Attitudes of Turkish university employees and their relatives towards whole body and organ donation.

BACKGROUND: Dissection of human anatomic specimens still keeps its importance in medical curriculum. Experiences of medical students in the anatomy laboratory and the time they spent there makes them feel as doctors at the beginning of their education and helps them to get used to the notion of death. Unfortunately, the number of human body donors available for medical research and education as well as organ transplantation is limited. Obtaining human anatomic specimens continues being a great problem especially in middle-east countries. Religious factors, socioeconomic status, education, marital status or age are probably the main factors those effect body donations. The aim of the present study is to evaluate the attitudes of Turkish university employees and their relatives towards whole body donation and organ donation. METHODS: A total of 780 questionnaires taken from the participants were evaluated. All the participants were academic and administrative staff from four different universities based in Ankara, Eskisehir, Istanbul and Adana and their relatives. Participants were between the ages of 18-85. All the subjects were provided a questionnaire composed of 38 questions. FINDINGS: 26.2% of the individuals declared that they could donate their body for medical education while 73.8% of them did not. In contrast, 69.1% of the participants were willing for being organ donors. Of the ones who had accepted to donate their organs, 64.5% refused to donate their bodies. CONCLUSION: The results of this study indicate that not only whole body donation, but also organ donation continue being a problem in Turkey.

Leaving gift-giving behind: the ethical status of the human body and transplant medicine.

The paper argues that the idea of gift-giving and its associated imagery, which has been founding the ethics of organ transplants since the time of the first successful transplants, should be abandoned because it cannot effectively block arguments for (regulated) markets in human body parts. The imagery suggests that human bodies or their parts are transferable objects which belong to individuals. Such imagery is, however, neither a self-evident nor anthropologically unproblematic construal of the relation between a human being and their body. The paper proposes an alternative conceptualization of that relation, the identity view according to which a human being is identical with their living body. This view, which offers a new ethical perspective on some central concepts of transplant medicine and its ethical and legal standards and institutions, supports widely shared intuitive ethical judgments. On this proposal, an act of selling a human body or one of its parts is an act of trade in human beings, not in owned objects. Transfers of human body parts for treatment purposes are to be seen as sharing in another human being's misfortune rather than as giving owned objects. From the perspective of policy-making, the proposal requires, first, that informed consent for removal of transplant material be obtained from the potential benefactor. Secondly, explicit consent by the prospective benefactor is obligatory in the case of removal of transplant material from a living benefactor. Thirdly, in the case of posthumous retrieval, informed consent by the potential benefactor during their life is not ethically indispensable. Additionally, while refusal of posthumous retrieval expressed by a potential benefactor during their life must be respected, such a refusal needs ethical justification and explanation.

Percepción de los profesionales de la salud sobre las creencias y las tradiciones derivadas del Islam como barreras a la donación de órganos en Argelia / Healthcare professionals’ perceptions of Islamic beliefs and traditions as barriers to organ donation and transplantation in Algeria

Objetivo: Explorar la percepción que tienen los profesionales de la salud sobre la influencia de las creencias y tradiciones derivadas del Islam en la donación y el trasplante de órganos en Argelia. Método: Estudio cualitativo exploratorio mediante entrevistas personales semiestructuradas a 17 profesionales de la salud (nueve hombres y ocho mujeres) de diferentes especialidades en un hospital universitario en Argel (Argelia). Se realizó un análisis de contenido cualitativo de las transcripciones con la ayuda del software informático ATLAS.ti 5. Resultados: Las y los profesionales de salud consideran que las creencias religiosas no afectan a la donación en vida, pero opinan que tienen un impacto negativo en la donación de órganos cadavérica debido a la existencia de mitos derivados de la religión islámica y al desconocimiento de la población argelina sobre el posicionamiento de los líderes religiosos en relación al trasplante y a la donación de órganos. Conclusión: Existe confusión entre la población argelina sobre la postura del Islam en torno a la donación y el trasplante de órganos, que perjudica fundamentalmente a la tasa de donación cadavérica. La colaboración entre el sector sanitario y las figuras religiosas para sensibilizar a la población podría contribuir a mejorar la disposición de la población a donar sus órganos no solo en vida (AU)

Objective: The aim of this study is to explore healthcare professionals’ perception of the influence of Islamic beliefs and traditions concerning organ donation and transplants in Algeria. Methods: Exploratory qualitative study using individual semi-structured interviews of 17 healthcare professionals (9 men, 8 women) of different specialties in a University hospital in Algiers (Algeria). Qualitative content analysis of transcripts was performed using the computer software ATLAS.ti 5. Results: Healthcare professionals believe that religious beliefs do not affect living donation but say they have a negative impact on donation of cadaveric organs due to the existence of myths derived from the Islamic religion and lack of knowledge of the Algerian population about the positioning of religious leaders in relation to organ donation and transplantation. Conclusion: There is confusion among the Algerian population on the position of Islam around organ donation and transplantation, mainly to the detriment of the rate of cadaveric donation. Collaboration between the health sector and religious leaders to raise public awareness could improve the willingness of the population to donate organs after death (AU)

The Tzu Chi Silent Mentor Program: Application of Buddhist Ethics to Teach Student Physicians Empathy, Compassion, and Self-Sacrifice.

The Buddhist Tzu Chi Silent Mentor Program promotes the donation of one's body to science as a selfless act by appealing to the Buddhist ethics of compassion and self-sacrifice. Together, faculty, families, and donors help medical students to learn the technical, spiritual, emotional, and psychological aspects of medicine. Students assigned to each "Silent Mentor" visit the family to learn about the donor's life. They see photos and hear family members' stories. Afterwards, students write a brief biography of the donor which is posted on the program website, in the medical school, and on the dissection table. In this paper, we: (1) summarize the Silent Mentor Program; (2) describe findings from an assessment of medical students who recently completed a new version of the program in Malaysia; and (3) explore how healthcare settings could benefit from this innovative program.

Use of standardized patients to teach medical students about living organ donation.

Educators routinely use standardized patients to teach medical students a variety of clinical concepts. Standardized patients have also been used to teach students about medical ethics and deceased organ donation. Not reported before, however, is the use of standardized patients to educate medical students about the ethical issues in living organ donation. It seems important to fill this gap because in the United States, roughly 45% of organ donors are living donors, and these patients will visit physicians throughout their lifespan, not just with the occurrence of donation. This article reports an experience teaching concepts in living donation and transplant ethics to second-year osteopathic medicine students using a standardized patient and supplementary instructional materials (eg, film, panel discussion, reading list). Specifically, a transplant ethics module was created that included an actor portraying a living donor candidate who had a number of case variables pertaining to medical and psychosocial matters. Instructional themes included informed consent, altruism, patient selection criteria, organ vending, and post-donation support systems.

Views of midwives about ethical aspects of participation in placental perfusion studies.

BACKGROUND: Little is known regarding the role of the midwife in recruiting mothers to participate in scientific research. OBJECTIVE: To describe ethical aspects of participation of midwives in placental perfusion studies. DESIGN: Qualitative study involving thematic interviews and thematic content analysis. SETTING: Two university hospitals in Finland in 2008-2009. PARTICIPANTS: Midwives (n=20) who had been involved in recruiting mothers for a placental perfusion study. FINDINGS: Midwives felt that the situation, when inviting the mothers to donate their placentas, was restless and hasty because of the considerable number of tasks required during a birth. For recruitment, they explained how they tried their best to find a quiet opportunity to provide information about the placental perfusion study, so that the mother could take her time reading the written information. During a birth, it was difficult to give information to the mother in such a way that she would truly understand. Information for the mother was planned to be provided in an equal, dialogic conversation, with the subject of research introduced by the midwife. Placental perfusion studies as carried out in this setting were not seen to have any risks for the mothers, and midwives were under less strain in this study than in other medical research projects. The midwives considered it normal to use placentas in scientific research, and did not see any associated ethical problems. In their opinion, the use of placentas was acceptable and even desirable, provided that the mother was informed about the research and gave voluntary informed consent. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Recruitment must be taken into account in management of the ward, and should be planned so that no recruitment is undertaken during medical procedures. Midwives need more education about the research including the important aspects of the creation of general knowledge about substances which may harm the fetus. Dialogue is needed between the mother and the midwife to ensure genuine informed consent.

Ethical aspects in placental perfusion studies: views of the researchers.

Within the EU-project NewGeneris human placental perfusion has been used for predicting fetal exposure to food carcinogens. Within the work package of ethical aspects of the research, we studied opinions of the researchers (n = 23) who carried out perfusions of human placenta. Data were collected by focus group interviews (n = 12) and an open-ended questionnaire (n =19 of which 8 were also attending the group session) from scientists representing 9 different nationalities. Both types of data were analysed together thematically and with data triangulation. Studied researchers considered communication between all stakeholders extremely important. Good communication was considered a prerequisite for the recruitment of mothers to donate the placenta, as well as for the process of getting the informed consent. Voluntariness, confidentiality and societal meaning were mentioned as important by all studied researchers. Educating the hospital personnel was regarded as essential in order to provide the best possible information to the mothers. The researchers also pointed out that cultural aspects should be respected, and that in Western thinking placenta is mostly considered as waste. Some researchers suggested that current guidelines and processes for obtaining informed consent should be reviewed also from a cultural perspective. With the development of biobanks, the use of human tissues, including placenta will most probably increase in the future, and the awareness of ethical considerations both in legislation and in practice need support. Thus, continuous effort for better research ethics is essential and requires research on research ethics.

National Kidney Registry: 213 transplants in three years.

Since its establishment in 2008, the National Kidney Registry has facilitated 213 kidney transplants between unrelated living donors and recipients at 28 transplant centers. Rapid innovations in matching strategies, advanced computer technologies, good communication and an evolving understanding of the processes at participating transplant centers and histocompatibility laboratories are among the factors driving the success of the NKR. Virtual cross match accuracy has improved from 43% to 91% as a result of changes to the HLA typing requirements for potential donors and improved mechanisms to list unacceptable HLA antigens for sensitized patients. A uniform financial agreement among participating centers eliminated a major roadblock to facilitate unbalanced donor kidney exchanges among centers. The NKR transplanted 64% of the patients registered since 2008 and the average waiting time for those transplanted in 2010 was 11 months.

Chronic kidney disease, transplantation practices and transplantation law in Pakistan: opportunity for a global meditation.

The majority of countries have enacted edicts to regulate organ transplantation due to mounting recognition of its intricacies and increasing level of global disquiet. Frail national economy and status of health care infrastructure restricts access of the local population to both dialysis and transplantation in Pakistan. There is a surge in kidney transplantation activities, however. I have reported the enormity of organ crime in Pakistan. The number of commercial renal transplants range from 3000 to 4500. Foreign nationals share the marketplace. There are current attempts from the government to stop organ trade by strictly enforcing a recently sanctioned law on organ transplantation. Scarcity of comprehensive reliable data has hampered plausible assessments and indispensable modifications to facilitate designs for the future health care. Alternatives to organ transplantation will augment the choice of treatment modalities for a proliferating end-stage renal disease (ESRD) population. The whole array of existing therapeutic modalities for ESRD has to be utilized. Promoting a fresh culture of organ donation by strengthening of the family institution may be another objective.

Exploring transplant opportunities in Hmong culture: a case report.

A clinical case is used to explore the ethical complexities of solid organ donation and transplantation within the Hmong community in the United States. Although many cultures can present various ethical issues, the challenges of the Hmong belief system are unique and distinctly complex. Ways for the medical team to integrate with the Hmong value system to attempt to create an environment of transcultural respect and appreciation are described.

The remains of the body: human tissue, competence and consent in an age of profit.

Over the past few decades human tissues and fluids have increasingly become of interest to health-oriented research due to their potential use in the development of new diagnostic tools, drugs and treatment modalities. They have also become valuable commodities that figure prominently in the recovery of hormones for cosmetic purposes, the production of proteins and in a whole range of uses in the biopharmacological industry. Unfortunately, current understanding of the ethical and legal status of human tissue and fluids, and of the conditions under which they may be recovered and used, is somewhat uneven. The aim of this presentation is to outline the ethical and legal considerations that must be met if a recovery and use protocol is to meet appropriate standards.

End-of-life issues for aboriginal patients: a literature review.

OBJECTIVE: To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. SOURCES OF INFORMATION: MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. MAIN MESSAGE: All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters and various communication styles add to the challenge. CONCLUSION: Cultural differences exist between medical caregivers and aboriginal patients. These include different assumptions and expectations about how communication should occur, who should be involved, and the pace of decision making. Aboriginal patients might value indirect communication, use of silence, and sharing information and decision making with family and community members.

Controversia en el diagnóstico de la muerte encefálica y la donación de órganos: aspectos éticos, legales y culturales / Controversy in the diagnosis of brain death and organ donation: legal, ethical and cultural issues

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