Critical appraisals and cultural acceptance of the dead donor rule: A revisit of the contemporary transplantation era

Transplantation remains one of the most rapidly expanding surgical specialties. Harvesting organs plays a crucial step in this highly complex surgical and communication process, and the moment at which vital organs can be donated depends on the declaration of end-of-life. This declaration must be performed by medical practitioners on the basis of clear standardized criteria of death confirmation, within competent local and regional jurisdictions, and with the use of confirmatory tests as indicated to ascertain the irreversibility of end-of-life. The current medically and legally accepted definition of death in most societies challenges the traditional and societal understandings of the process of end-of-life. Significant criticisms and cultural oppositions to transplantation still exist, and there is an ongoing debate about the role and the status of transplantation as surgical and medical sciences continue to evolve. By discussing the social acceptance and common understanding of end-of-life determination, we aim to highlight the current knowledge on transplant ethics with respect to the balance between the need to protect the potential organ donor and the need to donate organs at their utmost viability. No report has been done on social acceptance of transplantation in Rwanda or other Low- and Middle-Income countries (LMIC); though, as emphasis on organ transplantation evolves, we also aim to highlight the need for clear directions towards new transplantation regulations. Technical and non-technical critical arguments and moral acceptance are juxtaposed with the elucidated ethical and deontological principles to support the contemporary concept of the dead donor rule

Intracranial aneurysms clipping in Rwanda, can it be done? What are the challenges?

Background: Intracranial aneurysms are vascular abnormalities that cause outpouching of the arterial wall [1]. Although they are not uncommon, there is scanty information regarding intracranial aneurysms in Africa [2]. Intracranial aneurysms are often asymptomatic until they cause symptoms and signs resulting from mass compression and/ or spillage of blood products into the arachnoid space. Currently available diagnostic tools are computed tomography (CT) angiography, magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) [1]. In our setting we continue to diagnose and achieve clipping of intracranial aneurysms amongst the currently available choices of managing intracranial aneurysms.Objectives: To establish the feasibility and reflect on the challenges of clipping intracranial aneurysms in our settings. To raise awareness among health professionals and the general population.Methods: This is a retrospective case series of 5 patients diagnosed with intracranial aneurysms at King Faisal Hospital and Kigali University Teaching Hospital from October 2014 to October 2015. Available diagnostic methods used are the computed tomography (CT) angiography and/ or magnetic resonance angiography (MRA). We have excluded cases that were diagnosed with intracranial aneurysm at autopsy.Results: Five patients met inclusion criteria for our study. We describe case by case, the choices of therapeutic measures, the challenges encountered during their management and their outcome.Conclusion: Despite the challenges, intracranial aneurysms are treatable in Rwanda with good outcome. However, there is still lack of awareness about this pathology