuguese colony, to Chinese control in 1999. Second term (1999–2002) In the 1999 parliamentary election the Socialist Party and the opposition won exactly the same number of MPs (115). Guterres was re-appointed for the office and from January to July 2000, occupied the six-month rotating presidency of the European Council. This second term in government was not as successful, however. Internal party conflicts along with a slowdown in economic growth and the Hintze Ribeiro Bridge disaster damaged his authority and popularity. Nevertheless, some long-lasting measures were taken during his second term: in October 2000, the Parliament approved the decriminalization of drug use (effective from 1 July 2001) and in March 2001, same-sex civil unions were legalized.
In December 2001, following a disastrous defeat for the Socialist Party in local elections, Guterres resigned to "prevent the country from falling into a political swamp". President Jorge Sampaio dissolved Parliament and called for elections. Eduardo Ferro Rodrigues, until then Minister for Social Security, assumed the Socialist Party leadership, but the general election was lost to the Social Democratic Party of José Manuel Durão Barroso, who would later become President of the European Commission. President of Socialist International Guterres was elected president of Socialist International in November 1999, thus overlapping with his second term as Prime Minister of Portugal until his resignation from the latter post in December 2001.
He remained president of the Socialist International until June 2005. Diplomatic career In 2005, following Guterres' proposal, George Papandreou was elected vice president of the Socialist International; in 2006, Papandreou succeeded him as president of the Socialist International. In May 2005, Guterres was elected High Commissioner for Refugees for a five-year term by the UN General Assembly, replacing Ruud Lubbers. High Commissioner for Refugees As High Commissioner, Guterres headed one of the world's largest humanitarian organizations, one which at the end of his term had more than 10,000 staff working in 126 countries providing protection and assistance to over 60 million refugees, returnees, internally displaced people and stateless persons.
His time in office was marked by a fundamental organizational reform, cutting staff and administrative costs in the UNHCR's Geneva head office and expanding UNHCR's emergency response capacity during the worst displacement crisis since the Second World War. On 19–23 March 2006, Guterres visited Beijing, China, and expressed his objection to repatriation of North Korean refugees by the Chinese government. In a February 2007 NPR interview devoted mainly to the plight of Iraqi refugees, Guterres said that this was one of the greatest refugee crises in the Middle East since 1948. Among poorly publicized refugee crises, he cited those in the Central African Republic and the Democratic Republic of the Congo.
During his final years as High Commissioner, he worked chiefly to secure international aid for the refugees of the Syrian civil war, calling the refugee crisis an "existential" one for host countries (such as Lebanon and Jordan), and describing additional aid as a "matter of survival" for the refugees. He was an outspoken advocate for a more coordinated and humane approach by European countries to the Mediterranean refugee crisis. In June 2013, he launched a US$5 billion aid effort, its biggest ever, to help up to 10.25 million Syrians that year. In what was widely considered a very effective PR move, Guterres appointed American actress Angelina Jolie as his special envoy to represent UNHCR and himself at the diplomatic level in 2012.
Together they visited the Kilis Oncupinar Accommodation Facility in Turkey (2012); the Zaatari refugee camp in Jordan (2013); and the Maritime Squadron of the Armed Forces of Malta (2015). They also appeared jointly before the United Nations Security Council (2015). In early 2015, the General Assembly voted to extend Guterres' mandate by 6 months to 31 December, on recommendation of United Nations Secretary-General Ban Ki-moon. In light of the European migrant crisis, the UNHCR's 98-member executive committee (EXCOM) later requested that Ban recommend extending Guterres' term by a further year. However, Ban disregarded the request. Guterres left office on 31 December 2015, having served the second-longest term as High Commissioner in the organization's history, after Prince Sadruddin Aga Khan.
Also in 2015, Guterres was appointed by President Marcelo Rebelo de Sousa to serve as a Member of the Council of State of Portugal; he resigned after being appointed UN's 9th Secretary-General). United Nations Secretary-General Candidacy Guterres became United Nations Secretary-General on 1 January 2017, following his formal election by the UN General Assembly on 13 October 2016. On 29 February 2016, Guterres submitted his nomination as Portugal's candidate for the 2016 UN Secretary-General selection. This was the first time candidates for secretary-general had to present their platform in public hearings in the UN General Assembly, a process during which Guterres emerged as a much stronger candidate than had been initially expected, given that he fit the bill on neither the gender nor the geographic scores.
On 5 October, the 15-member United Nations Security Council announced that they had agreed to nominate Guterres, after an informal secret ballot in which he gained 13 "encourage" votes and two "no opinion" votes. The Security Council officially nominated Guterres by adopting a formal resolution on 6 October. A week later, he was formally elected by the United Nations General Assembly in its seventy-first session. Guterres took office on 1 January 2017. The UN's role in the Haiti cholera outbreak has been widely discussed and criticized after the Ban Ki-moon administration denied the issue for several months. According to the Boston-based Institute for Justice & Democracy in Haiti as well as numerous conclusive scientific studies, the UN is the proximate cause for bringing cholera to Haiti.
Peacekeepers sent to Haiti from Nepal in 2010 were carrying asymptomatic cholera and failed to treat their waste properly before dumping it into one of Haiti's main water streams. During his UNSG informal dialogue, Jamaica, on behalf of the Caribbean Community, asked if the UN should assume liability for any deaths within local populations that result from the introduction of infectious disease by its peacekeepers. Jamaica also asked if Guterres believes compensation should be provided. Guterres responded by calling the situation a "particularly complex question". He says that it is difficult to preserve diplomatic immunity while also ensuring there is no impunity, but that he would "pay a lot of attention in trying to find the right equilibrium between these two aspects that are absolutely crucial".
In a UN General Assembly meeting in late October 2016, the representative from Haiti called the UN's current and future response to the cholera epidemic "a litmus test of the system's commitment to the promotion of human rights". Though many had hoped Guterres' term would mark a break with the inaction that characterized Ban Ki-moon's response to the epidemic, Guterres has done little to signal a commitment to cholera victims in Haiti. As of April 2017, five months into Guterres' term as secretary-general, only $10 million had been contributed to the $400 million fund to fight cholera and provide material assistance to victims the UN announced in 2016.
In 2016, Anders Kompass exposed the sexual assault of children by peacekeepers in the Central African Republic and, as a consequence, was dismissed by Ban Ki-moon's administration before being rehabilitated in court. During the United Nations Secretary-General Candidate informal dialogues, Guterres indicated it was completely unacceptable that there be UN forces committing human rights violations such as rape and sexual violence. "All of us together—states and UN—must do our utmost to ensure that any kind of action of this type is severely punished," remarked Guterres. The United States raised the question of international tribunals to try peacekeepers for their crimes.
Guterres responded by saying an independent jurisdiction would be excellent but that "the only way to get there is through a new compact with all key parties—true contributors, financial contributors—and to make sure that there is an adjustment in the relation between countries, the UN, and the support those that are contributing with troops receive, in order to be able to do it much better." He also indicated that there is a gap between theoretical zero tolerance and the ineffective zero tolerance that actually exists on the ground and needs to be overcome. Tenure On 1 January 2017, on his first day at the helm of the United Nations as secretary-general, António Guterres pledged to make 2017 a year for peace.
"Let us resolve to put peace first," said Guterres, in an appeal for peace. On 12 April 2017, Guterres appointed an 8-member Independent Panel to assess, enhance effectiveness of UN-Habitat after Adoption of New Urban Agenda. The recommendation of the panel to establish an independent coordinating mechanism, ‘UN-Urban’ however was received with criticism from urban experts and the African Urban Institute. On 20 June 2017, however, "Secretary-General Antonio Guterres warned the Trump administration ... that if the United States disengages from many issues confronting the international community it will be replaced..." In response to the death of Chinese Nobel Peace Prize laureate Liu Xiaobo, who died of organ failure while in government custody, Guterres said he was deeply saddened.
After the violence during the Catalan independence referendum of 1 October 2017, Guterres trusted the Spanish institutions to look for a solution to the crisis. The same message he gave when Catalonia declared the independence on 27 October 2017 but the solution should be made under the constitutional framework. Guterres criticized the Saudi Arabian-led intervention in Yemen and the naval, land and air blockade of Yemen. The blockade has further aggravated the severe humanitarian crisis in the country. Guterres said that the intervention in Yemen "is a stupid war. I think this war is against the interests of Saudi Arabia and the Emirates... (and) of the people of Yemen."
Guterres opposed President Donald Trump's decision to recognize Jerusalem as Israel's capital. In March 2018, Guterres said the population of Syria's Eastern Ghouta was living in "hell on earth". In one district, 93% of buildings had been damaged or destroyed by December, according to UN satellite imagery analysis. A recent wave of bombings has caused further destruction. Guterres called the 2018 North Korea–United States summit a "crucial milestone" for nuclear disarmament. Guterres urged both sides to "seize this momentous opportunity" and offered UN assistance to achieve the goal of dismantling North Korea's nuclear weapons program. In August 2018, Guterres called for an independent investigation into a Saudi Arabian-led coalition air strike in Yemen that killed 51 civilians including 40 children.
Guterres condemned the persecution of the Rohingya Muslim minority in Myanmar and called for a stronger response to the crisis. In September 2018, during his address to the 73rd United Nations General Assembly, Guterres became the first secretary to recognize that advancing technology will disrupt labor markets like never before and we should begin to consider stronger safety nets like Universal Basic Income. In 2019, human rights groups criticized Guterres for being "silent" as China sends ethnic Uyghurs and other predominantly Muslim ethnic minorities in China's north-western province of Xinjiang to the massive re-education camps. Human Rights Watch chief Kenneth Roth said that Guterres "has been notably silent on one of the most important, .. the most brazen human rights abuses, .. because he is worried about upsetting the Chinese."
In September 2019, Guterres condemned Israeli PM's plans to annex the eastern portion of the occupied West Bank known as the Jordan Valley. Guterres expressed his "deep concern" at the spiralling violence in Syria a day after Turkey launched an offensive in Kurdish-controlled areas. He said any solution to the conflict needed to respect the sovereignty of the territory and the unity of Syria.
Other activities Dag Hammarskjöld Fund for journalists, chairman of the Honorary Advisory Council Caixa Geral de Depósitos, advisor to the board (2003–2005) Champalimaud Foundation, member of the Vision Award Jury Clean Cooking Alliance, member of the Leadership Council Club of Madrid, member (since 2002) European Council on Foreign Relations (ECFR), member International Gender Champions (IGC), Member European Regional Innovation Awards, chairman of the Jury (2004) Friends of Europe, member of the board of trustees Calouste Gulbenkian Foundation, non-executive member of the board of trustees (2013–2018) World Economic Forum (WEF), member of the Global Agenda Council on Humanitarian Assistance (2008–2009) Personal life In 1972, Guterres married child psychiatrist Luísa Amélia Guimarães e Melo, with whom he had two children, Pedro Guimarães e Melo Guterres (born 1977) and Mariana Guimarães e Melo de Oliveira Guterres (born 1985).
His wife died of cancer at the Royal Free Hospital in London in 1998 at the age of 51. In 2001, he married his second wife Catarina Marques de Almeida Vaz Pinto (b. 1960), a former Portuguese State Secretary for Culture and more recently Culture Secretary for the City Council of Lisbon. In addition to his native Portuguese, Guterres speaks English, French, and Spanish. According to CNN's Tim Hume, Guterres is a practicing Catholic. During his university years, he joined the Group of Light, a club for young Catholics, where he met Father Vítor Melícias, a prominent Franciscan priest and church administrator who remains a close friend and confidant.
Recognition Honours Portuguese : Grand Cross of the Order of Christ (9 June 2002) : Grand Cross of the Order of Liberty (2 February 2016) Foreign : Grand Cordon of the Order of Leopold (9 October 2000) : Grand Cross of the Order of the Southern Cross (23 July 1996) : Grand Cross of the Order of Merit (30 September 2001) : First Degree of the Order of Amílcar Cabral (27 April 2001) : Grand Cross of the National Order of Merit (4 February 2002) : Grand Cross of the Order of Honour (17 March 2000) : Grand Cross of the Order of Merit of the Italian Republic (3 December 2001) : Grand Cordon of the Order of the Rising Sun (4 April 2002) : Sash of Special Category of the Order of the Aztec Eagle (2 July 1999) : Grand Cross of the Order of Merit of the Republic of Poland (22 September 1997) : Grand Cross of the Order of Charles III (8 September 2000) : Collar of the Order of Isabella the Catholic (14 June 2002) : Grand Cordon of the Order of the Republic (4 April 2002) : Grand Officer of the Order of the Oriental Republic of Uruguay (10 December 1998) Honorary degrees 2010 – Honorary Doctorate, University of Beira Interior 2014 – Honorary Doctorate, Meiji University 2016 – Honorary Doctorate of Laws, Carleton University 2016 – Honorary Doctorate, University of Coimbra 2016 – Honorary Doctorate, European University of Madrid 2017 – Honorary Doctorate, University of South Carolina Other awards 2005 – Personality of the Year by the Associação de Imprensa Estrangeira em Portugal (AIEP) 2007 – Freedom Award 2009 – Calouste Gulbenkian International Prize (shared with the Peace Research Institute in the Middle East) 2009 – Forbes List of The World's Most Powerful People in 2009 2015 – W. Averell Harriman Democracy Award 2015 – The National German Sustainability Award 2019 – Charlemagne Prize See also Climate change mitigation List of trips by António Guterres References External links Official website of Antonio Guterres - UN Secretary-General Official website of António Guterres in Gov.pt Category:1949 births Category:Living people Category:20th-century Portuguese politicians Category:21st-century Portuguese politicians Category:Catholic socialists Category:Collars of the Order of Isabella the Catholic Category:Grand Cordons of the Order of the Rising Sun Category:Grand Cross of the National Order of Merit (France) Category:Grand Crosses of the Order of Christ (Portugal) Category:Grand Crosses of the Order of Honour (Greece) Category:Grand Crosses of the Order of Liberty Category:Grand Crosses of the Order of Merit of the Republic of Poland Category:Grand Crosses of the Order of the Southern Cross Category:Instituto Superior Técnico alumni Category:Knights Grand Cross of the Order of Merit of the Italian Republic Category:Members of the Assembly of the Republic (Portugal) Category:People from Lisbon Category:Portuguese Christian socialists Category:Portuguese engineers Category:Portuguese Roman Catholics Category:Presidents of the Socialist International Category:Prime Ministers of Portugal Category:Recipients of the Order of the Aztec Eagle Category:Socialist Party (Portugal) politicians Category:United Nations High Commissioners for Refugees Category:Secretaries-General of the United Nations Category:Under-Secretaries-General of the United Nations Category:Portuguese officials of the United Nations
George Ritzer (born October 14, 1940) is an American sociologist, professor, and author who studies globalization, metatheory, patterns of consumption, and modern and postmodern social theory. His most notable contribution to date is his concept of McDonaldization, which draws upon Max Weber's idea of rationalization through the lens of the fast food industry. In addition to creating his own theories, Ritzer has also written many general sociology books, including Introduction to Sociology (2012) as well as Essentials to Sociology (2014), and modern and postmodern social theory textbooks. He coined the term “McDonaldization”. Currently, Ritzer is a Distinguished Professor at the University of Maryland, College Park.
Biography Early life Ritzer was born in 1940 to a Jewish family in upper Manhattan, New York City. His father and mother were employed as a taxi cab driver and secretary, respectively, in order to support him and his younger brother. Ritzer later described his upbringing as "upper lower class". When his father contracted a strange illness, speculated to be from his job as a taxi driver, Ritzer's mother had to break open the family's piggy bank, where they stored half dollars, in order to provide for the family. Despite dealing with some tough economic times, he never felt deprived relative to others while growing up in a "working-class, multi-ethnic neighborhood".
Education and early employment Ritzer graduated from the Bronx High School of Science in 1958, stating to have "encountered the brightest people I have ever met in my life". While at Bronx High School of Science, Ritzer received a New York State Regents Scholarship which would follow him to whichever college he chose to attend. Ritzer began his higher education at City College of New York, a free college at the time. His scholarship in addition to the free college tuition proved to be a benefit to the economic positioning of the Ritzer family. While at CCNY, Ritzer initially planned to focus on business, but he later changed his major to accounting.
After graduating from CCNY in 1962, Ritzer decided that he was interested in pursuing business again. He was accepted into the M.B.A. program at the University of Michigan Ann Arbor, where he received a partial scholarship. While at Michigan, his official academic interest was human relations; however, he had many other intellectual hobbies, such as reading Russian novels. Ritzer reported that at Michigan, as he was able to grow and improve as a student. However, during his time at Michigan, he remembers being heavily involved in global events occurring at the time. He reports memories of going to the Michigan Union to watch the happenings of the Cuban Missile Crisis.
After graduating from The University of Michigan in 1964, Ritzer began working in personnel management for the Ford Motor Company; however, this proved to be a negative experience for him. His managers mistakenly hired three people, more than was necessary, for the one job, leaving him idle and unoccupied. As he once said: "[i]f we had two hours of work a day, it was a lot." Nevertheless, he was always expected to appear busy. He would constantly wander around the factory for hours observing people working, causing many of the workers and foremen to become hostile towards him. Moreover, Ritzer also found problems within the management structure at Ford.
Most of the younger people with advanced degrees defied their less educated authorities. Ritzer said, "I'd like to see a society in which people are free to be creative, rather than having their creativity constrained or eliminated." Furthermore, he found himself constrained and unable to do anything creative while working at Ford, encouraging him to apply to Ph.D. programs. Ritzer enrolled in Cornell University's School of Labor and Industrial Relations Ph.D. program in Organizational Behavior in 1965. There, his adviser Harrison Trice suggested that he minor in sociology. After a conversation with the head of the department, Gordon Streib, Ritzer realized that he knew nothing about sociology and was then urged to read "Broom and Selznick’s Introduction to Sociology" and found himself enthralled with the subject matter.
He continued to succeed in sociology courses at the graduate level. As a testament to his interest and dedication to the subject, he received an A+ on a 102-page paper he wrote for a course on American society. His professor stated that the paper was "too long not to be good". This experience as well as out-reading the other sociology students in a small seminar with Margaret Cussler allowed Ritzer to become more confident as a sociology student due to his ability to outwork the competition. He attributed his talent of being able to compete with well-read and experienced sociology students to his work ethic.
Academic career After graduating from Cornell in 1968, Ritzer received various academic appointments at universities around the United States and the world: 1968-1970: Assistant Professor, Tulane University 1970-1974: Associate Professor, University of Kansas 1974-2001: Professor, University of Maryland 1984: Visiting Exchange Professor, University of Surrey, England. 1988: Visiting Professor, Shanghai University, China; Peking University, Beijing, China 1990: Visiting Exchange Professor, University of Surrey, England 1996: Visiting Professor, University of Tampere, Finland 2001: Visiting Professor, University of Bremen, Germany 2001–present: Distinguished University Professor, University of Maryland, College Park 2002, 2004-2008: Visiting Professor, Associazione per l’Istituzione della Libera Università Nuorese, Sardinia, Italy 2012: Visiting Professor, University of Salzburg, Austria 2013: Visiting Scholar, Center for Advanced Study, University of Munich, Germany Main ideas Although known as a sociologist, Ritzer never earned a degree in sociology; he was trained in psychology and business.
As Ritzer said in a later interview, "I basically trained myself as a social theorist, and so I had to learn it all as I went." Despite this challenge, Ritzer found that not being trained in social theory was actually advantageous for him, simply because his reasoning was not limited to a particular theoretical perspective. Listed are his biggest accomplishments in social theory: McDonaldization George Ritzer wrote The McDonaldization of Society. Ritzer's idea of McDonaldization is an extension of Max Weber's (1864–1920) classical theory of the rationalization of modern society and culture. Weber famously used the terminology "iron cage" to describe the stultifying, Kafkaesque effects of bureaucratized life, and Ritzer applied this idea to an influential social system in the twenty-first century: McDonald's.
Ritzer argues that McDonald's restaurants have become the better example of current forms of instrumental rationality and its ultimately irrational and harmful consequences on people Ritzer shared similar views as Max Weber about the topic of rationalization. While Weber claims that “the most sublime values have retreated from public life”, Ritzer claims that even our food is subject to rationalization, whether it is “the McDonaldized experience or the steak dinner that is subjected to the fact that it contains 2,000 calories and 100 grams of fat. "”Ritzer identifies four rationalizing dimensions of McDonald's that contribute to the process of McDonaldization, claiming that McDonald's aims to increase: Efficiency: McDonald's delivers products quickly and easily without inputting an excessive amount of money.
The "McDonald's model" and therefore the McDonald's operations follow a predesigned process that leads to a specified end, using productive means. The efficiency of the McDonald's model has infiltrated other modern day services such as completing tax forms online, easy weight loss programs, The Walt Disney Company FASTPASSes, and online dating services, eHarmony and match.com. Calculability: America has grown to connect the quantity of a product with the quality of a product and that "bigger is better". The "McDonald's model" is influential in this conception due to providing a lot of food for not that much money. While the end products feed into the connection between the quantity and quality of the product, so does the McDonald's production process.
Throughout the food production, everything is standardized and highly calculated: the size of the beef patty, the amount of french fries per order, and the time spent in a franchise. The high calculability of the McDonald's franchise also extends over into academics. It is thought that the academic experience, in high school and higher education, can be quantified into one number, the GPA. Also, calculability leads to the idea that the longer the resume or list of degrees, the better the candidate, during an application process. In addition to academics being affected by the McDonaldization in society, sports, specifically basketball have also been affected.
It used to be that basketball was a more laid-back, slow-paced sort of game, yet through the creation of fast-food and McDonald's, a shot clock was added to increase not only the speed of the game, but also the number of points scored. Predictability: Related to calculability, customers know what to expect from a given producer of goods or services. For example, customers know that every Big Mac from McDonald's is going to be the same as the next one; there is an understood predictability to the menu as well as the overall experience. In order to maintain the predictability for each franchise, there has to be "discipline, order, systematization, formalization, routine, consistency, and a methodical operation".
The predictability of the McDonald's franchise also appears through the golden arches in front of every franchise as well as the scripts that the employees use on the customers. The Walt Disney Company also has regulations in place, like dress code for men and women, in order to add to the predictability of each amusement park or Disney operation. Predictability has also extended into movie sequels and TV shows. With each movie sequel, like Spy Kids 4, or TV show, Law & Order and its spinoffs, the plot is predictable and usually follow a preconceived model. Control: McDonald's restaurants pioneered the idea of highly specialized tasks for all employees to ensure that all human workers are operating at exactly the same level.
This is a way to keep a complicated system running smoothly; rules and regulations that make efficiency, calculability, and predictability possible. Oftentimes, the use of non-human technology, such as computers, is used. The McDonald's food is already "pre-prepared", the potatoes are already cut and processed, just needing to be fried and heated, and the food preparation process is monitored and tracked. The computers tell the managers how many hamburgers are needed at the lunchtime rush and other peak times and the size and shape of the pickles as well as how many go on a hamburger is managed and control.
The control aspect of McDonaldization has extended to other businesses, Sylvan Learning and phone operating systems, and even birth and death. Every step of the learning process at Sylvan, the U-shaped tables and instruction manuals, is controlled as well as each step of the birthing process, in modern-day hospitals, and the process of dying. McDonaldization is profitable, desirable, and at the cutting edge of technological advances. Many "McDonald's" aspects of society are beneficial to the advancement and enhancement of human life. Some claim that rationalization leads to "more egalitarian" societies. For example, supermarkets and large grocery stores offer variety and availability unlike smaller farmer's markets from generations past.
The McDonaldization of society also allows operations to be more productive, improve the quality of some products, and produce services and products at lower cost. The Internet has provided countless new services to people that were previously impossible, such as checking bank statements without having to go to a bank or being able to purchase things online without leaving the house. These things are all positive effects of the rationalization and McDonaldization of society. However, McDonaldization also alienates people and creates a disenchantment of the world. The increased standardization of society dehumanizes people and institutions. The "assembly line" feel of fast-food restaurants is transcending many other facets of life and removing humanity from previously human experiences.
Through implementing machines and computers in society, humans can start to "behave like machines" and therefore "become replaced by machines". Consumption An early admirer of Jean Baudrillard’s Consumer Society (1970), Ritzer is a leading proponent of the study of consumption. In addition to The McDonaldization of Society, the most important sources for Ritzer’s sociology of consumption are his edited Explorations in the Sociology of Consumption: Fast Food Restaurants, Credit Cards and Casinos (2001), Enchanting a Disenchanted World: Revolutionizing the Means of Consumption (2nd edition 2005, 3rd edition 2009), and Expressing America: A Critique of the Global Credit-Card Society (1995). Ritzer is also a founding editor, with Don Slater, of Sage's Journal of Consumer Culture.
Prosumption First coined by Alvin Toffler in 1980, the term prosumption is used by Ritzer and Jurgenson, to break down the false dichotomy between production and consumption and describe the dual identity of economic activities. Ritzer argues that prosumption is the primordial form of economic activities, and the current ideal separation between production and consumption is aberrant and distorted due to the effect of both Industrial Revolution and post-WWII American consumption boom. It has only recently become popularly acknowledged that the existence of prosumption as activities on the internet and Web 2.0 resemble prosumption much more so than production or consumption individually.
Various online activities require the input of consumers such as Wikipedia entries, Facebook profiles, Twitter, Blog, Myspace, Amazon preferences, eBay auctions, Second Life, etc. Ritzer argues that we should view all economic activities on a continuum of prosumption with prosumption as production (p-a-p) and prosumption as consumption (p-a-c) on each pole. Something vs. nothing According to Ritzer, "Something" is a locally conceived and controlled social form that is comparatively rich in distinctive substantive content. It also describes things as being fairly unusual. "Nothing" is "a social form that is generally centrally conceived, controlled and comparatively devoid of distinctive substantive content" "Nothing" usually aims at the standardized and homogenous, while "something" refers to things that are personal or have local flavor.
Examples of "nothing" are McDonald's, Wal-Mart, Starbucks, credit cards, and the Internet. Examples of "something" are local sandwich shops, local hardware stores, family arts and crafts places, or a local breakfast cafe. Ritzer believes that things that embody the "nothing" component of this dichotomy are taking over and pushing "something" out of society. He explains the advantages and disadvantages of both "something" and "nothing" in The McDonaldization of Society. Globalization In Ritzer's research, globalization refers to the rapidly increasing worldwide integration and interdependence of societies and cultures. This book presents a sophisticated argument about the nature of globalization in terms of the consumption of goods and services.
He defines it as involving a worldwide diffusion of practices, relations, and forms of social organization and the growth of global consciousness. The concept of "something" vs. "nothing" plays a large part in understanding Ritzer's Globalization. Society is becoming bombarded with "nothing" and Ritzer seems to believe that the globalization of "nothing" is almost unstoppable Ritzer's aforementioned The Globalization of Nothing (2004/2007) stakes out a provocative perspective in the ongoing and voluminous globalization discourse. For Ritzer, globalization typically leads to consumption of vast quantities of serial social forms that have been centrally conceived and controlled – one McDonald's hamburger, i.e., one instance of nothing again and again- dominates social life (Ritzer, George.
2004. The Globalization of Nothing. Thousand Oaks, CA: Pine Forge Press). To better understand globalization, it can be broken down into a few characteristics: The beginning of global communication through different media like television and the Internet The formation of a "global consciousness" In addition to The Globalization of Nothing, Ritzer has edited The Blackwell Companion to Globalization (2007), written Globalization: A Basic Text (2009), and edited an Encyclopedia of Globalization (forthcoming). Insight into Ritzer's distinctive approach to globalization is available via a special review symposium in the Sage journal Thesis Eleven (Number 76, February 2004). Grobalization In his book The Globalization of Nothing (2004), Ritzer quotes that globalization consists of glocalization and grobalization.
Grobalization, a term coined by Ritzer himself, refers to "imperialistic ambitions of nations, corporations, organizations, and the like and their desire, indeed need, to impose themselves on various geographic areas". As opposite to glocalization, grobalization aims to "overwhelm local". Its ultimate goal is to see profit grow through unilateral homogenization, thus earning its name grobalization. Capitalism, Americanization, and McDonaldization are all parts of grobalization. Grobalization involves three motor forces: capitalism, McDonaldization, and Americanization. Grobalization creates a world where: Things are more homogenous and ubiquitous. Larger forces overwhelm the power of people to adapt and innovate in ways that preserve their autonomy.
Social processes are coercive, determining the nature of local communities, which have little room to maneuver. Consumer goods and the media are key forces that largely dictate the nature of the self and the groups a person joins. Ritzer provides American textbook as an example of grobalization. In his book, The Globalization of Nothing, he quotes that textbooks are "oriented to rationalizing, McDonaldizing, the communication of information." Students, rather than evaluating the competing ideas, instead absorb the information given to them. Yet, these textbooks are surprisingly sold out worldwide, only to be slightly revised to reflect local standards. Glocalization Glocalization is a combination of the words "globalization" and "localization" used to describe a product or service that is developed and distributed globally, but is also fashioned to accommodate the user or consumer in a local market, causing the products, or results of glocalization, to vary depending on different locations.
The local individuals are able to manipulate their own situation in the world and become creative agents in what products and services are represented in their local environment within the glocalized world. Ritzer further explains Glocalization as a relatively benign process that is closest to the "something" end of things. It creates variety and heterogeneity within society. Metatheory Metatheory can be defined as the attainment of a deeper understanding of theory, the creation of new theory, and the creation of an overarching theoretical perspective. There are three types of metatheorizing: Mu, Mp, and Mo. Through the application of the three subsets of metatheory, Ritzer argues that the field of sociology can create a stronger foundation, experience "rapid and dramatic growth", and generally increase not only the knowledge of metatheory but social theory in general.
The first category of metatheory (Mu), aims at being a means of attaining a deeper understanding of theory. Within the greater category of Mu, Ritzer establishes four other subsets: internal-intellectual, internal-social, external-intellectual, and external-social. The internal-intellectual sector of Mu identifies the "schools of thought" and the structure of current sociologists and social theories. The internal-social subtype identifies connections between sociologists and connections between sociologists and society. The last two subsets of Mu are looking more at the macrolevel of sociology than the other two subsets. The third subtype of Mu is the external-intellectual view of sociology; it looks at different studies and their concepts, tools, and ideas in order to apply these aspects to sociology.
The fourth, and final, subset is external-social where the impact of social theory in a larger societal setting is studied. The second (Mp), aims at being a prelude to theory development. New social theory is created due to the complex study and interpretation of other sociologists. For example, Karl Marx's theories are based on Hegel's theories. The theories of the American sociologist, Talcott Parsons, are based on the theories of Émile Durkheim, Max Weber, Vilfredo Pareto, and Thomas Humphrey Marshall. The last (Mo), aims at being a source of perspectives that overarch sociological theory. Influenced by Thomas Kuhn’s The Structure of Scientific Revolutions (1962), Ritzer has long advocated the view that social theory is improved by systematic, comparative and reflexive attention to implicit conceptual structures and oft-hidden assumptions.
Key works include Sociology: A Multiple Paradigm Science (1975), Toward an Integrated Sociological Paradigm (1981), Metatheorizing in Sociology (1991), and Explorations in Social Theory: From Metatheorizing to Rationalization (2001). See also Ritzer’s edited Metatheorizing (1992). Modern and postmodern social theory Ritzer is known to generations of students as the author of numerous comprehensive introductions and compendia in social theory. Postmodern society is a consumer society that invents new means of consumption, such as credit cards, shopping malls, and shopping networks. Today, "Capitalism needs us to keep on spending at ever-increasing levels to be and remain capitalism." As with several of Ritzer's other principal works, many are translated into languages as diverse as Chinese, Russian, Persian, Hebrew and Portuguese.
Key volumes in this genre include The Sociological Theory (7th edition 2008), Classical Sociological Theory (5th edition 2008), and Modern Sociological Theory (7th edition 2008), Encyclopedia of Social Theory (2 vols. 2005), and Postmodern Social Theory (1997). For convenient access to many of Ritzer's substantive contributions to modern and postmodern social theorizing, see Explorations in Social Theory: From Metatheorizing to Rationalization (2001) as well as more recent work often co-authored with his many students, such as (with J. Michael Ryan) "Postmodern Social Theory and Sociology: On Symbolic Exchange with a ‘Dead’ Theory," in Reconstructing Postmodernism: Critical Debates (2007). Works George Ritzer has published many monographs and textbooks.
He has edited three encyclopedias, including the Blackwell Encyclopedia of Sociology. He has written approximately one hundred scholarly articles in respected journals. Sociology: A Multiple Paradigm Science (1975, 1980) Based on his original article appearing in the American Sociologist, this book provides a foundation for Ritzer's other works on metatheory. The piece applies Thomas Kuhn's idea of scientific paradigms to sociology and demonstrating that sociology is a science consisting of multiple paradigms. Ritzer also discusses what implications this has for the field of sociology. Toward an Integrated Sociological Paradigm (1981) In this book, Ritzer contends that sociology needs an integrated paradigm in order to add to the extant paradigms noted in Sociology: A Multiple Paradigm Science.
Ritzer proposes an integrated paradigm dealing with the interrelationships between the many levels of social reality. The McDonaldization of Society (1993) In this provocative book, George Ritzer explores how Weber's classic thoughts on rationalization take on new vitality and meaning when applied to the process of McDonaldization. He describes this as the process by which the principles of the fast food restaurants are coming to dominate more and more sectors of society in the United States as well as the rest of the world. George Ritzer is most well known for The McDonaldization of Society, which has five different editions and has sold over 175,000 copies as of 2007.
Ritzer shows how Weber's central characteristics of rationalized systems - efficiency, predictability, calculability, substitution of non-human for human technology and control over uncertainty - have found widespread expression in a broad range of organized human activity, including travel, consumer products and services, education, leisure, politics and religion as well as in the fast food industry. The Blackwell Companion to Major Contemporary Social Theorists (2003) Guide to thirteen leading social theorists: Robert K. Merton, Erving Goffman, Richard M. Emerson, James Coleman, Harold Garfinkel, Daniel Bell, Norbert Elias, Michel Foucault, Jürgen Habermas, Anthony Giddens, Pierre Bourdieu, Jean Baudrillard, Judith Butler. During the Introduction of this book, Ritzer writes, “Although any list of theorists covered in a collection such as this one can be read as an official cannon, this book is intended to be used as ‘cannon fodder’ in an open, contestable process of theory construction and reconstruction."
The McDonaldization of Society: 20th Anniversary Edition (2012) Ritzer's McDonaldization of Society, now celebrating its 20th anniversary, continues to stand as one of the pillars of modern-day sociological thought. By linking theory to 21st-century culture, this book resonates with audiences in a way that few other books do, opening their eyes to many current issues, especially in consumption and globalization. As in previous editions, the book has been updated and it offers new discussions of, among others, In-N-Out Burger and Pret a Manger as possible antitheses of McDonaldization. The biggest change, however, is that the book has been streamlined to offer an even clearer articulation of the McDonaldization thesis.
The final chapter also looks at "The DeMcDonaldization of Society", and concludes that while it is occurring on the surface, McDonaldization is alive and well. The Globalization of Nothing, Second Edition (2007) The Globalization of Nothing, Second Edition emphasizes the processes of globalization and how they relate to McDonaldization. As before, this book is structured around four sets of concepts addressing the issues of: "places/non-places," "things/non-things," "people/non-people," and "services/non-services." By drawing upon salient examples from everyday life, Ritzer invites the reader to examine the nuances of these concepts in conjunction with the paradoxes within the process of the globalization of nothing.
Critical questions are raised throughout, and the reader is compelled not only to seek answers to these questions, but also to critically evaluate the questions as well as their answers. The current edition features a greater emphasis on the main topic of globalization: a new first chapter offers an introductory overview of globalization and globalization theory, outlining the unique ways in which these topics are addressed throughout the text. It also delves into two subprocesses of globalization — "glocalization" and "grobalization." Enchanting a Disenchanted World, Third Edition (2009) Enchanting a Disenchanted World, Third Edition examines Disney, malls, cruise lines, Las Vegas, the World Wide Web, McDonald's, Planet Hollywood, credit cards, and all the other ways we now consume.
The current edition was updated to reflect the recent economic recession and the impact of the internet. Ritzer continues to explore this book's central thesis: that our society has undergone fundamental change because of the way and the level at which we consume. The third edition demonstrates how we have created new "cathedrals" of consumption (places that enchant us so as to entice us to stay longer and consume more) while continuing to take capitalism to a new level. These places of consumption, whether in our homes, the mall, or cyberspace, are in a constant state of "enchanting the disenchanted," luring us through new spectacles because their rational qualities are both necessary and deadening at the same time.
The book also includes a wide range of theoretical perspectives — Marxian, Weberian, critical theory, postmodern theory — as well as a number of concepts such as hyperconsumption, implosion, simulation, and time and space to show the audience how sociological theory can be applied to everyday phenomena. Sociological Theory , Ninth Edition (2013) George Ritzer and Jeffery Stepnisky are co-authors this book. The book is split into four parts. Part One goes into specific details about the early years of sociological theory, focusing on Karl Marx, Emile Durkheim, Max Weber, and Georg Simmel. Part Two shifts into modern sociological theories, such as Structural Functionalism, Systems Theory, Conflict Theory, varieties of Neo-Marxism Theory, Symbolic Interactionism, Ethnomethodology, Exchange, Network, and Rational Choice Theories, Contemporary Feminist Theory.
Part Three covers Integrative Sociological Theory, specifically Micro-Macro and Agency-Structure Integration Part Four is focuses on contemporary Theories of Modernity, Globalization Theory, Structuralism, Poststructuralism, and Postmodern Social Theory, and Social Theory in the Twenty-First Century Leadership roles George Ritzer has held notable positions of leadership, including 2009-2010 – First Chair of the ASA Section-in-Formation on Global and Transnational Sociology 2000 - American Sociological Association Distinguished Scholarly Publication Award Committee 1989–1990 Chair of Section on Theoretical Sociology, ASA Present Positions: Editor, Blackwell Encyclopedia of Sociology; Editor, Journal of Consumer Culture; Associate Editor, Journal of Tourism and Cultural Change ● Editorial Board, Sociology Analysis; Consulting Editor: St. Martin Press/Worth, Series on Contemporary Social Issues; Sage of England, Series on Cultural Icons; McGraw-Hill.
Personal life Ritzer and his wife, Sue (married 1963), have two children and five grandchildren. Despite being a workaholic, he has always made time for his family. Ritzer also loves to travel, oftentimes using the work trips as a time for a mini vacation with his wife.
Bibliography Toward an Integrated Sociological Paradigm (1981) Metatheorizing in Sociology (1991) Metatheorizing (1992) Expressing America: A Critique of the Global Credit Card Society (1995) Explorations in Social Theory: From Metatheorizing to Rationalization (2001) Encyclopedia of Sociology (2007) The Blackwell Companion to Globalization (2007) Globalization: A Basic Text (2009) Encyclopedia of Globalization (2012) See also Retailtainment References External links George Ritzer at the University of Maryland Interviews McDonaldization of Society Myspace Page Publisher's Website for McDonaldization of Society Junk Journalism and the McDonaldization of Society George Ritzer Amazon Ailun Category:1940 births Category:Living people Category:American sociologists Category:University of Maryland, College Park faculty Category:University of Maryland College of Behavioral and Social Sciences people Category:Ross School of Business alumni Category:Jewish social scientists Category:Anti-consumerists Category:Writers about globalization Category:The Bronx High School of Science alumni
Intestine transplantation (intestinal transplantation, or small bowel transplantation) is the surgical replacement of the small intestine for chronic and acute cases of intestinal failure. While intestinal failure can oftentimes be treated with alternative therapies such as parenteral nutrition (PN), complications such as PN-associated liver disease and short bowel syndrome may make transplantation the only viable option. One of the rarest type of organ transplantation performed, intestine transplantation is becoming increasingly prevalent as a therapeutic option due to improvements in immunosuppressive regimens, surgical technique, PN, and the clinical management of pre and post-transplant patients. History Intestine transplantation dates back to 1959, when a team of surgeons at the University of Minnesota led by Richard C. Lillehei reported successful transplantation of the small intestine in dogs.
Five years later in 1964, Ralph Deterling in Boston attempted the first human intestinal transplant, albeit unsuccessfully. For the next two decades, attempts at transplanting the small intestine in humans were met with universal failure, and patients died of technical complications, sepsis, or graft rejection. However, the discovery of the immunosuppressant ciclosporin in 1972 triggered a revolution in the field of transplant medicine. Due to this discovery, in 1988, the first successful intestinal transplant was performed in Germany by E. Deltz, followed shortly by teams in France and Canada. Intestinal transplantation was no longer an experimental procedure, but rather a life-saving therapy.
In 1990, a newer immunosuppressant drug, tacrolimus, appeared on the market as a superior alternative to ciclosporin. In the two decades since, intestine transplant efforts have improved tremendously in both number and outcomes. Pre-transplant diagnoses and short bowel syndrome Failure of the small intestine would be life-threatening due to the inability to absorb nutrients, fluids, and electrolytes from food. Without these essential substances and the ability to maintain energy balances, homeostasis cannot be maintained and one's prognosis will be dismal. Causes of intestinal failure may be clinically complex, and may result from a combination of nutritional, infectious, traumatic, and metabolic complications that affect ordinary anatomy and physiology.
Many underlying conditions that serve as precursors to failure are genetic or congenital in nature. For example, severe inflammation, ulceration, bowel obstruction, fistulation, perforation, or other pathologies of Crohn's disease may severely compromise intestinal function. Despite the danger these conditions may pose in themselves, they may lead to even further, more serious complications that necessitate replacement of the diseased intestine. The single leading cause for an intestinal transplant is affliction with short bowel syndrome, oftentimes a secondary condition of some other form of intestinal disease. Short-bowel syndrome was the cause for 73% of American intestinal transplantations in 2008, followed by functional bowel problems for 15% and other causes representing 12% of cases.
Natural SBS is mercifully rare, estimated to be 3 per 100,000 births. Surgical removal is the most common cause, performed as a treatment for various gastroenterological and congenital conditions such as Crohn's disease, necrotizing enterocolitis, mesenteric ischemia, motility disorder, omphalocele/gastroschisis, tumors, and volvulus. Alternative treatments Regardless of the underlying condition, the loss of intestinal function does not necessarily necessitate a transplant. Several conditions, such as necrotizing enterocolitis or volvulus, may be adequately resolved by other surgical and nonsurgical treatments, especially if SBS never develops. An individual can obtain nutrients intravenously through PN, bypassing food consumption entirely and its subsequent digestion.
Long-term survival with SBS and without PN is possible with enteral nutrition, but this is inadequate for many patients as it depends on the remaining intestine's ability to adapt and increase its absorptive capacity. Although more complicated and expensive to perform, any person may receive PN. Although PN can meet all energy, fluid, and nutrient needs and can be performed at home, quality of life can be significantly decreased. On average, PN takes 10 to 16 hours to administer but can take up to 24. Over this time frame, daily life can be significantly hindered as a consequence of attachment to the IV pump.
Over long periods of time, PN can lead to numerous health conditions, including severe dehydration, catheter-related infections, and liver disease. PN-associated liver disease strikes up to 50% of patients within 5–7 years, correlated with a mortality rate of 2–50%. Another alternative treatment to transplant for patients with SBS is surgical bowel lengthening via either serial transverse enteroplasty (STEP) or the older longitudinal intestinal lengthening and tailoring (LILT) technique. Although both procedures contribute to an approximate 70% increase in length, STEP appears somewhat more favorable in terms of lower mortality and progression to transplant. Nevertheless, a positive reception to either procedure may reduce the level of PN required, if not negate its required use altogether.
Indications There are four Medicare and Medicaid-approved indications for intestine transplantation: a loss of two of the six major routes of venous access, multiple episodes of catheter-associated life-threatening sepsis, fluid and electrolyte abnormalities in the face of maximal medical therapy, and PN-associated liver disease. Transplants may also be performed if the growth and development of a pediatric patient fails to ensue, or in extreme circumstances for patients with an exceptionally low quality of life on PN. A multidisciplinary team consisting of transplant surgeons, gastroenterologists, dieticians, anesthesiologists, psychiatrists, financial representatives, and other specialists should be consulted to evaluate the treatment plan and ensure transplantation is the patient's best option.
Psychological preparations should be made for the transplant team and patient as well. Early referral requires trust between all parties involved in the operation to ensure that a rush to judgment does not lead to a premature transplant. Other absolute contraindications to receiving an intestinal transplant include the presence of systemic and untreated local infections, malignant cancer, severe neurological impairment, and severe cardiac and/or pulmonary disease. These criteria are similar to established guidelines for transplants of other organ types. HIV infection is a relative contraindication for intestine transplantation; desperate terminal patients may accept a transplant from a HIV-positive donor if they are willing to expose themselves to HIV.
Transplant types There are three major types of intestine transplants: an isolated intestinal graft, a combined intestinal-liver graft, and a multivisceral graft in which other abdominal organs may be transplanted as well. In the most basic and common graft, an isolated intestinal graft, only sections of the jejunum and ileum are transplanted. These are performed in the absence of liver failure. In the event of severe liver dysfunction due to PN, enzyme deficiencies, or other underlying factors, the liver may be transplanted along with the intestine. In a multivisceral graft, the stomach, duodenum, pancreas, and/or colon may be included in the graft.
Multivisceral grafts are considered when the underlying condition significantly compromises other sections of the digestive system, such as intra-abdominal tumors that have not yet metastasized, extensive venous thrombosis or arterial ischemia of the mesentery, and motility syndromes. Pre-operative period Donated intestines, like all organs, should be matched to a recipient prior to recovery, as to prepare him or her and minimize the time the organ spends outside the body. Potential recipients are placed on the International Intestinal Transplant Registry (ITR), where they contribute to the world's growing understanding of intestine transplantation. Before a transplant may be performed, an organ must first be located.
In the United States, the matching of all organs is coordinated by the United Network for Organ Sharing (UNOS). The standard intestinal donor is deceased with a diagnosis of brain death. In terms of transplant outcomes, brain-dead donors are highly preferable to donors who have suffered cardiopulmonary death. If respiration can be assisted by a ventilator, brain-dead donors may exhibit maintainable cardiac, endocrine, and excretory function. If appropriately managed, the continuation of blood flow and bodily metabolism allows for healthier organs for procurement and additional time to prepare recipients for transplant. Furthermore, terminal ileum recovery from living donors is possible., and a laparoscopic technique is being developed to harvest limited sections of small bowel from living donors.
When determining potential donor-recipient matches, important characteristics include donor size, age, tissue quality, and ABO and histo-compatibility. If the intestine is too large, it may be not transplantable into young or small patients. Ideally, intestines should be selected from donors of lighter weight than the proposed recipients to ensure simple closure of the abdominal wound. If a patient is too young or too old, they may not be hardy enough to survive the operation and recovery period. If the donor and recipient organs do not meet compatibility requirements, the threat of organ rejection by the body is all but certain.
Organ rejection is the unfortunate circumstance of the host immune system recognizing the transplanted organ as foreign. This is the most notable complication facing transplant recipients. Through T-cell receptors, T-lymphocytes are able to distinguish between self and non-self by recognizing human leukocyte antigens (HLA) bound to the major histocompatibility complex (MHC) protein located on the surface of organ cells. Once identified as foreign, the immune system proceeds to destroy the transplanted tissue. The panel reactive antibody (PRA) test measures the proportion of the population to which a recipient will react via pre-existing antibodies to various HLA antigens; in other words, how likely a patient is to acutely reject their new transplant.
Therefore, it is essential that HLA and PRA statuses are tested for and demonstrate low immunoreactivity of the patient to the graft. In some cases, a recipient may suffer from graft-versus-host disease, in which cells of the transplanted organ attack the recipient's cells. To ensure proper histocompatibility, tissue quality, and safety from infection, blood work should be collected and tested in the laboratory. In addition to HLA and PRA typing, the complete blood count (CBC), coagulation profile, complete metabolic panel, and ABO blood group determination tests should be performed for both the donor and recipient. ABO-incompatible grafts can sometimes be performed on very young pediatric patients, as their immune systems have not fully developed and for whom waiting list mortality remains high.
Additionally, blood serum should be tested for the presence of viruses, including HIV, hepatitis B and C, cytomegalovirus (CMV), and Epstein-Barr virus (EBV) antibodies to prevent infection. Particularly in the immunocompromised system necessitated by the transplant, these viruses can wreak havoc on the body and become extremely dangerous, even fatal. Even with healthy physiological levels, ABO and HLA compatibilities, and no signs of bacterial, viral, and fungal infections, organ transplantation is not without extrasurgical risk. Waitlist and donation outcomes A major challenge facing the intestinal transplant enterprise is meeting the need for transplantable intestines, particularly in the United States where the majority of intestinal transplants take place.
There exists a narrow timeslot between procurement and transplantation that any organ remains viable, and logistical challenges are faced regarding bringing organ and recipient together. During procurement, organs that are being recovered are cooled and perfused with preservation solution. This slows organ activity and increases the time they remain viable for transplant. Although chilling and perfusion may extend intestinal lifespans by several hours, failure is still imminent unless transplanted. This duration between the cooling of the organ during procurement and the restoration of physiological temperature during implantation is the cold ischemic time. Due to the sensitivity of the intestine to ischemic injury, many potential donor intestines are lost to the events following brain death and trauma.
Furthermore, irreversible intestinal damage is seen after approximately only 5 hours of cold ischemia in the form of mucosal damage and bacterial translocation outside the gastrointestinal tract. Therefore, ensuring cardiac survival and nearby donor-recipient proximity before procurement are essential so organs do not wait too long outside the body and without blood flow. Not only is there a lack of transplantable intestines, but a deficiency in the number of centers possessing the capability to carry out the complicated transplant procedure as well. , there were only 61 medical centers in the world capable of executing an intestinal transplant. Furthermore, many young, small children, particularly those weighing less than 5 kg, cannot find a transplant due to the lack of size-matched donors.
Despite these challenges, obtaining an intestine for transplant is rather probable in the United States. In 2008, there were 212 people on the U.S. intestinal transplant waitlist, 94% of whom were U.S. citizens. Regardless of transplant type, over half of new registrants are 5 years of age or younger. Adults compromise the next largest cohort, followed by pediatric patients aged 6 and older. In 2008, the ethnic composition of the intestinal transplant waitlist was 65% White, 18% Black, 16% Hispanic, 1% Asian, and 0.5% other or mixed race, resembling the demographics of the American general population at the time aside from a below-average Asian cohort.
ABO blood types also matched the general population, with 31% A, 14% B, 5% AB, and 50% O. In 2004, the average waiting period to receive a transplant was 220 days, with a median of 142 days in 2008. The rate of waitlist additions has shifted from year to year; gains increased until 2006 (with 317 added), but then decreased in 2012 (to 124 added). In 2007, only 9% of patients on the U.S. waitlist died while waiting for a transplant. Waitlist mortality peaked around 2002 and was highest for liver-intestine (pediatric) patients. Deaths among all pediatric groups awaiting intestine-liver transplants have decreased in the years leading up to 2014 whereas adult intestine-liver deaths have dropped less dramatically.
The decrease in recent years is likely due to improved care of infants with intestinal failure and subsequently a decrease in referrals for transplant. Although many improvements have been made in the States, outcomes everywhere still demonstrate much room for improvement. Worldwide, 25% of pediatric patients on the waitlist for an intestinal transplant die before they can receive one. Procurement protocol Following matching of the organ, the complicated procurement of the small bowel can be performed by a team of abdominal transplant surgeons. Once a donor has been selected and approved for donation, several pretreatments may be initiated to destroy microorganisms and immune cells.
The donor intestine must be decontaminated with several antibiotics, including neomycin, erythromycin, amphotericin B, and cephalosporin. They may also be treated with anti-lymphocyte antibodies (anti-thymocyte globulin, alemtuzumab), irradiation directed against excessive mesenteric lymphatic tissue, and have their bowel irrigated. Once donor preparation is accomplished, procurement can begin by utilizing the same standard techniques for all abdominal organ procurements. The team exposes the abdominal cavity and inserts two cannulae for the infusion of University of Wisconsin organ preservation solution into the aorta and inferior mesenteric vein. As the abdominal organs are cooled in situ, the surrounding tissue is dissected so that they may be quickly extracted.
In the next step, the aorta is cross-clamped, cutting off blood supply to the organs. Once blood and oxygen supply to an organ is cut off, organ death will approach swiftly unless steps are taken to preserve them until transplant. Organs are therefore fully drained of blood, flushed with cool preservation solution, and removed from the body. In an isolated intestinal transplant, the colon will be detached from the small intestine. The cecum and ascending colon are devascularized, while care is taken to preserve major vasculature in the ileum. The jejunum will be separated from the duodenum while preserving the vasculature of the jejunum, ileum, mesentery, and the pancreas.
If healthy, the pancreas can oftentimes be retrieved as an additional isolated procurement. The intestinal allograft, when ready to be extracted, is attached by the mesenteric pedicle, where the vessels converge out of the intestinal system. This pedicle will be stapled closed, and can be separated from the body via a transverse cut to create a vascular cuff. The complete intestinal allograft can then be removed and wrapped in a surgical towel. The protocols for combined liver and multivisceral procurements are far more complicated and meticulous than isolated intestine alone. Transplantation protocol First, any abdominal scar tissue from previous surgeries must be removed.
The aorta and vena cava are dissected in preparation for vascular anastomosis, followed by dissection of the proximal and distal ends of the digestive tract. Anastomosis is then performed to revascularize the graft. Arterial vessels are connected to the abdominal aorta, below the kidneys. However, venous drainage, or the reattachment of the transplanted organ to the venous system, may be performed differently depending on the unique intra-abdominal vasculature of the recipient. The graft is usually drained systemically into the infrarenal vena cava, but may also be drained portally into the hepatic portal or superior mesenteric vein. The graft is then reperfused with blood and any bleeding is stopped before the proximal and distal ends of the transplant bowel are connected to the original digestive tract.
A loop ileostomy is then created as to provide easy access for future endoscopic observation and biopsies. A gastronomy or jejunostomy feeding tube may be placed before the abdominal wall is closed. When a liver is being transplanted in conjunction with the intestine, the recipient must first have their own liver removed. Following this, the aorta, cava, and portal veins of the donor and recipient are anastomosed. The graft is then flushed before the caval clamps are removed. The intestine is then reconstructed as in an isolated intestinal transplant, before being connected to the bile duct servicing the new liver.
Multivisceral transplants are especially difficult and susceptible to complications because all organs must survive a conjoined procurement, transport, and transplantation. All three of these measures are tailored to the individual needs of the recipient. Preservation of the native spleen, pancreas, and duodenum during a multivisceral transplant can reduce the risk of additional complications related to these structures. Post-operative period Following the procedure, the patient is actively monitored in an intensive care unit (ICU). Broad-spectrum antibiotics are administered, bleeding monitored, and serum pH and lactate levels measured for evidence of intestinal ischemia. The patient's immune system is strongly modulated immediately post-operation.
The initial phase of treatment consists of the administration of tacrolimus with corticosteroids to suppress T-lymphocyte activation. Next, various assortments of interleukin-2 (IL-2) receptor antagonists (daclizumab, basiliximab), anti-proliferation agents (azathioprine, mycophenolate mofetil), and the drugs cyclophosphamide and sirolimus are administered on an individual patient basis to further suppress the immune system. The bioavailability of these drugs is dependent on intestinal surface area and transit time, and therefore the length of the allograft determines the immunosuppression regimen. Intravenous administration of prostaglandin E1 is occasionally performed for the first 5 to 10 days following transplant to improve intestinal circulation and a potential dispensing of immunosuppressive effects.
The gut is selectively decontaminated against high-risk flora and preventative care is taken against CMV and fungal infections. It is ideal to commence enteral nutrition as early as possible following transplantation. Therefore, a feeding tube connecting to the stomach or jejunum is quickly placed to facilitate rehabilitation. If gastrointestinal function is restored, a diet can be reestablished and cautiously advanced as tolerated. Most patients are weaned from PN within 4 weeks of transplantation, and nearly all are free from additional enteral supplementation by one year. Evidence for the restoration of function includes decreasing gastrostomy tube returns and increasing gas and enteric contents in the ileostomy.
Routine surveillance endoscopy and biopsies via the ileostomy should be performed with decreasing frequency over several months to observe signs of rejection, ideally before clinical symptoms present themselves. Should the patient continue to perform well through the first post-transplant year, the ileostomy would generally be closed. Should rejection be suspected in the future, endoscopies would be performed and an appropriate antirejection therapy will be tailored. The median time for hospital discharge varies between procedures. The median times for isolated intestine, intestine-liver, and multivisceral transplants are 30, 60, and 40 days post-operation respectively. Within the first several months, carbohydrate and amino acid absorptive capacity should normalize, followed by the absorptive capacity for fats.
Once enteral nutrition is capable of providing all nutritional needs, PN can be discontinued. Nearly all patients with a successful transplant are free of PN within one year. Biological complications Intestinal transplantation is the least performed type of transplant due to a number of unique obstacles. The most major of these is the profound immunosuppression required due to the ability of the intestine to elicit strong immune responses. Because of exposure to a wide range of gut flora and material consumed by the body, the intestinal epithelium possesses a highly developed innate immune system and antigen-presenting abilities. Immunosuppression is the primary determinant of outcome in small bowel transplantation; the risk for graft rejection is increased by under-immunosuppression and for local and systemic infection with over-immunosuppression.
Ensuring an appropriate dose of immunosuppressant can therefore be difficult, especially as both ciclosporin (14–36%) and tacrolimus (8.5–22%) have generally low bioavailabilities. A major problem due to immunosuppression in intestinal transplant patients is post-transplant lymphoproliferative disorder, in which B-lymphocytes excessively proliferate due to infection by EBV and result in infectious mononucleosis-like lesions. Intestinal transplant recipients are also at risk for chronic renal failure because calcineurin inhibitors are toxic to the kidneys. A transplant recipient must remain on immunosuppressants for the rest of his or her life. Intestinal transplants are highly susceptible to infection even more so than the standard immunocompromised recipient of other organs due to the great composition and variety of the gut flora.