GCSE · Biology · AQA GCSE Biology Notes: Homeostasis and Response (Topic 5)
AQA GCSE Biology Notes: Homeostasis and Response (Topic 5)
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Full text of AQA GCSE Biology Notes: Homeostasis and Response (Topic 5)
These notes cover Topic 5, Homeostasis and Response, for AQA GCSE Biology (8461) and the Biology content of AQA Combined Science: Trilogy (8464). They cover control systems and homeostasis, the nervous system and reflex arc with the required practical on reaction time, the brain and eye, thermoregulation, the endocrine system and blood glucose control, the kidneys and water/nitrogen balance, hormones in reproduction, contraception, hormones used in infertility treatment, negative feedback in adrenaline and thyroxine, and plant hormones. Sections marked "Biology only" are not required for Combined Science: Trilogy, though the underlying idea of homeostasis and negative feedback is common to both courses.
1. Homeostasis: why the body needs control systems
Definition: Homeostasis is the regulation of the internal conditions of a cell or organism to maintain optimum conditions for function, in response to internal and external changes.
Cells only work efficiently within a narrow range of conditions, so the body regulates body temperature, blood glucose, water/ion levels and blood carbon dioxide. Control may be nervous or hormonal. Every control system has:
- Receptors – detect a stimulus (a change in the environment).
- Coordination centres – e.g. the brain, spinal cord and pancreas; process information and organise a response.
- Effectors – muscles (contract) or glands (secrete hormones) that carry out the response.
Most systems use negative feedback: a rise above normal triggers a response that lowers the level; a fall below normal triggers a response that raises it, keeping levels close to a set point.
AQA's three named examples of homeostatic control are core body temperature (around 37°C), blood glucose concentration, and the water and ion content of the blood (each covered in detail below). Breathing rate and depth also increase to help control blood carbon dioxide levels, but this response is covered under gas exchange and the response to exercise rather than examined as part of this homeostasis topic. Some responses involve only the nervous system, some involve only hormones, and some (such as blood glucose control during exercise) involve both working together.
2. The human nervous system
The nervous system lets the body detect and react to changes. Receptors convert stimuli into electrical impulses, carried by neurones to the central nervous system (CNS: brain and spinal cord), which coordinates a response sent to effectors.
| Sense organ | Stimulus detected |
|---|---|
| Eyes | Light |
| Ears | Sound; also balance and head position |
| Nose | Chemicals (smell) |
| Tongue | Chemicals (taste) |
| Skin | Touch, pressure, temperature, pain |
Pathway: stimulus → receptor → coordinator (CNS) → effector → response. Neurones meet at synapses; the impulse cannot cross directly, so a neurotransmitter diffuses across the gap and triggers a new impulse in the next neurone.
| Feature | Nervous system | Hormonal system |
|---|---|---|
| Signal | Electrical impulse | Chemical, in the blood |
| Speed | Very fast | Slower |
| Duration | Short-lived | Longer-lasting |
| Area affected | Precise, localised | Often widespread |
3. Reflex actions and the reflex arc
Definition: A reflex action is a rapid, automatic response to a stimulus that does not involve conscious thought, helping to protect the body.
Reflexes are fast because the pathway is short and bypasses conscious brain processing:
stimulus → receptor → sensory neurone → relay neurone (spinal cord) → motor neurone → effector → response
- Sensory neurone – receptor to CNS.
- Relay neurone – within the CNS; links sensory to motor neurone.
- Motor neurone – CNS to effector.
Example: touching a hot object. Skin receptors detect heat/pain; a sensory neurone carries the impulse to the spinal cord; a relay neurone passes it to a motor neurone; the motor neurone makes an arm muscle (effector) contract, pulling the hand away before the brain registers pain.
4. Required practical: investigating human reaction time
Method (ruler-drop test):
- Hold a ruler vertically; the subject's thumb and forefinger start level with the zero mark, not touching it.
- Release the ruler without warning.
- The subject catches it as quickly as possible.
- Read the distance fallen (or read time directly from a reaction-timer ruler).
- Repeat several times for the same person, discard anomalies, and calculate a mean.
- Repeat with the independent variable changed (e.g. with/without a distraction).
Variables: independent – the factor tested (e.g. distraction present/absent); dependent – reaction time (distance or time); control – same person, ruler, starting position and conditions each repeat.
Worked example: distance to time. A free-falling object obeys s = 0.5 × g × t2, so t = √(2 × s ÷ g), with g ≈ 9.8 m/s2.
Ruler falls s = 0.18 m. t = √(2 × 0.18 ÷ 9.8) = √0.0367 ≈ 0.19 s. A shorter distance means a faster reaction.
5. The brain (Biology only)
Not required for Combined Science: Trilogy.
| Region | Main function |
|---|---|
| Cerebral cortex | Conscious thought, memory, language, intelligence |
| Cerebellum | Coordination of movement and balance |
| Medulla oblongata | Unconscious activities: heart rate, breathing rate |
Studying and treating the brain is difficult: the skull is hard to access without risking infection/damage, the brain is not fully understood, and many drugs cannot cross the blood-brain barrier. Methods used: MRI scanning; studying patients with brain damage. (Other techniques, such as electrically stimulating regions of the brain during surgery, also help map brain function, but only MRI scanning and studying brain-damaged patients are required by the specification.)
6. The eye (Biology only)
Not required for Combined Science: Trilogy.
| Structure | Function |
|---|---|
| Cornea | Transparent; refracts light entering the eye |
| Iris | Controls pupil diameter, so light entering |
| Pupil | Hole through which light passes |
| Lens | Fine-focuses light onto the retina by changing shape |
| Ciliary muscles / suspensory ligaments | Change lens shape during accommodation |
| Retina | Contains light receptors (rods and cones) |
| Optic nerve | Carries impulses from retina to brain |
| Sclera | Tough outer layer; protects the eyeball |
Definition: accommodation is the change in shape of the lens to focus on near or distant objects.
Near object: ciliary muscles contract → suspensory ligaments loosen → lens becomes fatter/more curved → refracts light more strongly.
Distant object: ciliary muscles relax → suspensory ligaments pulled taut → lens becomes thinner → refracts light less strongly.
| Defect | Cause | Effect | Correction |
|---|---|---|---|
| Myopia (short-sightedness) | Eyeball too long, or lens too curved | Image of distant objects focuses in front of the retina; blurred | Concave (diverging) spectacle or contact lens; or laser/lens-replacement surgery |
| Hyperopia (long-sightedness) | Eyeball too short, or lens under-refracts | Image of near objects focuses behind the retina; blurred | Convex (converging) spectacle or contact lens; or laser/lens-replacement surgery |
7. Control of body temperature (thermoregulation)
Definition: Thermoregulation is the maintenance of a constant core body temperature around the optimum for enzyme action.
Core temperature is maintained at about 37°C, controlled by the thermoregulatory centre in the brain, which senses blood temperature and receives input from skin temperature receptors.
| Situation | Blood vessels | Sweat glands | Effect |
|---|---|---|---|
| Too hot | Vasodilation: skin capillaries widen, more blood near the surface | More sweat produced; evaporation transfers heat away | More heat lost by radiation and evaporation; temperature falls |
| Too cold | Vasoconstriction: skin capillaries narrow, less blood near the surface | Little/no sweat; hair-erector muscles raise hairs to trap insulating air | Less heat lost; shivering increases respiration, releasing heat; temperature rises |
8. The endocrine system
Definition: The endocrine system is a collection of glands that secrete hormones directly into the blood; hormones are chemical messengers carried in the blood plasma to target organs.
| Gland | Hormone(s) | Main effect |
|---|---|---|
| Pituitary gland (base of brain) | FSH, LH, ADH, TSH, others | "Master gland": acts directly and stimulates other glands |
| Thyroid gland | Thyroxine | Regulates metabolic rate; role in growth/development |
| Adrenal glands | Adrenaline | Prepares body for "fight or flight" |
| Pancreas | Insulin, glucagon | Regulate blood glucose concentration |
| Ovaries | Oestrogen, progesterone | Menstrual cycle; female secondary characteristics |
| Testes | Testosterone | Sperm production; male secondary characteristics |
9. Control of blood glucose concentration
The pancreas monitors blood glucose. After a carbohydrate meal, glucose is absorbed into the blood and blood glucose concentration rises.
Too high → pancreas secretes insulin → glucose moves from blood into cells (liver, muscle); liver converts glucose to glycogen for storage → blood glucose falls.
Too low → pancreas secretes glucagon → liver converts glycogen to glucose, released into the blood → blood glucose rises.
Insulin and glucagon have opposite effects, together forming a negative feedback loop that keeps blood glucose within a narrow range. People with diabetes often monitor their own blood glucose concentration using a finger-prick blood test or a continuous glucose monitor, so that treatment can be adjusted.
| Feature | Type 1 diabetes | Type 2 diabetes |
|---|---|---|
| Cause | Pancreas produces little or no insulin | Cells no longer respond properly to insulin (resistance); often insufficient insulin too |
| Onset | Usually childhood | Usually later life; linked to obesity |
| Treatment | Insulin injections; carbohydrate-controlled diet; monitoring | Controlled diet; exercise; sometimes medication |
Worked example: BMI. BMI = mass (kg) ÷ [height (m)]2. Mass 88 kg, height 1.60 m.
Height2 = 1.60 × 1.60 = 2.56 m2. BMI = 88 ÷ 2.56 = 34.4 (3 s.f.). Healthy range ≈ 18.5 ≤ BMI ≤ 24.9, so BMI 34.4 is obese (≥30), raising Type 2 diabetes risk.
BMI is not the only measure used to assess obesity-related risk: waist:hip ratio (waist circumference ÷ hip circumference) is also used, with a higher ratio indicating greater risk. BMI can be misleading for very muscular individuals, since muscle is denser than fat and adds mass without adding fat-related risk.
10. The kidneys: water and nitrogen balance (Biology only)
Not required for Combined Science: Trilogy.
The kidneys remove urea from the blood and regulate ion and water levels (osmoregulation). Excess amino acids are broken down in the liver (deamination); the amino group forms toxic ammonia, immediately converted to less toxic urea for excretion.
- Filtration: blood enters at high pressure; small molecules (glucose, water, ions, urea) are filtered into the kidney tubules. Large molecules (proteins, blood cells) stay in the blood.
- Selective reabsorption: all the glucose, and the ions/water the body needs, are reabsorbed into the blood. Urea and the rest leave as urine, stored in the bladder.
Water is lost via urine, sweat and exhaled air, and gained from food, drink and respiration.
ADH. Dehydrated (blood too concentrated) → more ADH released from pituitary → tubules more permeable → more water reabsorbed → small volume, concentrated urine.
Overhydrated (blood too dilute) → less ADH → tubules less permeable → less water reabsorbed → large volume, dilute urine.
| Treatment | How it works | Key points |
|---|---|---|
| Dialysis | Blood passes a partially permeable membrane against dialysis fluid with normal glucose/ion levels but no urea; urea diffuses out down its gradient | Repeated several hours, several times a week; manages but does not cure failure |
| Kidney transplant | A matched donor kidney is implanted and takes over function | Needs close tissue matching; lifelong immunosuppressants; removes need for dialysis |
11. Hormones in human reproduction
At puberty the pituitary triggers release of sex hormones (oestrogen in females, testosterone in males), producing secondary sexual characteristics. The menstrual cycle (~28 days) is controlled by four hormones.
| Hormone | Source | Main effect |
|---|---|---|
| FSH | Pituitary | Matures an egg in the ovary; stimulates oestrogen release |
| Oestrogen | Ovaries | Thickens uterus lining; triggers LH surge; inhibits FSH |
| LH | Pituitary | Surge triggers ovulation (~day 14) |
| Progesterone | Ovary | Maintains uterus lining; inhibits FSH and LH; falling level causes menstruation |
12. Contraception
Contraception is the deliberate prevention of pregnancy, using hormonal methods, barrier methods, or surgery.
| Method | Type | How it works |
|---|---|---|
| Combined pill | Hormonal | Inhibits FSH, so no eggs mature |
| Progesterone-only pill | Hormonal | Thickens cervical mucus, blocking sperm |
| Injection/implant/patch | Hormonal | Slow-release progesterone (or oestrogen+progesterone); weeks to years |
| Intrauterine device (IUD) | Hormonal or non-hormonal | Releases progesterone, or (copper) prevents sperm survival/implantation |
| Condom | Barrier | Physical barrier; also reduces STI spread |
| Diaphragm/cap + spermicide | Barrier | Covers cervix; spermicide kills/disables sperm |
| Natural (rhythm) method | Non-hormonal | Avoids intercourse around estimated ovulation |
| Sterilisation | Surgical | Vasectomy or tubal occlusion; usually permanent |
13. Using hormones to treat infertility: IVF (Biology only)
Not required for Combined Science: Trilogy.
Women with low FSH may not mature eggs naturally; FSH and LH given as fertility drugs stimulate egg maturation and release, and are also the basis of IVF.
- Mother given FSH and LH to mature several eggs at once.
- Eggs collected from the ovaries.
- Fertilised with sperm in a laboratory dish.
- Fertilised eggs develop into embryos.
- One or two embryos inserted into the uterus.
Benefits: allows couples who could not otherwise conceive to have a genetically related baby. Risks/issues: success rate not high and falls with age; physically/emotionally stressful; multiple embryos raise the chance of multiple pregnancy and associated health risks; ethical concerns over unused embryos; cost.
14. Negative feedback control of adrenaline and thyroxine (Biology only)
Not required for Combined Science: Trilogy.
Thyroxine (thyroid gland) controls basal metabolic rate and growth/development; controlled by negative feedback:
Thyroxine too low → pituitary releases more TSH → thyroid releases more thyroxine → level rises, reducing further TSH release.
Thyroxine too high → pituitary releases less TSH → thyroid releases less thyroxine → level falls.
Adrenaline (adrenal glands) is released in stressful/frightening situations, triggered by nerve impulses from the brain rather than by its own blood level. It increases heart rate, increases blood flow (oxygen/glucose) to brain and muscles, and raises blood glucose by stimulating glycogen breakdown in the liver — a fast "fight or flight" response, rather than a classic level-controlled feedback loop like thyroxine. For example, a sudden fright increases heart rate within seconds, well before any change in blood hormone concentration could be detected and fed back on, which is why this response is better described as a rapid nervous-hormonal reflex than a negative feedback loop.
15. Plant hormones (Biology only)
Not required for Combined Science: Trilogy.
Definition: A tropism is the growth of a plant in response to a directional stimulus, such as light (phototropism) or gravity (gravitropism).
Auxin, made in shoot and root tips, controls cell elongation. In shoots, more auxin increases elongation; in roots, more auxin inhibits elongation — the opposite effect.
| Response | Shoots | Roots |
|---|---|---|
| Phototropism | Positive: grow towards light. In one-sided light, auxin builds up on the shaded side, which elongates more, bending the shoot towards light | Little/no response in most GCSE examples |
| Gravitropism | Negative: grow upward, away from gravity. Auxin builds up on the lower side of a horizontal shoot, increasing elongation there, bending it upward | Positive: grow downward, with gravity. Auxin builds up on the lower side of a horizontal root, but inhibits elongation there, so the root bends downward |
Gibberellins end seed dormancy and trigger germination; also involved in stem elongation and flowering.
Commercial uses:
- Auxins as selective weedkillers: disrupt growth of broad-leaved weeds without harming narrow-leaved crops/grasses.
- Auxins as rooting powder, to make cuttings grow roots for propagation.
- Auxins in tissue culture (micropropagation), to grow new plantlets from tissue samples.
- Gibberellins to end seed dormancy for reliable, simultaneous germination.
- Gibberellins to promote flowering and increase fruit size (including seedless fruit).
- Ethene, another plant hormone, is used to control fruit ripening: fruit is picked unripe for transport, then ripened using ethene before sale.
Key terms
| Term | Definition |
|---|---|
| Homeostasis | Regulation of internal conditions of a cell/organism to maintain optimum conditions for function, in response to internal/external changes |
| Receptor | Cell/organ that detects a stimulus |
| Coordination centre | Part of the body (e.g. brain, spinal cord, pancreas) that processes information and organises a response |
| Effector | Muscle or gland that brings about a response |
| Negative feedback | Mechanism where a change away from normal triggers a response that returns the level to normal |
| Stimulus | A detectable change in the internal or external environment |
| Central nervous system (CNS) | Brain and spinal cord; coordinates responses |
| Neurone | Nerve cell that carries electrical impulses |
| Sensory neurone | Carries impulses from a receptor to the CNS |
| Relay neurone | Neurone within the CNS linking sensory to motor neurones |
| Motor neurone | Carries impulses from the CNS to an effector |
| Synapse | Junction between neurones; crossed by diffusion of a neurotransmitter |
| Reflex action | Rapid, automatic response to a stimulus not involving conscious thought |
| Reflex arc | Pathway of a reflex: receptor, sensory neurone, relay neurone, motor neurone, effector |
| Cerebral cortex | Brain region for conscious thought, memory, language, intelligence |
| Cerebellum | Brain region controlling coordination and balance |
| Medulla oblongata | Brain region controlling unconscious activities (heart rate, breathing) |
| MRI scanning | Imaging technique showing brain structure/activity without surgery |
| Cornea | Transparent front of the eye; refracts light entering |
| Iris | Controls pupil diameter and light entry |
| Pupil | Opening through which light enters the eye |
| Lens | Flexible structure that focuses light onto the retina |
| Retina | Light-sensitive layer containing rods and cones |
| Optic nerve | Carries impulses from the retina to the brain |
| Accommodation | Change in lens shape to focus on near or distant objects |
| Ciliary muscles | Contract/relax to alter suspensory ligament tension and lens shape |
| Suspensory ligaments | Hold the lens and adjust its shape with the ciliary muscles |
| Myopia | Short-sightedness; distant objects blurred; corrected with a concave lens |
| Hyperopia | Long-sightedness; near objects blurred; corrected with a convex lens |
| Thermoregulation | Maintenance of a constant core body temperature |
| Thermoregulatory centre | Brain region monitoring and controlling body temperature |
| Vasodilation | Widening of skin blood vessels, increasing heat loss |
| Vasoconstriction | Narrowing of skin blood vessels, reducing heat loss |
| Shivering | Involuntary muscle contraction increasing respiration to release heat |
| Endocrine system | Glands that secrete hormones directly into the blood |
| Hormone | Chemical messenger carried in the blood to a target organ |
| Pituitary gland | "Master gland" at the base of the brain; secretes hormones directly and stimulates other glands |
| Thyroid gland | Secretes thyroxine; regulates metabolic rate |
| Thyroxine | Hormone regulating metabolic rate and growth/development; controlled by negative feedback via TSH |
| TSH | Pituitary hormone that stimulates thyroxine release from the thyroid |
| Adrenal gland | Secretes adrenaline in response to stress/fear |
| Adrenaline | Hormone preparing the body for "fight or flight" |
| Pancreas | Monitors and controls blood glucose via insulin and glucagon |
| Insulin | Lowers blood glucose by promoting uptake into cells and glycogen storage |
| Glucagon | Raises blood glucose by converting glycogen to glucose in the liver |
| Glycogen | Storage carbohydrate made from excess glucose |
| Type 1 diabetes | Little/no insulin produced; treated with insulin injections |
| Type 2 diabetes | Cells stop responding properly to insulin; linked to obesity; treated by diet/exercise/medication |
| Body Mass Index (BMI) | Mass (kg) ÷ [height (m)]2; used to assess obesity-related risk |
| Kidney | Organ filtering blood, removing urea, regulating water/ion balance |
| Deamination | Breakdown of excess amino acids in the liver, producing ammonia then urea |
| Urea | Less toxic waste made from ammonia; removed by the kidneys |
| Filtration (kidney) | Small molecules filtered from blood into tubules under pressure |
| Selective reabsorption | Useful substances reabsorbed from tubules back into the blood |
| Osmoregulation | Control of water and ion levels in the body |
| ADH | Pituitary hormone increasing water reabsorption by kidney tubules |
| Dialysis | Filtering blood through an external machine against a dialysis fluid |
| Kidney transplant | Surgical replacement of a failed kidney with a donor kidney |
| Menstrual cycle | ~28-day cycle of ovary/uterus changes controlled by FSH, LH, oestrogen, progesterone |
| FSH | Matures an egg in the ovary; stimulates oestrogen release |
| LH | Surge triggers release of a mature egg (ovulation) |
| Oestrogen | Thickens the uterus lining; triggers the LH surge |
| Progesterone | Maintains the uterus lining after ovulation |
| Ovulation | Release of a mature egg from the ovary |
| Contraception | Deliberate prevention of pregnancy |
| Barrier method | Physically prevents sperm reaching an egg |
| Spermicide | Chemical that kills or disables sperm |
| Sterilisation | Surgical procedure permanently preventing fertilisation |
| Infertility | Inability to conceive a child naturally |
| IVF | Eggs fertilised with sperm in a laboratory, then embryos placed in the uterus |
| Tropism | Plant growth response to a directional stimulus |
| Phototropism | Growth response to light |
| Gravitropism | Growth response to gravity |
| Auxin | Plant hormone controlling cell elongation and tropisms |
| Gibberellin | Plant hormone ending seed dormancy; involved in stem growth/flowering |
| Ethene | Plant hormone used to control fruit ripening |
| Puberty | Stage of development when reproductive hormones trigger sexual maturity |
| Secondary sexual characteristics | Physical features that develop at puberty under hormonal control |
| Basal metabolic rate | The rate at which the body uses energy at rest |
| Concentration gradient | Difference in concentration between two regions, down which particles diffuse |
| Partially permeable membrane | A membrane that allows some substances through but not others |
| Fight-or-flight response | Rapid physiological changes, triggered by adrenaline, preparing the body for action |
| Seed dormancy | A period during which a seed does not germinate even if conditions seem suitable |
| Germination | The beginning of growth of a seed into a new plant |
| Selective weedkiller | A herbicide that kills certain plants (e.g. broad-leaved weeds) without harming others |
| Micropropagation | Growing many identical new plants from small samples of tissue using plant hormones |
Quick check
- Name the three main parts of an automatic control system. [3]
- State the normal core human body temperature. [1]
- Give the order of structures in a spinal reflex arc, from stimulus to response. [5]
- Describe how the body responds when it becomes too hot, referring to skin blood vessels and sweating. [4]
- Describe what happens to the lens, ciliary muscles and suspensory ligaments when the eye focuses on a near object. (Biology only) [3]
- Explain why myopia causes distant objects to appear blurred, and state its correction. (Biology only) [3]
- Explain, using glucagon, how the body responds when blood glucose falls too low. [4]
- Compare Type 1 and Type 2 diabetes in cause and treatment. [4]
- Calculate the BMI of a person of mass 70 kg and height 1.75 m, and state if it is in the healthy range (18.5 ≤ BMI ≤ 24.9). [3]
- Explain how ADH helps control blood water content when a person is dehydrated. (Biology only) [4]
- Explain, using auxin distribution, why a horizontal shoot bends upward while a horizontal root bends downward. (Biology only) [5]
- Evaluate dialysis compared with a kidney transplant as treatments for kidney failure. (Biology only) [6]
Answers
- Receptors; coordination centres; effectors.
- 37°C.
- Receptor → sensory neurone → relay neurone → motor neurone → effector.
- Skin blood vessels dilate (vasodilation), so more blood flows near the surface and more heat is lost by radiation; more sweat is produced, which evaporates and transfers heat away, cooling the body.
- Ciliary muscles contract; suspensory ligaments loosen; the lens becomes fatter/more curved, refracting light more strongly onto the retina.
- The eyeball is too long or the lens too curved, so light is refracted too strongly and focuses in front of the retina instead of on it; corrected with a concave (diverging) lens, which spreads light out before it enters the eye.
- Low blood glucose is detected by the pancreas, which secretes glucagon; glucagon makes the liver convert glycogen into glucose, released into the blood; this raises blood glucose back towards normal (negative feedback).
- Type 1: little/no insulin produced; treated with insulin injections and a controlled diet. Type 2: cells stop responding properly to insulin, often linked to obesity; treated mainly with diet, exercise and sometimes medication, not usually insulin injections.
- Height2 = 1.75 × 1.75 = 3.0625 m2; BMI = 70 ÷ 3.0625 = 22.9 (3 s.f.); within the healthy range (18.5–24.9).
- Dehydration makes the blood more concentrated; more ADH is released from the pituitary; kidney tubules become more permeable to water, so more water is reabsorbed into the blood; a smaller volume of more concentrated urine is produced, conserving water.
- Auxin builds up on the lower side of both a horizontal shoot and root. In the shoot, more auxin increases cell elongation, so the lower side grows faster, bending the shoot upward. In the root, more auxin inhibits cell elongation, so the lower side grows slower, bending the root downward.
- Dialysis needs no donor/surgery and can start quickly, but must be repeated for hours several times a week for life, restricts diet/lifestyle, and does not cure the failure. A transplant can restore near-normal function and end regular dialysis, but needs a well-matched donor (possible long wait), major surgery, and lifelong immunosuppressants, which raise infection risk. The best choice depends on donor availability, health and patient preference.
