An ethical analysis of conditional and partially directed live kidney donation among strangers-The Israeli experience.

Living donor kidney transplantation (LDKT) is one of the most effective treatment options for people with end-stage renal disease. Traditionally, LDKT can be either "directed" or "nondirected," based on whether the recipient is specified by the donor. Recently, there has been an increase in conditional and semidirected live kidney donation among strangers, where the donor specifies the characteristics of the recipient whom they wish to donate to. This practice has both gained popularity and sparked controversy in the state of Israel through the nonprofit organization Matnat Chaim. We analyze the ethical implications of this practice by applying traditional principles of medical ethics to conditional LDKT. Although semidirected and conditional LDKT presents some ethical challenges, overall, its practice effectively aligns with core ethical principles. The donors' right to make stipulations respects the donor's autonomy, the practice avoids harm and benefits both donor and recipient, and justice and utility are upheld as the practice specifically benefits marginalized patients and optimizes resource utilization. Finally, we present data from our institution demonstrating how conditional LDKT increased transplantation for all ethnic groups; Jewish recipients of LDKT increased by 151.32% (P = .034) Arab recipients of LDKT increased by 111.11% (P = .036).

The future of surrogacy: a review of current global trends and national landscapes.

The practice of surrogacy is frequently the subject of media, scientific, social, regulatory and policy attention. Although it is, for many, an accepted form of assisted reproduction for those who would otherwise not be able to have children, surrogacy often generates strong feeling, particularly where there is any possibility of exploitation. Therefore, there is disagreement about how it should be regulated. In some countries, surrogacy is prohibited in any form, although this does not stop people using it. In others, it is unregulated but still practised. In some nations it is regulated in either a 'commercial' or an 'altruistic' model. This review article considers the possible regulatory future of surrogacy, initially from a UK perspective considering a recent review of the legal framework in a country where surrogacy works well (although some cross borders to access it), and then through an assessment of global trends and other national perspectives. It concludes that the international regulation of surrogacy, although potentially desirable, is unlikely. This being the case, it would be preferable for individual nations to regulate surrogacy so it can be undertaken in ways that are safe, ethical and protective of the best interests of children, surrogates, intended parents and families.

Antigenic cooperation in viral populations: Transformation of functions of intra-host viral variants.

In this paper, we study intra-host viral adaptation by antigenic cooperation - a mechanism of immune escape that serves as an alternative to the standard mechanism of escape by continuous genomic diversification and allows to explain a number of experimental observations associated with the establishment of chronic infections by highly mutable viruses. Within this mechanism, the topology of a cross-immunoreactivity network forces intra-host viral variants to specialize for complementary roles and adapt to the host's immune response as a quasi-social ecosystem. Here we study dynamical changes in immune adaptation caused by evolutionary and epidemiological events. First, we show that the emergence of a viral variant with altered antigenic features may result in a rapid re-arrangement of the viral ecosystem and a change in the roles played by existing viral variants. In particular, it may push the population under immune escape by genomic diversification towards the stable state of adaptation by antigenic cooperation. Next, we study the effect of a viral transmission between two chronically infected hosts, which results in the merging of two intra-host viral populations in the state of stable immune-adapted equilibrium. In this case, we also describe how the newly formed viral population adapts to the host's environment by changing the functions of its members. The results are obtained analytically for minimal cross-immunoreactivity networks and numerically for larger populations.

Disrupting the Dorsolateral Prefrontal Cortex Attenuates the Difference in Decision-Making for Altruistic Punishment Between the Gain and Loss Contexts.

Altruistic punishment is a primary response to social norms violations; its neural mechanism has also attracted extensive research attention. In the present studies, we applied a low-frequency repetitive transcranial magnetic stimulation (rTMS) to the bilateral dorsolateral prefrontal cortex (DLPFC) while participants engaged in a modified Ultimatum Game (Study 1) and third-party punishment game (Study 2) to explore how the bilateral DLPFC disruption affects people's perception of violation of fairness norms and altruistic punishment decision in the gain and loss contexts. Typically, punishers intervene more often against and show more social outrage towards Dictators/Proposers who unfairly distribute losses than those who unfairly share gains. We found that disrupting the function of the left DLPFC in the second-party punishment and the bilateral DLPFC in the third-party punishment with rTMS effectively obliterated this difference, making participants punish unfairly shared gains as often as they usually would punish unfairly shared losses. In the altruistic punishment of maintaining the social fairness norms, the inhibition of the right DLPFC function will affect the deviation of individual information integration ability; the inhibition of the left DLPFC function will affect the assessment of the degree of violation of fairness norms and weaken impulse control, leading to attenuate the moderating effect of gain and loss contexts on altruistic punishment. Our findings emphasize that DLPFC is closely related to altruistic punishment and provide causal neuroscientific evidence.

Constructing vaccination slogans in the late stage of vaccine launch: an experimental study based on the framing effect theory.

BACKGROUND: Vaccination is an important strategy for overcoming public health crises. Considerable studies have analyzed strategies to promote people's willingness to vaccinate, but few have explored effective strategies based on the stage of vaccine launch. This study considered the framing effect theory to explore whether egoism, altruism and loss frames can boost vaccination willingness when people feel the vaccine is effective in the late stage of vaccine launch. METHODS: This study designed a scenario experiment consisting of three experimental groups (egoism, altruism and loss frames) and one control group (non-framed). Participants (N = 1085) from China were randomly assigned to any of the four groups. Vaccination willingness, perceived vaccine effectiveness and control variables included perceived susceptibility, perceived severity, worry about the side effects of vaccination and socio-demographics were collected. RESULTS: Perceived vaccine effectiveness and message frames can increase people's willingness to be vaccinated. Message frames can amplify the positive impact of perceived effectiveness on vaccination willingness. Moreover, loss-framed messages had a stronger amplification effect than egoistic- and altruistic-framed messages. CONCLUSIONS: Governments and other health authorities should prioritize the loss-framed approach when constructing vaccination slogans to maximize vaccination willingness when vaccines are considered effective at the late implementation stage of the vaccine strategy.

Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria.

BACKGROUND: Evidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria's Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria. METHODS: The study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage kidney disease (ESKD) patients. We obtained informed written consent from respondents before data collection. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents' WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one's and another's haemodialysis. The level of significance in the final model was ρ < 0.05. RESULTS: About 88.3% and 64.8% of ESKD patients were willing to pay for personal and altruistic haemodialysis, correspondingly. The mean annual WTP for haemodialysis for one's and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (ß = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (ß = -1.65, 95%CI: -2.51 to -0.79, p < 0.001). CONCLUSIONS: The willingness to pay for haemodialysis for themselves and others was high. The type of facility ESKD patients attended influenced their willingness to pay for haemodialysis. The findings highlight the need for policies to enhance affordable and equitable access to haemodialysis in Nigeria through pre-payment mechanisms and altruistic financing strategies.

Testosterone reduces generosity through cortical and subcortical mechanisms.

Recent evidence has linked testosterone, a major sex hormone, to selfishness in economic decision-making. Here, we aimed to investigate the neural mechanisms through which testosterone reduces generosity by combining functional MRI with pharmacological manipulation among healthy young males in a double-blind, placebo-controlled, between-subject design. After testosterone or placebo gel administration, participants performed a social discounting task in which they chose between selfish options (benefiting only the participant) and generous options (providing also some benefit to another person at a particular social distance). At the behavioral level, testosterone reduced generosity compared to the placebo. At the neural level (n = 60), the temporoparietal junction (TPJ) encoded the other-regarding value of the generous option during generous choices, and this effect was attenuated by testosterone, suggesting that testosterone reduced the consideration of other's welfare as underpinned by TPJ activity. Moreover, TPJ activity more strongly reflected individual differences in generosity in the placebo than the testosterone group. Furthermore, testosterone weakened the relation between the other-regarding value of generous decisions and connectivity between the TPJ and a region extending from the insula into the striatum. Together, these findings suggest that a network encompassing both cortical and subcortical components underpins the effects of testosterone on social preferences.

Analytic and heuristic process for prudent antimicrobial use in animals: What are triggers and how do they work?

The over and misuse of antimicrobials in animal agriculture causes a prevailing crisis for humans, animals, and the environment. From the One Health approach perspective, the formation process of adopting prudent antimicrobial use (AMU), once established, can be used to mitigate this crisis. The study aimed to determine the analytic-based and heuristic-based process that evoked prudent AMU among animal farmers by synthesis of stimulus-organism-response framework and dual-system theory and to explore gender differences on risk-benefit trade-offs. A structural equation model was employed to test the proposed hypotheses with field survey data from 1100 small-scale farmers. The results reveal that for the analytic-based process, social influence, antimicrobial-related threats, and self-efficacy are all salient stimuli having indirect effects on intention via the two organisms of perceived risks and perceived benefits. For heuristic-based process, farmers' altruistic value orientations are positively associated with intention. An interesting fact is that threat awareness has two opposite effects on intention, namely, the suppression effect and the enhancement effect. Moreover, the negative effect of perceived risks on intention is greater among female farmers, compared to male counterparts. These findings provide valuable insights for the forming of theory-based intervention strategies to perfect China's national action plan.

The influence of altruistic personality, interpersonal distance and social observation on prosocial behavior: An event-related potential (ERP) study.

The psychological mechanisms that high and low altruists exhibit in different contexts remain unknown. This study examined the underlying mechanisms of the effect of altruistic personality, social observation, and interpersonal distance on prosocial behavior using event-related potentials (ERPs). Participants with high and low altruism were asked to make prosocial or non-prosocial choices toward different interpersonal distances (friends, acquaintances, or strangers) under the (non)observer condition. The electrophysiological responses to the choice stimuli were simultaneously recorded. The behavioral results demonstrated that high altruists had more prosocial choices, and these choices were unaffected by interpersonal distance and social observation. However, low altruists made more prosocial choices toward friends and acquaintances under the observer than nonobserver conditions, whereas their prosocial choices toward strangers showed no difference. The ERP results demonstrated that low altruists showed more negative N2 when the choice stimuli were toward strangers and acquaintances or under the nonobserver condition. Furthermore, low altruists showed larger P3 under the observer than nonobserver conditions when the choice stimuli were toward friends and acquaintances, while this difference was absent when the choice stimuli were toward strangers. However, for high altruists, no effect of interpersonal distance and social observation was observed in N2 and P3. These results suggest that the prosocial behavior of low altruists is mainly driven by reputational incentives, whereas high altruists are primarily motivated by concern about the well-being of others. Our findings provide insights into the prosocial behavior of high and low altruists in different contexts and support the empathy-altruism hypothesis.

Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study.

Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.

Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study.

Unspecified kidney donation (UKD) has made substantial contributions to the UK living donor programme. Nevertheless, some transplant professionals are uncomfortable with these individuals undergoing surgery. This study aimed to qualitatively explore the attitudes of UK healthcare professionals towards UKD. An opportunistic sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering six UK transplant centres: three high volume and three low volume centres. Interview transcripts were analysed using inductive thematic analysis. The study provided comprehensive coverage of the UK transplant community, involving 59 transplant professionals. We identified five themes: staff's conception of the ethics of UKD; presence of the known recipient in the donor-recipient dyad; need for better management of patient expectations; managing visceral reactions about the "typical" unspecified kidney donor; complex attitudes toward a promising new practice. This is the first in-depth qualitative study of attitudes of transplant professionals towards UKD. The data uncovered findings with strong clinical implications for the UKD programme, including the need for a uniform approach towards younger candidates that is adhered to by all transplant centres, the need to equally extend the rigorous assessment to both specified and unspecified donors, and a new approach to managing donor expectations.

Twenty Years of Unspecified Kidney Donation: Unspecified Donors Looking Back on Their Donation Experiences.

The Netherlands was the first European country to implement unspecified kidney donation in 2000. This qualitative study aimed to evaluate the experiences of unspecified kidney donors (UKDs) in our transplant institute to improve the care for this valuable group of donors. We conducted semi-structured interviews with 106 UKDs who donated between 2000-2016 (response rate 84%). Interviews were audio-recorded, transcribed verbatim and independently coded by 2 researchers in NVivo using thematic analysis. The following 14 themes reflecting donor experiences were found: Satisfaction with donation; Support from social network; Interpersonal stress; Complaints about hospital care; Uncertainty about donor approval; Life on hold between approval and actual donation; Donation requires perseverance and commitment; Recovery took longer than expected; Normalization of the donation; Becoming an advocate for living kidney donation; Satisfaction with anonymity; Ongoing curiosity about outcome or recipient; Importance of anonymous communication; Anonymity is not watertight. The data reinforced that unspecified kidney donation is a positive experience for donors and that they were generally satisfied with the procedures. Most important complaints about the procedure concerned the length of the assessment procedure and the lack of acknowledgment for UKDs from both their recipients and health professionals. Suggestions are made to address the needs of UKDs.

Bidirectional relations between altruistic tendency and benign/malicious envy among adolescents: A longitudinal study and weekly diary study.

Altruism is a prosocial tendency that has developed through long-term evolutionary selection. The present study adopts social comparison and evolutionary psychology theories to examine how benign/malicious envy can affect altruism and how altruism can affect the two types of envy in turn, respectively. In Study 1, 513 adolescents participated in a three-wave longitudinal survey to explore the relationships between dispositional altruistic tendency and dispositional benign/malicious envy. The cross-lagged analysis showed a long-term and stable negative bidirectional relationship between dispositional altruistic tendency and dispositional malicious envy and a short-term positive bidirectional relationship between dispositional altruism and dispositional benign envy. In Study 2, 109 adolescents kept a weekly diary for seven consecutive weeks to record state levels of altruistic tendency and benign/malicious envy in their daily lives. The hierarchical linear model demonstrated that weekly altruistic tendency and weekly benign envy could positively predict each other, and weekly altruistic tendency presented a negative bidirectional relationship with weekly malicious envy. These findings offer an effective way to study the relationship between human behavior and emotions from perspectives of social comparison and evolutionary psychology theories. Meanwhile, it also has practical significance for the harmonious development of society.

Altruistic behaviors relieve physical pain.

Engaging in altruistic behaviors is costly, but it contributes to the health and well-being of the performer of such behaviors. The present research offers a take on how this paradox can be understood. Across 2 pilot studies and 3 experiments, we showed a pain-relieving effect of performing altruistic behaviors. Acting altruistically relieved not only acutely induced physical pain among healthy adults but also chronic pain among cancer patients. Using functional MRI, we found that after individuals performed altruistic actions brain activity in the dorsal anterior cingulate cortex and bilateral insula in response to a painful shock was significantly reduced. This reduced pain-induced activation in the right insula was mediated by the neural activity in the ventral medial prefrontal cortex (VMPFC), while the activation of the VMPFC was positively correlated with the performer's experienced meaningfulness from his or her altruistic behavior. Our findings suggest that incurring personal costs to help others may buffer the performers from unpleasant conditions.

The psychological examination and evaluation of unrelated kidney donors in Israel: a suggested model.

Altruistic organ donors represent a special population when compared to related living donors, requiring appropriate protection and attention regarding informed consent and psychological aspects related to the donation. Following the introduction of the Israeli Transplant Law of 2008, a retrospective study of altruistic donor files revealed that important psycho-diagnostic aspects were not emphasized in the existing guidelines. Thus, a new tool was formulated which incorporated those elements, including assessment of emotional maturity, ego strength, degree of interest in others, reality testing, degree of pressure to donate, anxiety, dysphoric and depressive factors and the ability to function under stress. The study examined 598 cases reviewed by the Central Evaluation Board over the period May 2008 - June 2016. Overall, 23.4% candidates were disqualified of whom 41% were declined on grounds related to mental health. Most of the donors were rejected based on 3-5 elements. Of these, a deficient assessment of reality in ambiguous situations, lack of emotional maturity, and lacking or partial ability to function effectively under stress, were most commonly cited as reasons for rejection. This model allowed the detection of important conditions previously not incorporated into existing guidelines and may serve as a model for other transplantation programs worldwide.

Sustainable consumption behaviour: Mediating role of pro-environment self-identity, attitude, and moderation role of environmental protection emotion.

This study aims to examine how these factors-egoistic and altruistic values and social consumption motivation-stimulus factors-influence sustainable consumption behaviour (response factor), the mediating role of pro-environmental self-identity and attitude (organism factor), and the moderating effect of environmental protection emotion. We used the stimulus organism response theory to gain a solid and holistic understanding of the concept. We collected 328 original surveys from Indian customers who recently purchased sustainable products via convenience and purposive sampling, and we analysed the data by using structural equation modelling. Intriguingly, the results show that (a) stimulus factors, such as egoistic and altruistic values and social consumption motivation, had a positive influence on pro-environment self-identity and attitude and sustainable consumption behaviour; (b) pro-environment self-identity had a positive effect on attitude; (c) mediation factors (pro-environment self-identity and attitude) had a significantly positive mediation relationship between stimulus and response factors; and (d) environmental protection emotion significantly moderated the relationship between stimulus, organism factors, and response factors. The study contributes to the current body of knowledge in the area of sustainable marketing by examining the rapidly growing phenomenon of sustainable consumer behaviour.

Altruistic behaviour decreases agent's unhealthy food intake: Based on the self-determination theory model of vitality.

This study explored whether altruistic behaviour would decrease agent's unhealthy food intake, and whether vitality and state self-control would sequentially mediate this effect based on the Self-Determination Theory Model of Vitality. It included 1019 college students in total across three studies. Study 1 was a laboratory experiment. By framing a physical task as a helping behaviour or a neutral experimental task, we examined whether these framed tasks impacted participants' subsequent unhealthy food intake levels. Study 2 was an online investigation measuring the relationship between donation (vs. no donation) behaviour and participant's estimated unhealthy food intake level. Study 3 was an online experiment with a mediation test. By random assignment of conducting a donation behaviour versus a neutral task, we examined whether these behaviours affected participants' vitality, state self-control, and estimated unhealthy food intake levels. In addition, we tested a sequential mediation model with vitality and state self-control as the mediators. Both unhealthy and healthy foods were included in Study 2 and 3. Results showed that altruistic behaviour could decrease agent's unhealthy (but not healthy) food intake, and this effect was sequentially mediated by vitality and state self-control. The findings highlight that altruistic acts may buffer agents against unhealthy eating behaviour.

Suicide Among Monotheistic Religions: Between Sacrifice, Honour and Power.

This article discusses the problem of suicide in monotheistic religions (Judaism, Christianity and Islam), focusing on their early existence and considering the original contribution of Christianity. The first part presents the main theses of E. Durkheim on altruistic suicide and the concept of honour. This provides an opportunity to examine the problem of suicide in monotheistic religions from a more comprehensive perspective and recognise a certain specificity of suicide that was absent in altrusitic suicide. The analysis of the problem in relation to the concept of honour is also a valuable starting point for complementary psychological theories. The second part of the article is a more detailed discussion of suicide in Judaism, Christianity and Islam. The results provide a better understanding of the origins and nature of suicide in monotheistic religions whilst opening up a discussion on the possibility of suicide prevention.

Just world beliefs and altruistic behaviors of college students during the COVID-19 pandemic: The mediating role of empathy.

Altruistic behavior is of great significance for individual happiness and social development. The study has focused on the influence of two factors at the individual level on college students' altruistic behavior. The self-report questionnaires of 2,272 college students on belief in a just world, empathy and altruistic behavior were investigated. The results of the study found that: 1) Just-world belief and empathy both positively predicted altruistic behavior; 2) Empathy influenced altruistic behavior through just-world belief. And from the perspective of motivation theory, it explains that individuals affirm that altruistic behavior will bring spiritual pleasure, so individuals will maintain the consistency of their own internal factors to promote altruistic behavior.This study enriches the research value of altruistic behavior at the individual level and provides an empirical basis for the cultivation of altruistic behavior at the individual level.

Computational and Neurobiological Substrates of Cost-Benefit Integration in Altruistic Helping Decision.

Although altruistic behaviors, e.g., sacrificing one's own interests to alleviate others' suffering, are widely observed in human society, altruism varies greatly across individuals. Such individual differences in altruistic preference have been hypothesized to arise from both individuals' dispositional empathic concern for others' welfare and context-specific cost-benefit integration processes. However, how cost-benefit integration is implemented in the brain and how it is linked to empathy remain unclear. Here, we combine a novel paradigm with the model-based functional magnetic resonance imaging (fMRI) approach to examine the neurocomputational basis of altruistic behaviors. Thirty-seven adults (16 females) were tested. Modeling analyses suggest that individuals are likely to integrate their own monetary costs with nonlinearly transformed recipients' benefits. Neuroimaging results demonstrate the involvement of an extended common currency system during decision-making by showing that selfish and other-regarding motives were processed in dorsal anterior cingulate cortex (ACC) and right inferior parietal lobe in a domain-general manner. Importantly, a functional dissociation of adjacent but different subregions within anterior insular cortex (aINS) was observed for different subprocesses underlying altruistic behaviors. While dorsal aINS (daINS) and inferior frontal gyrus (IFG) were involved in valuation of benefactors' costs, ventral aINS and middle INS (vaINS/mINS), as empathy-related regions, reflected individual variations in valuating recipients' benefits. Multivariate analyses further suggest that both vaINS/mINS and dorsolateral prefrontal cortex (DLPFC) reflect individual variations in general altruistic preferences which account for both dispositional empathy and context-specific other-regarding tendency. Together, these findings provide valuable insights into our understanding of psychological and neurobiological basis of altruistic behaviors.SIGNIFICANCE STATEMENT Altruistic behaviors play a crucial role in facilitating solidarity and development of human society, but the mechanisms of the cost-benefit integration underlying these behaviors are still unclear. Using model-based neuroimaging approaches, we clarify that people integrate personal costs and non-linearly transformed other's benefits during altruistic decision-making and the implementations of the integration processes are supported by an extended common currency neural network. Importantly, multivariate analyses reveal that both empathy-related and cognitive control-related brain regions are involved in modulating individual variations of altruistic preference, which implicate complex psychological and computational processes. Our results provide a neurocomputational account of how people weigh between different attributes to make altruistic decisions and why altruistic preference varies to a great extent across individuals.