(1/48) It's only love? Some pitfalls in emotionally related organ donation.
Transplanting organs from emotionally related donors has become a fairly routine procedure in many countries. However, donors have to be chosen carefully in order to avoid not just medically, but also morally, questionable outcomes. This paper draws attention to vulnerabilities that may affect the voluntariness of the donor's decision. Suggestions are made as to how to approach the evaluation and selection of potential donors. (+info)
(2/48) Factors influencing decisions about donation of the brain for research purposes.
OBJECTIVES: to find out the attitudes to brain donation for research purposes and factors involved in decision-making in elderly people. DESIGN: questionnaire administered after the decision had been made. SETTING AND SUBJECTS: 200 of the 640 people in Nottingham aged 67-100 who were assessed as part of the Medical Research Council multicentre Cognitive Function and Ageing Study of 2,518 people over 65 and were approached to consider brain donation for the neuropathology component of the study of dementia incidence. RESULTS: Most people completing the questionnaire had positive or neutral feelings about being approached. Positive influences included: personal approach, awareness of need for research and of suffering caused by dementia and a desire to help others. Many had fears about not being really dead, about post mortem examinations and feeling pain after death. Most preferred cremation and these were much more likely to donate. Two-thirds thought death was not talked about enough: 65% of those visited found talking helpful. Relatives had an important influence, usually dissuading the person from donating. CONCLUSIONS: some families who agreed to a relative's decision to donate only did so after discussing it together well in advance of death would have been unlikely to have agreed had they been approached for the first timeonly after death. There is a need to: (i) talk more about death, addressing people's fears, (ii) increase awareness of the need for autopsies and donation for research and (iii) provide more training in talking about death andautopsies. (+info)
(3/48) What's not wrong with conditional organ donation?
In a well known British case, the relatives of a dead man consented to the use of his organs for transplant on the condition that they were transplanted only into white people. The British government condemned the acceptance of racist offers and the panel they set up to report on the case condemned all conditional offers of donation. The panel appealed to a principle of altruism and meeting the greatest need. This paper criticises their reasoning. The panel's argument does not show that conditional donation is always wrong and anyway overlooks a crucial distinction between making an offer and accepting it. But even the most charitable reinterpretation of the panel's argument does not reject selective acceptance of conditional offers. The panel's reasoning has no merit. (+info)
(4/48) Benefit of child-to-parent kidney donation.
Use of child-to-parent (CTP) kidney donation may be limited because of ethical concerns as well as doubts about its effectiveness. We used the United Network for Organ Sharing database to examine the effectiveness of CTP kidney donation compared with other types of living-related (LD) kidney donation and to cadaveric kidney donation. Data from 56 873 kidney transplants performed between 1988 and 1998 showed significantly greater transplant and patient survival for CTP kidney transplants compared with cadaveric kidney transplants. The average gain in kidney transplant half-life is 3.6 years for a CTP compared with a cadaveric kidney transplant, and it is estimated that this gain for the recipient far outweighs the 1 in 3000 risk of death to the donor associated with kidney donation. We conclude that CTP kidney donation should not be discouraged, and represents a useful source of transplantable kidneys. (+info)
(5/48) Baby marrow: ethicists and privacy.
A family had a child in large part to use its marrow in the hopes of saving the life of an older child afflicted with leukaemia. Public response from medical ethicists was negative. This paper argues that what the family did was not clearly wrong and that the ethicists should not have made public pronouncements calling the morals of the family into question. (+info)
(6/48) Kidney transplantation from living donors: comparison of results between related and unrelated donor transplants under new immunosuppressive protocols.
BACKGROUND: Recent advances in immunosuppressive therapy have led to a substantial improvement in the outcome of kidney transplantation. Living unrelated donors may become a source of additional organs for patients on the kidney waiting list. OBJECTIVES: To study the impact of the combination of calcineurin inhibitors and mycophenolate-mofetile, together with steroids, on outcomes of living related and unrelated transplants. METHODS: Between September 1997 and January 2000, 129 patients underwent living related (n = 80) or unrelated (n = 49) kidney transplant. The mean follow-up was 28.2 months. Immunosuppressive protocols consisted of MMF with cyclosporine (41%) or tacrolimus (59%), plus steroids. Patient and graft survival data, rejection rate, and graft functional parameters were compared between the groups. RESULTS: LUD recipients were older (47.8 vs. 33.6 years) with a higher number of re-transplants (24.5% vs. 11.2% in LRD recipients, P < 0.05). Human leukocyte antigen matching was higher in LRD recipients (P < 0.001). Acute rejection developed in 28.6% of LUD and 27.5% of LRD transplants (P = NS). Creatinine levels at 1, 2 and 3 years post-transplant were 1.6, 1.7 and 1.7 mg/dl for LRD patients and 1.5, 1.5 and 1.3 mg/dl for LUD recipients (P = NS). There was no difference in patient survival rates between the groups. One, 2 and 3 years graft survival rates were similar in LRD (91.3%, 90% and 87.5%) and LUD (89.8%, 87.8% and 87.8%) recipients. CONCLUSIONS: Despite HLA disparity, rejection and survival rates of living unrelated transplants under current immunosuppressive protocols are comparable to those of living related transplants. (+info)
(7/48) Pre-donated autologous blood transfusion in scoliosis surgery.
We studied the use of autologous pre-donatedblood transfusion in surgery for scoliosis in 45 patients who were divided into two groups; 27 who pre-donated autologous blood (group 1) and 18 who were planned recipients of allogenic blood (group 2). Normovolaemic haemodilution and intra-operative blood salvage was used in six patients in group 1 and three patients in group 2. The two groups did not differ significantly with respect to age, American Society of Anaesthesiologists score, mean operative time, number of vertebral segments fused, total blood loss, length of stay in intensive care and length of stay in hospital. The risk of requiring allogenic blood transfusion was found to be significantly less in group 1 (7.4% v 88.9%, p < 0.001). Only 5.21% of autologous units were wasted. Although intra-operative blood salvage reduced the total blood loss in both groups, it did not affect the need for subsequent allogenic transfusion or reduce the number of pre-donated autologous units which were given (p < 0.67). Autologous blood transfusion requiredextra time, personnel, resources and cost pounds sterling 28.88 per patient more than allogenic transfusion, however, the projected costs at May 2002 make this programme cost-effective by pounds sterling 51.54 per patient. Pre-donated autologous blood transfusion is acceptable and safe in scoliosis surgery. It significantly reduces the subsequent requirement of allogenic transfusion. Although the cost is currently more than allogenic transfusion, with the increase in the costs of the latter and the decrease in potential donors which is anticipated, pre-donation of autologous blood will become comparatively cost-effective. (+info)
(8/48) Assessment of the willingness of potential live related kidney donors.
Even in the case of live related kidney donation, coercion within families is applied on the most vulnerable amongst them. This vulnerability could be financial, social or psychological In this paper we discuss how to assess the willingness or unwillingness of a kidney donor and discover if any coercion has been applied on him/her be it direct or indirect. (+info)