Financial incentives for cadaver organ donation: an ethical reappraisal.

A panel of ethicists, organ procurement organization executives, physicians, and surgeons was convened by the sponsorship of the American Society of Transplant Surgeons to determine whether an ethically acceptable pilot trial could be proposed to provide a financial incentive for a family to consent to the donation of organs from a deceased relative. An ethical methodology was developed that could be applied to any proposal for monetary compensation to elucidate its ethical acceptability. An inverse relationship between financial incentives for increasing the families' consent for cadaver donation that clearly would be ethically acceptable (e.g., a contribution to a charity chosen by the family or a reimbursement for funeral expenses) and those approaches that would more likely increase the rate of donation (e.g., direct payment or tax incentive) was evident. The panel was unanimously opposed to the exchange of money for cadaver donor organs because either a direct payment or tax incentive would violate the ideal standard of altruism in organ donation and unacceptably commercialize the value of human life by commodifying donated organs. However, a majority of the panel members supported reimbursement for funeral expenses or a charitable contribution as an ethically permissible approach. The panel concluded that the concept of the organ as a gift could be sustained by a funeral reimbursement or charitable contribution that conveyed the appreciation of society to the family for their donation. Depending on the amount of reimbursement provided for funeral expenses, this approach could be ethically distinguished from a direct payment, by their intrusion into the realm of altruism and voluntariness. We suggest that a pilot project be conducted to determine whether this kind of a financial incentive would be acceptable to the public and successful in increasing organ donation.

MIC expression in renal and pancreatic allografts.

BACKGROUND: MHC class I chain-related antigen A (MICA) and MHC class I chain-related antigen B (MICB) are HLA class I related products of polymorphic MHC genes. Constitutive expression in normal tissue is limited to gut epithelium but can be induced in other epithelial cells by stress. Specific antibodies against MICA have been reported in the serum of patients who had rejected kidney allografts, suggesting a potential role for these molecules in transplant immunopathology. However, expression of MICA and MICB in transplanted organs has not been demonstrated. In this study, we report the expression of MICA and MICB in renal and pancreatic allograft biopsies, which were obtained due to clinical signs of rejection. METHODS: A monoclonal antibody directed against MICA and MICB was used to perform indirect immunohistochemistry on formalin fixed, paraffin embedded needle biopsies of kidney and pancreas allografts. The results of staining were then compared to the standard light microscopic evaluation of the biopsies for rejection. RESULTS: A total of 53 individual renal transplant biopsies and 19 pancreas transplant biopsies were assayed for expression of MIC. Histologically, renal biopsies were diagnosed as no rejection, acute tubular necrosis (ATN), acute rejection (AR), chronic rejection (CR), and acute and chronic rejection (ACR). No staining was observed in 7 of 10 kidneys showing no rejection. All 11 of the kidney biopsies with AR were positive, as were the 11 ATN cases, 9 of the 11 kidney biopsies with CR, and 7 of the 10 with ACR. The acini of normal, nontransplanted, pancreas, control specimen were consistently negative; however, islets were positive in all specimens. The acini and islets of five histologically normal pancreas biopsies were positive, as were the four biopsies with AR, seven biopsies with CR, and two with ACR. CONCLUSIONS: MICA and MICB are expressed in epithelial cells in allografted kidney and pancreas that show histologic evidence of rejection and/or cellular injury. In addition to previous findings of alloantibodies against MICA, expression of these gene products may play a role in allograft rejection.

Prediction of liquefaction - induced ground displacement near bridges

Liquefaction - induced ground displacement resulting from lateral spread is a major causes of bridge damage during large earthquakes. Most damage of this type occurs at river crossings where bridges are founded on thick, liquefiable deposits of floodplain alluvium. An estimate of the probable ground displacement at potentially liquefiable sites in an important parameter for engineers to design safe bridges and to assess potential losses for lateral spread. Tothis and, case histories of lateral spread displacement resulting from several major earthquakes were analyzed using multiple linear regression (MIR) techniques. This paper discusses the type of lateral spread damage to bridges and presents and empirical model that can be used to estimate liquefaction-induced horizontal ground displacement near bridge crossings (AU)

Empirical analysis of horizontal ground displacement generated by liquefaction - induced lateral spreads

Liquefaction-induced ground failure is responsible for considerable damage to engineered structures during major earthquakes. Presently, few empirical techniques exist for estimating the amount of horizontal ground dusplacement resulting from liquefaction-induced lateral spread. None of these techniques fully addresses all the earthquake and site conditions known to influence ground displacement. This study compiles earthquake, geological, topographical, and soil factors that affect ground displacement and develops empirical models from these factors. Case histories of lateral spread are gathered from the 1906 San Francisco, 1964 Alaska, 1964 Niigata, 1971 San Fernando, 1979 Imperial Valley, 1983 Nihonkai-Chubu, 1983 Borah Peak, Idaho, and 1987 Superstition Hills earthquakes. Multiple linear regression (MLR) is used to develop empirical models from the compiled data. Two general models are derived herein, one for free face failures and one for ground slope failures. The predictive performance of the proposed empirical models is determined by comparing predicted displacements with those actually measured at the case history sites (AU)

Empirical prediction of lateral spread displacement

Data compiled from case histories of liquefaction-induced lateral spread are used to develop an empirical model for predicting the amount of horizontal ground displacement at potentially liquefiable sites. Earthquake, topographical, geological, and soil factors associated with lateralspreads from eight major earthquakes are analyzed. Multiple linear regression (MLR) is used to determine which factors are most strongly correlated with horizontal ground displacement and an empirical model is developed from those factors. The perfomance of the MLR model is evaluated by comparing the displacements measured at the case history sites with those predicted by the model.(AU)