Dilemma of commercial organ transplant in the Middle East.

In recent years, the Middle East has witnessed a significant rise in commercial transplantation activities. This practice is driven by a multitude of factors including economic disparities, inadequate healthcare infrastructure, and cultural attitudes towards organ donation. In this article, we try to explore the complex landscape of commercial transplantation within the Middle East, shedding light on the ethical, legal, and socio-economic dimensions of this contentious issue.

Ethical and Policy Issues Arising in Crowdfunding for Solid Organ Transplantation: A Content Analysis of Newspaper Coverage of Recipient and Donor Fundraising Campaigns.

BACKGROUND: Solid organ transplantation improves the quality of life for patients but has significant out-of-pocket expenses for donors and recipients in the USA, leading many to utilize crowdfunding for donations to cover expenses. We sought to characterize crowdfunding for transplant patients and to identify ethical and policy issues. METHODS: We obtained newspaper articles that described crowdfunding campaigns for organ transplant patients from Nexis-Uni. Using Nvivo, we identified and analyzed article details, patient characteristics, features of campaigns, additional fundraisers, and policy and ethical issues related to crowdfunding. RESULTS: Most sources were published between 2015 and 2020. Of 231 patients identified, 43% were thoracic organ recipients and 42% were kidney recipients. GoFundMe was the most popular platform. 78% of patients reported at least one intended use of crowdfunding; medical expenses were the most cited reason. Ten percent of articles described at least one ethical or policy consideration related to crowdfunding for organ transplant. Concerns included violations of federal laws prohibiting donors from receiving "valuable consideration" for an organ, taxation of funds, loss of Medicaid or disability benefits, accountability for fund usage, and crowdfunding requirements for organ waiting list placement. In several cases, transplants were delayed due to crowdfunding concerns. CONCLUSIONS: Our findings reveal crowdfunding characteristics and financial barriers present among transplant patients. Furthermore, our study suggests that the ethical and policy implications for crowdfunding in the transplant population are not yet adequately assessed. National regulations and transplant center policies may need to be modified to address issues raised by patient crowdfunding.

American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Ethical, Legal, and Operational Conformance.

BACKGROUND: The American Society of Transplant Surgeons convened a multidisciplinary working group to address operational, ethical, and legal considerations surrounding normothermic regional perfusion (NRP) procurement. METHODS: The working group, comprising members from American Society of Transplant Surgeons and AST across various disciplines including transplant surgery, hepatology, critical care, and bioethics, collaborated to formulate recommendations and guidance for NRP procurement. RESULTS: The following topics were identified by the group as essential standards that need to be addressed for ethical, legal, and operational conformance: terminology; conceptualization of death in the context of NRP; and communication, logistics, and training and competency. CONCLUSIONS: Fourteen recommendations that support the ethical and legal acceptability of NRP in the United States and set expectations for the conduct of NRP procedures are provided.

Midwifery students' spiritual and ethical values and their views and attitudes towards uterine transplantation: A qualitative study.

This qualitative study was conducted to examine the relationship between Muslim midwives' spiritual values and ethical orientations and their attitudes towards uterine transplantation. The phenomenological study sample group consisted of students in the Midwifery undergraduate programme of a public university in Istanbul (n:26). The data were collected in semi-structured focus group interviews. It was among the student midwives, it was determined that some students rejected uterine transplantation with thoughts such as "I am a Muslim, according to my religious belief, I should go to the grave without damaging my organs" or "This transplantation is not a vital necessity", as well as students who considered uterine transplantation as religious and ethically appropriate. It was determined that midwife candidates who will provide reproductive health services have different ethical and moral views regarding uterus transplantation, and there are some who see this method as religiously acceptable, and there are also students who emphasize that it is not suitable for Islam. In addition, training programs are planned to increase students' awareness and knowledge on this subject, aiming to be beneficial to the women they will care for in the future.

Cette étude qualitative a été menée pour examiner la relation entre les valeurs spirituelles et les orientations éthiques des sages-femmes musulmanes et leurs attitudes à l'égard de la transplantation utérine. Le groupe échantillon de l'étude phénoménologique était composé d'étudiants du programme de premier cycle de sages-femmes d'une université publique d'Istanbul (n : 26). Les données ont été recueillies lors d'entretiens de groupe semi-structurés. Parmi les étudiantes sages-femmes, il a été déterminé que certaines étudiantes rejetaient la transplantation utérine avec des pensées telles que "Je suis musulmane, selon ma croyance religieuse, je devrais aller dans la tombe sans endommager mes organes" ou "Cette transplantation n'est pas une nécessité vitale", ainsi que des étudiants qui considéraient la transplantation utérine comme religieusement et éthiquement appropriée. Il a été déterminé que les candidates sages-femmes qui fourniront des services de santé reproductive ont des opinions éthiques et morales différentes concernant la transplantation d'utérus. Certaines personnes considèrent cette méthode comme religieusement acceptable, et d'autres étudiants soulignent qu'elle n'est pas adaptée à l'Islam. De plus, des programmes de formation sont prévus pour accroître la sensibilisation et les connaissances des étudiants sur ce sujet, dans le but d'être bénéfiques aux femmes dont elles s'occuperont à l'avenir.

Another Defense of Abortion: What Transplant Ethics Tells Us about the Ethics of Abortion after Dobbs.

In 1971, two years before Roe v. Wade affirmed federal protection for abortion, Judith Jarvis Thomson attempted to demonstrate the wrongs of forced gestation through analogy: you awake to find that the world's most esteemed violinist is wholly, physically dependent on you for life support. Here, the authors suggest that Thomson's intuition, that there is a relevant similarity between providing living kidney support and forced gestation, is realized in the contemporary practice of living organ donation. After detailing the robust analogy between living kidney donation and gestation, we turn to current ethical guidelines incorporated in the United Network for Organ Sharing's requirements for legally authorized organ donation and transplantation. We conclude that if, as we-and Thomson-suggest, organ donation and gestation are relevantly similar, then the ethical framework supporting donation may aid in articulating ethical grounds that will be compelling in informing the legal grounds for a defense of abortion.

An Ethics Committee's Evaluation of Normothermic Regional Perfusion (NRP) in 2018-Unsatisfactory Answers Then-and Now.

An adult university hospital ethics committee evaluated a proposed TA-NRP protocol in the fall of 2018. The protocol raised ethical concerns about violation of the Uniform Determination of Death Act and the prohibition known as the Dead Donor Rule, with potential resultant legal consequences. An additional concern was the potential for increased mistrust by the community of organ donation and transplantation. The ethics committee evaluated the responses to these concerns as unable to surmount the ethical and legal boundaries and the ethics committee declined to endorse the procedure. These concerns endure.

Road To Deceased Donor Transplantation in Egypt.

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.

Should Antimicrobial Resistance Limit Access to an Organ Transplant?

Burkholderia cenocepacia (B cenocepacia) is a gram-negative bacteria associated with significant morbidity and mortality following lung transplantation. Most US transplant programs consider B cenocepacia colonization to be an absolute contraindication to transplantation. This article argues that, if clinicians have good clinical reasons to expect poor outcomes for patients with B cenocepacia, then offering transplantation anyway is an abrogation of clinicians' fiduciary duties. This article also discusses other fiduciary obligations transplant programs might have to patients with B cenocepacia, such as referring to another transplant center, considering novel treatment options, and investigating how the infection's virulence factors stratify that patient's risk for poor transplant outcomes.

Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion.

In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's-more and higher-quality organs and more efficient allocation-can be achieved by removing organs from deceased donors and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call "ethical parsimony," which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy-makers should favor NMP over NRP.

Squaring the Circle. Brain death and organ transplantation.

PURPOSE OF REVIEW: The adoption of brain death played a crucial role in the development of organ transplantation, but the concept has become increasingly controversial. This essay will explore the current state of the controversy and its implications for the field. RECENT DEVELOPMENTS: The brain death debate, long limited to the bioethics community, has in recent years burst into the public consciousness following several high-profile cases. This has culminated in the reevaluation of the Uniform Determination of Death Act (UDDA), which is in the process of being updated. Any change to the UDDA has the potential to significantly impact the availability of organs. SUMMARY: The current update to the UDDA introduces an element of uncertainty, one the brain death debate had not previously had.

Developing Guidance for Donor Intervention Randomized Controlled Trials: Initial Discussions From the Canada-United Kingdom 2022 Workshop.

BACKGROUND: Donor interventions, including medications, protocols, and medical devices administered to donors, can enhance transplantable organ quality and quantity and maximize transplantation success. However, there is paucity of high-quality evidence about their effectiveness, in part because of ethical, practical, and regulatory challenges, and lack of guidance about conduct of donor intervention randomized controlled trials (RCTs). METHODS: With the vision to develop authoritative guidance for conduct of donor intervention RCTs, we convened a workshop of Canadian-United Kingdom experts in organ donation and transplantation ethics, research, and policy to identify stakeholders, explore unique challenges, and develop research agenda to inform future work in this promising field. RESULTS: Donor intervention trials should consider perspectives of broad group of stakeholders including donors, transplant recipients, and their families; researchers in donation and transplantation; research ethics boards; and healthcare providers and administrators involved in donation and transplantation. Unique challenges include (1) research ethics (living versus deceased status of the donor at the time of intervention, intervention versus outcomes assessment in different individuals, harm-benefit analysis in donors versus recipients, consent, and impact on research bystanders); (2) outcome data standardization and linkage; and (3) regulatory and governance considerations. CONCLUSIONS: Donor intervention RCTs hold potential to benefit organ transplantation outcomes but face unique research ethics, outcome data, and regulatory challenges. By developing research agenda to address these challenges, our workshop was an important first step toward developing Canada-United Kingdom guidance for donor intervention RCTs that are poised to improve the quality and availability of transplantable organs.

Transplantation in the Context of Migration and Refugees: A Summary of the DICG and TTS Ethics Committee Workshop, Buenos Aires, Argentina, September 2022.

Global conflicts and humanitarian crises have resulted in an unprecedented number of refugees and migrants. This challenges the limited resources of health care systems and jeopardizes the availability of transplant care for these deserving migrants and refugees. This was the basis for a workshop held during the Congress of the Transplantation Society (Buenos Aires, 2022). We elaborate on the proceedings of the workshop entitled "Transplantation in the Context of Migration and Refugees," organized by the Ethics Committee of The Transplantation Society and Declaration of Istanbul Custodian Group. Transplant providers from around the world shared strategies of how each region has responded to providing access to care for refugees and migrants in need of transplant services. The potential exploitation of this vulnerable group leading to illicit organ removal was addressed for each region. The Transplantation Society, Declaration of Istanbul Custodian Group, and global transplant community should continue to focus on the status of refugees and migrants and collaborate on strategies to provide access to transplant care for this deserving population. Global cooperation will be essential to provide vigilant oversight to prevent exploitation of this vulnerable population.

Living Donor Ethics and Uterus Transplantation.

This article provides an in-depth ethical analysis of living donor uterus transplantation, incorporating clinical, psychological, and qualitative study data into the discussion. Although the concept of living organ donors as patients in their own right has not always been present in the field of transplantation, this conceptualization informs the framework for living donor ethics that we apply to living uterus donation. This framework takes root in the principles of research ethics, which include respect for persons, beneficence, and justice. It incorporates an analysis based on eight potential vulnerabilities of living donors: capacitational, juridic, deferential, social, medical, situational, allocational, and infrastructural. Finally, it recognizes that special relationships-such as that of the living donor advocate with the potential donor-require special responsibilities, including identifying vulnerabilities and engaging donors in a shared decision-making process. Directed and non-directed uterus donors require separate ethical analyses because their different relationships with recipients will influence the types of vulnerabilities, they are subject to as well as the potential benefits they may gain from donation.

Ethical dilemmas and principles in organ transplantation in China / Dilemas y principios éticos en el trasplante de órganos en China / Dilemas e princípios éticos no transplante de órgãos na China

Abstract In medical clinical practice, organ transplantation is mainly applied to patients with end-stage organ lesions and organ failure. However, with the development of organ transplantation, many ethical issues and controversies have arisen. From the perspective of bioethics, the article compares the relevant ethical and legal regulations of organ transplantation in various countries. Due to the complexity of the real situation, many ethical dilemmas arise in organ transplantation in China. The article analyzes and researches three aspects of organ donation, distribution, and trading, and finds that there are various ethical problems in these three aspects of organ transplantation in China, such as whether the principle of presumed consent is ethical, whether brain death is legalized, the selection and determination of transplant patients, and whether human organ trading is legalized, etc. With the help of the four principles of bioethics and the current development of organ transplantation in China, the article proposes that organ transplantation in China should follow four ethical principles: the principle of respect for life, the principle of do no harm/benefit, the principle of respect for autonomy, and the principle of justice, in order to provide a defense for the legitimacy of organ transplantation.

Resumen En la práctica clínica médica, el trasplante de órganos se aplica principalmente a los pacientes con lesiones orgánicas en fase terminal y con insuficiencia orgánica. Sin embargo, con el desarrollo del trasplante de órganos, han surgido muchas cuestiones éticas y controversias. Desde la perspectiva de la bioética, el artículo compara las normas éticas y jurídicas pertinentes del trasplante de órganos en varios países. Debido a la complejidad de la situación real, surgen muchos dilemas éticos en el trasplante de órganos en China. El artículo analiza e investiga tres aspectos de la donación, la distribución y el comercio de órganos, y constata que hay varios problemas éticos en estos tres aspectos del trasplante de órganos en China, como si el principio del consentimiento presunto es ético, si la muerte cerebral está legalizada, la selección y determinación de los pacientes de trasplante y si el comercio de órganos humanos está legalizado, etc. Con la ayuda de los cuatro principios de la bioética y el desarrollo actual del trasplante de órganos en China, el artículo propone que el trasplante de órganos en China debe seguir cuatro principios éticos: el principio de respeto a la vida, el principio de no hacer daño/beneficio, el principio de respeto a la autonomía y el principio de justicia, con el fin de proporcionar una defensa de la legitimidad del trasplante de órganos.

Resumo Na prática clínica médica, o transplante de órgãos é principalmente destinado a pacientes em estágio final de lesões e falência dos órgãos. Entretanto, com o desenvolvimento do transplante de órgãos, surgiram muitas questões e controvérsias éticas. O artigo compara, desde uma perspectiva bioética, as regulações éticas e legais relevantes sobre transplantes de órgãos em vários países. Devido à complexidade da situação real, muitos dilemas éticos surgiram no transplante de órgãos na China. O artigo analisa e investiga aspectos de doação, distribuição e comercialização de órgãos, e encontra que há vários problemas éticos nestes três aspectos do transplante de órgãos na China, tais como se o princípio do consentimento presumido é ético, se morte cerebral é legalizada, a seleção e determinação de pacientes que irão receber transplante, se a comercialização de órgãos humanos é legalizada, etc. O artigo propõe, com a ajuda de quatro princípios da bioética e o desenvolvimento atual de transplante de órgãos na China, que o transplante de órgãos na China deve seguir quatro princípios éticos: o princípio do respeito à vida, o princípio de beneficiar/não causar dano, o princípio do respeito pela autonomia e o princípio da justiça, de forma a possibilitar a defesa da legitimidade do transplante de órgãos.