RESUMO
In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.
Assuntos
Transplante de Órgãos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Humanos , Egito , Transplante de Órgãos/legislação & jurisprudência , Transplante de Órgãos/ética , Doadores de Tecidos/provisão & distribuição , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Religião e Medicina , Turismo Médico/legislação & jurisprudência , Turismo Médico/ética , Conhecimentos, Atitudes e Prática em Saúde , Atitude Frente a Morte , Morte Encefálica , Formulação de Políticas , Regulamentação Governamental , Consentimento Livre e Esclarecido/legislação & jurisprudênciaRESUMO
The first living donor kidney transplant in Syria was performed 44 years ago; by the end of 2022, 6265 renal transplants had been performed in Syria. Kidney, bone marrow, cornea, and stem cells are the only organs or tissues that can be transplanted in Syria. Although 3 heart transplants from deceased donors were performed in the late 1980s, cardiac transplant activities have since discontinued. In 2003, national Syrian legislation was enacted authorizing the use of organs from living unrelated and deceased donors. This important law was preceded by another big stride: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the law was enacted, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to <2% in 2007. Rates plateaued through 2010, before the political crisis started in 2011. Forty-four years after the first successful kidney transplant in Syria, patients needing an organ transplant rely on living donors only. Moreover, 20 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be factors inhibiting initiation of a deceased donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.
Assuntos
Doadores Vivos , Transplante de Órgãos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Humanos , Síria , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/tendências , Transplante de Órgãos/legislação & jurisprudência , Transplante de Órgãos/tendências , Doadores Vivos/provisão & distribuição , Doadores Vivos/legislação & jurisprudência , Doadores de Tecidos/provisão & distribuição , Doadores de Tecidos/legislação & jurisprudência , Religião e Medicina , Transplante de Rim/legislação & jurisprudência , Islamismo , Fatores de Tempo , Política de Saúde/legislação & jurisprudência , Regulamentação GovernamentalAssuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Estados Unidos , Transplante de Órgãos/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Doadores de Tecidos/provisão & distribuição , Doadores de Tecidos/legislação & jurisprudência , Formulação de PolíticasRESUMO
Donation after circulatory death (DCD) donors are an increasingly more common source of livers for transplantation in many parts of the world. Events that occur during DCD liver recovery have a significant impact on the success of subsequent transplantation. This working group of the International Liver Transplantation Society evaluated current evidence as well as combined experience and created this guidance on DCD liver procurement. Best practices for the recovery and transplantation of livers arising through DCD after euthanasia and organ procurement with super-rapid cold preservation and recovery as well as postmortem normothermic regional perfusion are described, as are the use of adjuncts during DCD liver procurement.
Assuntos
Seleção do Doador/legislação & jurisprudência , Hepatectomia/legislação & jurisprudência , Transplante de Fígado/legislação & jurisprudência , Preservação de Órgãos , Doadores de Tecidos/legislação & jurisprudência , Benchmarking , Causas de Morte , Isquemia Fria , Consenso , Hepatectomia/efeitos adversos , Humanos , Transplante de Fígado/efeitos adversos , Preservação de Órgãos/efeitos adversos , Perfusão , Formulação de Políticas , Fatores de Tempo , Isquemia QuenteAssuntos
Necessidades e Demandas de Serviços de Saúde , Turismo Médico , Tráfico de Órgãos , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos , Transplantes , Regulamentação Governamental , Política de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/ética , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Turismo Médico/economia , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Tráfico de Órgãos/economia , Tráfico de Órgãos/ética , Tráfico de Órgãos/legislação & jurisprudência , Formulação de Políticas , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Transplantes/economiaAssuntos
Política de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Transplante de Órgãos/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Regulamentação Governamental , Política de Saúde/história , Necessidades e Demandas de Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Transplante de Órgãos/história , Formulação de Políticas , Doadores de Tecidos/história , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/história , TurquiaRESUMO
The first living-donor kidney transplant in Syria was performed 41 years ago; by 2019, 5407 renal transplants had been performed there. Three heart transplants from deceased donors were performed in the late 1980s; cardiac transplant activities have since discontinued. In 2003, a new, national Syrian legislation was enacted authorizing the use of organs from living unrelated donors and from deceased donors. This important law was preceded by another big stride in this regard: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the enactment of this law, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to < 2% in 2007. Kidney transplants continued at comparable rates until 2010, before the beginning of the political crisis in 2011. Four decades after the first successful kidney transplant in Syria, however, patients needing an organ transplant must rely on living donors only. Moreover, 17 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria, and additional improvement of the legal framework is needed. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be major factors inhibiting initiation of a deceased-donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased-donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.
Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Transplante de Órgãos/tendências , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/tendências , Conflitos Armados/tendências , Atitude Frente a Morte , Regulamentação Governamental , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Islamismo , Doadores Vivos/provisão & distribuição , Transplante de Órgãos/legislação & jurisprudência , Formulação de Políticas , Religião e Medicina , Síria , Fatores de Tempo , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudênciaRESUMO
On 1 July 2020, the registration of organ and tissue donors in the Netherlands changed from an opt-in to an opt-out system. This means that everyone in the Netherlands will be registered as an organ and tissue donor unless they have registered a different choice in the donor register. The hope is that this new method for donor registration will lead to more donors. Only a small majority of members of the Senate and the House of Representatives in the Netherlands voted for the legislative amendment that enabled this new system to come into effect. In the Senate the amendment was defended on the grounds that it would do more justice to the autonomy of the deceased; the new law will, however, have to be defended from the principles of justice and solidarity by a government that feels responsibility towards those needing a donor organ.
Assuntos
Seleção do Doador/legislação & jurisprudência , Autonomia Relacional , Justiça Social/ética , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Seleção do Doador/ética , Humanos , Países Baixos , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/éticaRESUMO
OBJECTIVES: We aimed to compare the possible outcomes of the current (opt-in) system and an opt-out system for organ donation in South Korea using a mathematical model. MATERIALS AND METHODS: A structured questionnaire was used to investigate the decision on organ donation and family consent after brain death under the current system and an opt-out system. The survey was conducted in August 2018 by means of a voluntary survey of 100 opposite-sex married couples. RESULTS: Sixty-three percent of participants wished to self-donate their organs after brain death: 69.5% were positive and 30.5% were negative regarding the implementation of the opt-out system. Among 200 participants, the total number of possible donors increased from 110 (55.0%) in the current system to 139 (69.5%) in the opt-out system. Positive autonomy was defined as obtainment of consent from the donor and the spouse, and negative autonomy was defined as concordaence of refusal between the donor and the spouse. Comparisons between the systems showed that the rate of autonomy increased from 57.0% in the current system to 61.5% in the opt-out system. Although the achievement of positive autonomy increased from 59.5% in the current system to 74.6% in the opt-out system, the achievement of negative autonomy decreased from 52.7% in the current system to 39.2% in the opt-out system. CONCLUSIONS: An opt-out system can increase the number of organ donors; however, achievement of negative autonomy can decrease.
Assuntos
Morte Encefálica , Política de Saúde , Consentimento Livre e Esclarecido , Modelos Teóricos , Consentimento Presumido , Cônjuges , Doadores de Tecidos , Adulto , Morte Encefálica/legislação & jurisprudência , Comportamento de Escolha , Relações Familiares , Feminino , Política de Saúde/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Formulação de Políticas , Consentimento Presumido/ética , Consentimento Presumido/legislação & jurisprudência , República da Coreia , Cônjuges/legislação & jurisprudência , Inquéritos e Questionários , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Doadores de Tecidos/provisão & distribuição , Adulto JovemRESUMO
: With current antiretroviral therapy, the lifespan of newly diagnosed persons with HIV (PWH) approaches that of uninfected persons. However, metabolic abnormalities related to both the disease and the virus itself, along with comorbidities of aging, have resulted in end-organ disease and organ failure as a major cause of morbidity and mortality. Solid organ transplantation is a life-saving therapy for PWH who have organ failure, and the approval of the HIV Organ Policy Equity Act has opened and expanded opportunities for PWH to donate and receive organs. The current environment of organ transplantation for PWH will be reviewed and future directions of research and treatment will be discussed.
Assuntos
Infecções por HIV/complicações , Disparidades em Assistência à Saúde/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Envelhecimento , Antirretrovirais/uso terapêutico , Comorbidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Política de Saúde/legislação & jurisprudência , Humanos , Transplante de Rim , Transplante de Fígado , Transplante de Órgãos/legislação & jurisprudênciaRESUMO
In spite of the fact that brain death during pregnancy is not a common occurrence, it is an important ethical problem for all cultures and religions can have a significant influence on the donation decision after brain death. Therefore, this study aimed to present the case of a pregnant patient developing brain death which occurred in our intensive care unit and to compare the medical, ethical and legal problems relating to pregnant cases developing brain death with 24 cases in the literature. A 21-year-old 19-week pregnant case with gestational diabetes was monitored in the anesthesia intensive care unit and developed brain death due to intracranial mass and intraventricular hemorrhage. Though brain death is a situation well understood by organ transplant professionals, brain death developing in pregnant patients still involves many medical, ethical and legal problems.
Assuntos
Morte Encefálica/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Hemorragia Cerebral Intraventricular/complicações , Islamismo , Transplante de Órgãos , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos , Ásia , Neoplasias Encefálicas/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Ética , Europa (Continente) , Feminino , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Pacientes , Gravidez , Complicações Neoplásicas na Gravidez , Ultrassonografia , Adulto JovemRESUMO
Focusing on the UK as a case study, this article argues that having the choice to enter into an international commercial surrogacy arrangement can be harmful, but that neither legalisation nor punitive restriction offers an adequate way to reduce this risk. Whether or not having certain options can harm individuals is central to current debates about the sale of organs. We assess and apply the arguments from that debate to international commercial surrogacy, showing that simply having the option to enter into a commercial surrogacy arrangement can harm potential vendors individually and collectively, particularly given its sexed dimension. We reject the argument that legalizing commercial surrogacy in the UK could reduce international exploitation. We also find that a punitive approach towards intended parents utilizing commercial rather than altruistic services is inappropriate. Drawing on challenges in the regulation of forced marriage and female genital cutting, we propose that international collaboration towards control of commercial surrogacy is a better strategy for preserving the delicate balancing of surrogate mothers' protection and children's welfare in UK law.
Assuntos
Comportamento de Escolha/ética , Comércio/ética , Comércio/legislação & jurisprudência , Técnicas de Reprodução Assistida/economia , Mães Substitutas/legislação & jurisprudência , Coerção , Feminino , Regulamentação Governamental , Humanos , Renda , Direito Internacional , Pobreza , Gravidez , Política Pública , Classe Social , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Reino Unido , Populações VulneráveisRESUMO
The Organ Transplantation Act issued by the Government of India 1994 has undergone major and minor changes in the form of addition of rules and amendments in order to improve the Act to make it much acceptable legally. Over a period of time, with an increase in cadaver organ donations, the rules and policies with regard to the same have been defined and redefined over the years. In this article, the Act, the rules, the amendments, the quick essentials of approach, and the forms are reviewed.
Assuntos
Política de Saúde/legislação & jurisprudência , Transplante de Órgãos/legislação & jurisprudência , Formulação de Políticas , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Termos de Consentimento/legislação & jurisprudência , Controle de Formulários e Registros/legislação & jurisprudência , Humanos , Índia , Consentimento Livre e Esclarecido/legislação & jurisprudênciaRESUMO
Commercial gamete donation in Canada is prohibited by the Assisted Human Reproduction Act. However, the Act permits gamete recipients to reimburse donors for donation-related expenses. Until recently, the types of expenses that were eligible and the process for reimbursing donors were not specified. In 2016, Health Canada announced its intent to develop regulations that would regulate gamete donor reimbursement; it released the proposed policy in 2017. As a result of consultations with Canadian lawmakers, physicians, and patients, debates surrounding commercial gamete donation are being revisited. Considering the ethical implications of gamete donation payment arrangements, a patient-centred care framework is useful going forward in the regulation of this practice. Patient-centred values of communication, respecting relational autonomy, and respecting patient interests should guide decisions regarding regulation of gamete donation arrangements in Canada.
Assuntos
Óvulo , Espermatozoides , Doadores de Tecidos/legislação & jurisprudência , Canadá , Feminino , Humanos , Masculino , Óvulo/citologia , Óvulo/fisiologia , Assistência Centrada no Paciente/legislação & jurisprudência , Mecanismo de Reembolso , Espermatozoides/citologia , Espermatozoides/fisiologiaAssuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Cuidados para Prolongar a Vida , Doadores Vivos/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Morte Encefálica , Humanos , Doadores Vivos/ética , Formulação de Políticas , Doadores de Tecidos/ética , Doadores de Tecidos/provisão & distribuiçãoRESUMO
With the ongoing and expanding use of willed bodies in medical education and research, there has been a concomitant rise in the need for willed bodies and an increase in the means of supplying these bodies. A relatively recent development to enlarge this supply has been the growth of for- profit willed body companies ("body brokers") in the United States. These companies advertise for donors, cover all cremation and other fees for the donor, distribute the bodies or body parts nationally and internationally, and charge their users for access to the body or body parts. In doing so, they generate substantial profits. This review examines the historical development of willed body programs, the legal and economic aspects of willed body programs, and then provides an ethical framework for the use of willed bodies. The ethical principles described include detailed informed consent from the donors, comprehensive and transparent information about the process from the body donation organizations, and societal input on the proper and legal handling of willed bodies. Based on the ethical principles outlined, it is recommended that there be no commercialization or commodification of willed bodies, and that programs that use willed bodies should not generate profit.
Assuntos
Anatomia/educação , Pesquisa Biomédica/métodos , Comércio/ética , Educação Médica/métodos , Obtenção de Tecidos e Órgãos/economia , Pesquisa Biomédica/economia , Pesquisa Biomédica/ética , Pesquisa Biomédica/legislação & jurisprudência , Cadáver , Comércio/história , Comércio/legislação & jurisprudência , Educação Médica/ética , Educação Médica/legislação & jurisprudência , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/história , Consentimento Livre e Esclarecido/legislação & jurisprudência , Princípios Morais , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/história , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Estados UnidosRESUMO
Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of donated oocytes, and donor compensation.
Assuntos
Concepção por Doadores/legislação & jurisprudência , Doação de Oócitos/legislação & jurisprudência , Técnicas de Reprodução Assistida/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Concepção por Doadores/economia , Feminino , Humanos , Jurisprudência , Doação de Oócitos/economia , Doação de Oócitos/métodos , Pais , Gravidez , Mães Substitutas/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudênciaAssuntos
Política de Saúde/legislação & jurisprudência , Transplante de Órgãos/legislação & jurisprudência , Consentimento Presumido/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Regulamentação Governamental , Política de Saúde/tendências , Humanos , Transplante de Órgãos/tendências , Formulação de Políticas , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/tendências , País de GalesRESUMO
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue.