Ethical analysis of organ recovery denials by medical examiners, coroners, and justices of the peace.

CONTEXT: Despite its pivotal nature, until the early 1990s the role of medical examiners, coroners, and justices of the peace was largely ignored in discussions of the critical shortage of organs for transplantation in the United States. These officials have the right to determine, from a medico-legal perspective, whether a deceased person can be an organ donor. Thus, they play an important role in the donation process. Using a principles-based ethical framework, this article examines the problem of nonrecovery of life-saving organs for transplantation in the United States because a medical examiner or other official denies recovery. OBJECTIVE: The goals of organ donation and the collection of forensic evidence are not mutually exclusive. An analysis of the ethical principles and obligations of beneficence, respect for autonomy, and justice reveals that medical examiners and other officials could probably, after appropriate review, release all cases under their jurisdiction for organ donation. CONCLUSION: Medical examiners, coroners, and justices of the peace could assume a leadership role, working together on public policy with medical, social, and legal groups, spearheading efforts to stop the loss of organs due to official denials, up to and including state and federal regulation and legislation. Beyond their professional obligations, as agents of a social institution, medical examiners and other officials have the more general ethical responsibility of promoting the public health and welfare and of reinforcing societal consensus that transplantation is a social good which should be optimized through formal and informal activities.

Urinary volume, creatinine and thiocyanate of Africans of a tropical savanna region.

For 130 healthy African subjects of savanna region, the 24 h urine output was found to be of the order of 1000 ml. This appears somewhat less than levels found among temperate region peoples. These results permit one to grossly evaluate 24 h excretion of substances on rapid field studies. The creatinine urine excretions found, confirm the known characteristics--the variability with age, sex and amount of muscular tissue. Further the 24 h excretion cannot be accurately measured when one calculates it on the basis of urine creatinine excretion of a single micturition; therefore for an accurate measure one needs controlled 24-h urine collections. The urine thiocyanate excretion of this non-goitrous population on a low cassava diet is significantly lower than that found in an endemic goitrous population.