(1/1276) Feasibility of finding an unrelated bone marrow donor on international registries for New Zealand patients.
Allogeneic bone marrow transplantation is the treatment of choice for several hematological conditions. Unfortunately, for the majority (70%) of patients an HLA-matched sibling donor is not available and a matched unrelated donor must be found if they are to proceed to allogeneic transplantation. Most of the donors on international registries are of Caucasian ethnic origin. It has been recognized that patients from certain racial groups have a reduced chance of finding an unrelated donor. This study reports the feasibility of finding an unrelated donor for our local New Zealand patients of Caucasian, New Zealand Maori and Pacific Islander ethnic origin presenting with transplantable hematological conditions at a single center. The search was performed on international registries using HLA-A,B and DR typings for our patients. Six of six and five of six matches were evaluated. We have shown that Maori and Pacific Islanders have significantly lower hit rates than Caucasians when searched for 6/6 antigen matches, but there was no significant difference between the three ethnic groups in finding a 5/6 antigen matched donor. This study supports the policy of the New Zealand Bone Marrow Donor Registry in recruiting New Zealand Maori and Pacific Islanders. (+info)
(2/1276) Tissue donation after death in the accident and emergency department: an opportunity wasted?
OBJECTIVE: To investigate whether the accident and emergency department (A&E) is a potential source of tissues for donation, from non-heart beating donors (NHBDs). METHODS: A telephone survey of 30 A&E departments was conducted to determine current tissue harvesting practices from NHBDs. The potential number of tissue donors in our own medium sized district general hospital A&E department was estimated. Senior nursing staff were asked to complete a questionnaire to establish their knowledge, attitudes, and experience of tissue harvesting from NHBDs. RESULTS: Only seven of the 30 A&E departments surveyed (23%) had an active involvement in requesting tissue donation after a sudden death. Several others had limited experience. The level of involvement was unrelated to department size. In our own A&E department, there were 110 deaths in 1995. Tissue donation had occurred on just three occasions. However, departmental staff attitudes towards reducing this shortfall were positive. CONCLUSIONS: The A&E department is a resource of tissues for donation, which is currently under used. (+info)
(3/1276) Cloning, killing, and identity.
One potentially valuable use of cloning is to provide a source of tissues or organs for transplantation. The most important objection to this use of cloning is that a human clone would be the sort of entity that it would be seriously wrong to kill. I argue that entities of the sort that you and I essentially are do not begin to exist until around the seventh month of fetal gestation. Therefore to kill a clone prior to that would not be to kill someone like you or me but would be only to prevent one of us from existing. And even after one of us begins to exist, the objections to killing it remain comparatively weak until its psychological capacities reach a certain level of maturation. These claims support the permissibility of killing a clone during the early stages of its development in order to use its organs for transplantation. (+info)
(4/1276) Indigenous peoples and the morality of the Human Genome Diversity Project.
In addition to the aim of mapping and sequencing one human's genome, the Human Genome Project also intends to characterise the genetic diversity of the world's peoples. The Human Genome Diversity Project raises political, economic and ethical issues. These intersect clearly when the genomes under study are those of indigenous peoples who are already subject to serious economic, legal and/or social disadvantage and discrimination. The fact that some individuals associated with the project have made dismissive comments about indigenous peoples has confused rather than illuminated the deeper issues involved, as well as causing much antagonism among indigenous peoples. There are more serious ethical issues raised by the project for all geneticists, including those who are sympathetic to the problems of indigenous peoples. With particular attention to the history and attitudes of Australian indigenous peoples, we argue that the Human Genome Diversity Project can only proceed if those who further its objectives simultaneously: respect the cultural beliefs of indigenous peoples; publicly support the efforts of indigenous peoples to achieve respect and equality; express respect by a rigorous understanding of the meaning of equitable negotiation of consent, and ensure that both immediate and long term economic benefits from the research flow back to the groups taking part. (+info)
(5/1276) Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review.
BACKGROUND: Organ transplantation is the treatment of choice for patients with end-stage organ failure, but the supply of organs has not increased to meet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet the criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donors). METHODS: The charts of 209 patients who died during 1995 in the Emergency Department and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome measure was the time from discontinuation of ventilation until cardiopulmonary arrest. RESULTS: Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more brain stem reflexes were present. At the time of withdrawal of ventilatory support, the mean serum creatinine level was 71 (29) mumol/L, mean urine output was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agents. The mean time from withdrawal of ventilatory support to cardiac arrest was 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but one died within 6 hours. For the year for which charts were reviewed, 33 potential conventional donors (people whose hearts were beating) were identified, of whom 21 (64%) became donors. On the assumption that 40% of the potential controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the organs), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%. INTERPRETATION: A significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors. (+info)
(6/1276) The ambiguity about death in Japan: an ethical implication for organ procurement.
In the latter half of the twentieth century, developed countries of the world have made tremendous strides in organ donation and transplantation. However, in this area of medicine, Japan has been slow to follow. Japanese ethics, deeply rooted in religion and tradition, have affected their outlook on life and death. Because the Japanese have only recently started to acknowledge the concept of brain death, transplantation of major organs has been hindered in that country. Currently, there is a dual definition of death in Japan, intended to satisfy both sides of the issue. This interesting paradox, which still stands to be fully resolved, illustrates the contentious conflict between medical ethics and medical progress in Japan. (+info)
(7/1276) Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.
NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future. (+info)
(8/1276) Bioethics regulations in Turkey.
Although modern technical and scientific developments in medicine are followed closely in Turkey, it cannot be claimed that the same is true in the field of bioethics. Yet, more and more attention is now being paid to bioethics and ethics training in health sciences. In addition, there are also legal regulations in bioethics, some of which are not so new. The objective of these regulations is to provide technical and administrative control. Ethical concerns are rather few. What attracts our attention most in these regulations is the presence of the idea of "consent". (+info)