Investigating moral distress over a shortage of organs for transplantation / Investigando la angustia moral por la escasez de órganos para trasplantes / Investigando sofrimento moral por falta de órgãos para transplante

Abstract We verified moral distress related to organ shortage for transplantation in nursing students. This quantitative pilot study analyzed data from 104 nursing undergraduate students. Data were collected through a survey composed of four questions and two sociodemographic items. The chi-squared test was used to examine categorical variables, whereas continuous variable data were analyzed using ANOVA and the Pearson Product Moment correlational test for determining the existence of moral distress regarding the availability of one heart for four individuals susceptible to heart transplantation. A high level of moral distress was identified with regard to the hypothetical decision-making process, which justifies the need for further studies on the subject. Given the hypothetical scenario, moral distress was observed among the students, reaching severe distress in some cases. Approval CEP-University of Alberta Pro00068610

Resumen Nuestro objetivo con esta investigación fue identificar la angustia moral en estudiantes de enfermería relacionada con la escasez de órganos para trasplante. Este es un estudio piloto cuantitativo que analizó datos de 104 estudiantes de grado de enfermería. Los datos fueron recolectados a través de una investigación compuesta por 4 preguntas y 2 ítems sociodemográficos. Posteriormente, se utilizó la prueba de Chi-cuadrado para examinar las variables categóricas, mientras que las variables continuas se analizaron utilizando las pruebas correlacionales Anova y Pearson Product Moment para determinar la existencia de angustia moral en relación con la disponibilidad de un corazón para cuatro personas que requieren el trasplante. Se identificó un alto nivel de angustia moral en relación con el hipotético proceso de toma de decisiones, lo que justifica la necesidad de realizar más estudios sobre el tema. Dada la situación hipotética, la angustia moral entre los estudiantes, incluida la angustia severa, es notable. Aprobado CEP-University of Alberta Pro00068610

Resumo Objetivou-se identificar sofrimento moral em estudantes de enfermagem relacionado à escassez de órgãos para transplante. Este estudo-piloto quantitativo analisou dados de 104 graduandos de enfermagem. Os dados foram coletados por meio de questionário composto de quatro questões e dois itens sociodemográficos. O teste qui--quadrado foi usado para examinar as variáveis categóricas, enquanto as variáveis contínuas foram analisadas utilizando os testes correlacionais Anova e Pearson Product Moment a fim de determinar a existência de sofrimento moral quanto à disponibilidade de um coração para quatro indivíduos que necessitam de transplante. Identificou-se alto nível de sofrimento moral relacionado ao processo de tomada de decisão hipotético, o que justifica a necessidade de novos estudos acerca do tema. Diante da situação hipotética, observou-se sofrimento moral entre estudantes, incluindo sofrimento severo. Aprovação CEP-University of Alberta Pro00068610

Evolución de la legislación brasileña sobre donación y trasplante de órganos / Evolution of the Brazilian legislation on organ donation and transplantation / Evolução da legislação brasileira sobre doação e transplante de órgãos

Resumen: El trasplante de órganos representa uno de los capítulos más exitosos en la historia de la salud mundial. Esta práctica terapéutica ya no es asociada, como otrora, al riesgo del procedimiento, sino a la oportunidad de ofrecer una nueva vida al receptor. El trasplante depende de la aceptación de la donación de órganos que, por involucrar aspectos relacionados con la vida y la muerte, implica dilemas éticos que estimulan la formulación de normas a su respecto. Este estudio tuvo como objetivo reflexionar sobre la evolución de la legislación brasileña que regula el Sistema Nacional de Trasplantes en lo que se refiere al proceso donación-trasplante, teniendo como foco los aspectos bioéticos asociados a la temática. Se identificó que la comprensión de la legislación en materia de salud propicia una actuación basada en los derechos fundamentales y la dignidad humana por parte del profesional de la salud. Desde esta perspectiva, es esencial que los profesionales de la salud posean, además de conocimientos técnicos, conocimientos jurídicos y comprensión de las normas existentes y su evolución, con el fin de garantizar los derechos fundamentales de las personas.

Abstract: Organ transplantation represents one of the most successful chapters in the history of world health. This therapeutic practice is no longer associated, as once, with the risk of the procedure, but with the opportunity to offer a new life to the recipient. The transplant depends on the acceptance of the donation of organs that, by involving aspects related to life and death, implies ethical dilemmas that stimulate the formulation of norms in this regard. This study aimed to reflect on the evolution of Brazilian legislation that regulates the National Transplant System in regard to the donation-transplant process, focusing on the bioethical aspects associated with the subject. It was identified that the understanding of health legislation encourages action based on fundamental rights and human dignity by the health professional. From this perspective, it is essential that health professionals possess, in addition to technical knowledge, legal knowledge and understanding of existing norms and their evolution, in order to guarantee the fundamental rights of people.

Resumo: O transplante de órgãos representa um dos capítulos de mais sucesso na história da saúde mundial. Essa prática terapêutica já não é associada, como antes, ao risco do procedimento, mas, sim, à oportunidade de oferecer uma nova vida ao receptor. O transplante depende da aceitação da doação de órgãos que, por envolver aspectos relacionados com a vida e a morte, implica dilemas éticos que estimulam a formulação de normas a seu respeito. Este estudo teve como objetivo refletir sobre a evolução da legislação brasileira que regula o Sistema Nacional de Transplante no que se refere ao processo doação-transplante, tendo como foco os aspectos bioéticos associados à temática. Identificou-se que o entendimento da legislação em matéria de saúde propicia uma atuação baseada nos direitos fundamentais e na dignidade humana por parte do profissional da saúde. A partir dessa perspectiva, é essencial que os profissionais da saúde possuam, além de conhecimentos técnicos, conhecimentos jurídicos e entendimento das normas existentes e sua evolução, com o fim de garantir os direitos fundamentais das pessoas.

Perspectives toward brain death diagnosis and management of the potential organ donor.

BACKGROUND: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical-legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. AIM: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. STUDY DESIGN: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. ETHICAL CONSIDERATIONS: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. RESULTS: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation-transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical-legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse's duties toward the brain dead person. CONCLUSION: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.

Evaluation of the therapeutic effect of methylene blue on the liver of rats submitted to ischemia and reperfusion

Abstract Purpose: To analyze the effect of methylene blue (MB) therapy during the liver ischemia-reperfusion injury (I/R) process. Methods: Thirty-five male Wistar rats were used, (70%) submitted to partial ischemia (IR) or not (NIR) (30%) were obtained from the same animal. These animals were divided into six groups: 1) Sham (SH), 2) Sham with MB (SH-MB); 3) I/R, submitted to 60 minutes of partial ischemia and 15 minutes of reperfusion; 4) NI/R, without I/R obtained from the same animal of group I/R; 5) I/R-MB submitted to I/R and MB and 6) NI/R-MB, without I/R. Mitochondrial function was evaluated. Osmotic swelling of mitochondria as well as the determination of malondialdehyde (MDA) was evaluated. Serum (ALT/AST) dosages were also performed. MB was used at the concentration of 15mg/kg, 15 minutes before hepatic reperfusion. Statistical analysis was done by the Mann Whitney test at 5%. Results: State 3 shows inhibition in all ischemic groups. State 4 was increased in all groups, except the I/R-MB and NI/R-MB groups. RCR showed a decrease in all I/R and NI/R groups. Mitochondrial osmotic swelling showed an increase in all I/R NI/R groups in the presence or absence of MB. About MDA, there was a decrease in SH values in the presence of MB and this decrease was maintained in the I/R group. AST levels were increased in all ischemic with or without MB. Conclusions: The methylene blue was not able to restore the mitochondrial parameters studied. Also, it was able to decrease lipid peroxidation, preventing the formation of reactive oxygen species.

Liver ischemia and reperfusion injury. Pathophysiology and new horizons in preconditioning and therapy.

It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.

Liver ischemia and reperfusion injury. Pathophysiology and new horizons in preconditioning and therapy

Abstract It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.

Evaluation of the therapeutic effect of methylene blue on the liver of rats submitted to ischemia and reperfusion.

PURPOSE: To analyze the effect of methylene blue (MB) therapy during the liver ischemia-reperfusion injury (I/R) process. METHODS: Thirty-five male Wistar rats were used, (70%) submitted to partial ischemia (IR) or not (NIR) (30%) were obtained from the same animal. These animals were divided into six groups: 1) Sham (SH), 2) Sham with MB (SH-MB); 3) I/R, submitted to 60 minutes of partial ischemia and 15 minutes of reperfusion; 4) NI/R, without I/R obtained from the same animal of group I/R; 5) I/R-MB submitted to I/R and MB and 6) NI/R-MB, without I/R. Mitochondrial function was evaluated. Osmotic swelling of mitochondria as well as the determination of malondialdehyde (MDA) was evaluated. Serum (ALT/AST) dosages were also performed. MB was used at the concentration of 15mg/kg, 15 minutes before hepatic reperfusion. Statistical analysis was done by the Mann Whitney test at 5%. RESULTS: State 3 shows inhibition in all ischemic groups. State 4 was increased in all groups, except the I/R-MB and NI/R-MB groups. RCR showed a decrease in all I/R and NI/R groups. Mitochondrial osmotic swelling showed an increase in all I/R NI/R groups in the presence or absence of MB. About MDA, there was a decrease in SH values in the presence of MB and this decrease was maintained in the I/R group. AST levels were increased in all ischemic with or without MB. CONCLUSIONS: The methylene blue was not able to restore the mitochondrial parameters studied. Also, it was able to decrease lipid peroxidation, preventing the formation of reactive oxygen species.

Doação de órgãos: tema bioético à luz da legislação / Organ donation: a bioethical issue in the light of legislation / Donación de órganos: tema bioético a la luz de la legislación

Resumo Objetivou-se analisar a opinião de profissionais de saúde que atuam no processo de doação e transplante de órgãos a respeito da implementação da Lei 10.211/2001, que regula o consentimento familiar para a doação de órgãos no Brasil. Trata-se de estudo qualitativo desenvolvido em hospital universitário do interior paulista. Os resultados mostram que a maioria dos profissionais de saúde concorda com o consentimento familiar para obtenção de órgãos para transplante. Contudo, há discordâncias quanto à forma de se obter esse consentimento. Conclui-se que são necessárias ações de conscientização urgentes direcionadas à população e a profissionais de saúde com relação à doação, buscando atingir o cumprimento efetivo da legislação e, sobretudo, aumentar substancialmente o número de órgãos disponíveis para transplante.

Abstract This study aimed to analyze the opinion of health professionals that work in the organ donation and organ transplant process regarding the implementation of Law 10,211/2001, which deals with family consent for organ donation in Brazil. It is a qualitative study conducted in a university hospital in the state of São Paulo. The results show that the majority of health professionals agree with family consent to obtain organs for transplantation. However, there is disagreement as to how to obtain this consent. The study concludes that it is necessary to promote urgent actions for awareness regarding donation amongst the public and health professionals, aiming to achieve compliance with the law, and, most of all, to increase the number of organs available for transplant.

Resumen Este estudio tuvo como objetivo analizar la opinión de los profesionales de la salud que trabajan en el proceso de donación y trasplante de órganos en relación a la aplicación de la Ley 10.211/2001, que se ocupa del consentimiento familiar para la donación de órganos en Brasil. Se trata de un estudio cualitativo realizado en un hospital universitario en el estado de São Paulo. Los resultados muestran que la mayor parte de los profesionales de la salud están de acuerdo con el consentimiento familiar para obtener órganos para trasplantes. Sin embargo, hay desacuerdo sobre cómo obtener este consentimiento. Se concluye que es necesario promover acciones de concientización urgentes sobre la donación de órganos, dirigidas a la población en general y a los profesionales de la salud, procurando alcanzar el cumplimiento efectivo de la legislación y, sobre todo, aumentar el número de órganos disponibles para trasplante.