Expanding renal transplantation organ donor pool in Nigeria.

Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.

[Hand transplantation in Sweden ­ preparations under way]. / Handtransplantation snart verklighet i Sverige.

English summary: Hand transplantation in Sweden - preparations under way Some patients with a uni- or bilateral hand- or forearm amputation cannot use a hand prosthesis, although high-tech prostheses have been developed. A hand transplantation, particularly for those with bilateral amputations, may be an alternative solution. In a hand-transplanted patient, grip function, strength, sensibility and subsequent improved quality of life can be restored. Risks related to immunosuppression must be balanced by expected benefits, and thorough selection of patients has to be performed from both medical and psychological point of view. Therefore, a national network has been established in Sweden to achieve coordination with the needed competence.

Quality assessment and performance improvement in transplantation: hype or hope?

PURPOSE OF REVIEW: Healthcare reform and the national quality strategy is increasingly impacting transplant practice, as exemplified by quality assessment and performance improvement (QAPI) regulations for pretransplant and posttransplant care. Transplant providers consider not just patient comorbidities, donor quality, and business constraints, but also regulatory mandates when deciding how to care for transplant candidates and recipients. This review describes transplant quality oversight agencies and regulations, and explores recent literature on the pros and cons of transplant QAPI. RECENT FINDINGS: Transplant's heavily regulated system of care and remuneration involves extensive QAPI process and outcome requirements, and assessment of lifelong, risk-adjusted data from the national, audited, publicly reported, electronic registry. Transplant is a model-integrated delivery system, with payment bundling and accountability for equitable access to high quality, efficient, cost-sensitive, and multidisciplinary care. However, transplant QAPI requires expensive resources and, to bolster wise risk-taking, novel treatments, and access to care, more nuanced risk adjustment, public reporting, and attention to geographic competitive variability. However, transplant QAPI requires expensive resources. In order to bolster wise risk-taking, novel treatments, and access to care, QAPI also requires more nuance in the areas of risk adjustment, public reporting, and attention to geographic competitive variability. SUMMARY: With its focus on innovation and on clinical outcomes, transplantation is poised to continue providing outstanding clinical care and to pioneering systems that advance patient safety, satisfaction, and resource utilization, leading in the field of QAPI and healthcare reform.

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.

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.

Organ donation consanguinity or universality.

1. Neither the "Diseased Persons" nor the "Genetic Relations" provide an answer to "trading" in human body parts. 2. Live human body constitutes a vital source of supply of organs and tissues and the possibilities of optimum utilisation should be explored. 3. There is no scope for dogmatic postures and open-mindedness should be the approach while dealing with the issue of Organ Transplantation. 4. Society owes a duty to save the file of a dying man and in the event of failure to do so, it is absolutely immoral to interfere with his own arrangements by making unrealistic laws. No immorality is involved if an individual disposes of his spare body parts for a valid consideration to a needy person. 5. The scarcity needs to be urgently overcome otherwise unwarranted trade and crime are liable to thrive. 6. Families are not unconnected or antagonistic fragments of humanity. After thousands of years of continuous efforts the individuals on this earth have attained the stage of organic and functional integration. Atomisation of society on the basis of consanguineous proximities amounts to reversing this holistic trend. Organ transplantation is a functional expression of a highly evolved pursuit with inherent and intimate interaction in the form of organic exchange at the individual level, independent of consanguineous inducements or motivations. As such there is absolutely no scope for restricting organ donations by strangers. 7. Commercialisation should be curbed by making the enforcement agencies more efficient and not by depriving a needy person of his genuine requirements. Legislative craftsmanship lies in providing an answer without curtailing the freedom of the people.

[Use of human body parts in the preparation of "protective medicine" in Lesotho. Parallels between African preventive medicine and drug preparations in Western paramedicine]. / Verwendung menschlicher Teile in der Zubereitung von "protective medicine" in Lesotho. Parallelen zwischen afrikanischer Schutzmedizin and Arzneimittelpräparationen der westlichen Paramedizin.

Special situations in life require very strong "protective medicine" which then has to contain human flesh. Such ingredients are obtained by so called medicine murder. Post-mortem examination on the victim, which in this case a difficult task, has to be performed by the medical officer in the District Hospitals of Lesotho. The exclusion of medicine murder has a calming effect on the community. Analysing the rationale of such medicine brings parallels to paramedical practice in our country.