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2.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
3.
Ir J Med Sci ; 188(4): 1185-1189, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30798504

RESUMO

Living donor liver transplantation (LDLT) has evolved rapidly in Asia with good outcomes for both donor and recipient. Nonetheless, LDLT remains a highly demanding technique and complex surgery. The potential risks to the donors provide the basis for many of the ethical dilemmas associated with LDLT. The transplant team must have a good knowledge of the principles of bioethics in order to handle these matters. To look after the need, donor's safety and the chance for good recipient outcomes, the principles of respect for the donor's autonomy, beneficence, and non-maleficence should be practiced. In accordance with the concept of equipoise, the risk to the donor must balance the benefit to the recipient. The transplant center should have adequate experience and proven expertise in LDLT. There are concerns regarding the validity of informed consent given by the donor. While donations to non-relative patients may, at first sight, indicate radical altruism, it is important to apply careful scrutiny. Though organ trading is strictly prohibited by the law, there seems to be an inherent risk with directed donations to strangers. Transplant tourism has flourished in some countries in spite of the existence of strict laws. There are reservations regarding transplantation done by foreign visiting teams. Donor websites facilitating patients and donors and Facebook pages bear no responsibility for the outcomes of their matches and cannot ensure sufficient and accurate information about donation, transplantation, and post-operation life. Telemedicine and virtual consultations appeared to work better when the clinician and the patient know and trust each other.


Assuntos
Consentimento Livre e Esclarecido/ética , Transplante de Fígado/ética , Doadores Vivos/ética , Ásia , Humanos , Turismo Médico/ética , Período Pós-Operatório , Telemedicina
5.
Transplant Proc ; 50(10): 3053-3058, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577165

RESUMO

BACKGROUND: Transplant societies continue to actively concentrate on increasing rates of living kidney donation (LKD) to bridge the gap between individuals awaiting transplantation and the number of kidneys available. A widely discussed strategy to increase living donation rates is the provision of incentives and removal of disincentives. Though opinions of the public regarding this strategy have been studied, the opinions of health care providers, including younger professionals, are less clear. We studied the opinions of medical students and other health care providers on strategies to increase LKD to determine if opinions were different among those < 25 or ≥ 25 years of age. METHODS: A simple cross-sectional survey was conducted at an academic medical center. Participants included medical students and employees in Internal Medicine, General Surgery, and the Organ Transplantation Center. Pearson's χ2 and Fisher's exact test were conducted on the responses regarding disincentives and incentives to determine whether opinions differed based on age. RESULTS: Six hundred and twenty-four participants completed the survey. There was no statistical difference in opinions between groups on reimbursing transportation costs, loss of wages, or childcare costs, but those aged ≥ 25 were more agreeable with covering food/lodging costs compared to those < 25 (96.5% vs 90.7%, P = .009). Respondents < 25 years old were more willing to donate a kidney for a financial incentive (P = .0002) accepting a median amount of $25,000. CONCLUSIONS: Health care personnel broadly support removing financial disincentives for living kidney donation, and those ≥ 25 were more in favor of covering food/lodging costs compared to those < 25. Those < 25 years old were more likely to accept financial incentives towards donating their kidney compared to those ≥ 25 years.


Assuntos
Atitude do Pessoal de Saúde , Doadores Vivos/ética , Remuneração , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Doadores Vivos/provisão & distribução , Masculino , Inquéritos e Questionários , Adulto Jovem
6.
Acta bioeth ; 24(2): 219-225, Dec. 2018.
Artigo em Inglês | LILACS | ID: biblio-973426

RESUMO

Objectives: In this study, we examine the ethical issues concerning living organ transplant in China. We attempt to review and analyze the ethical disputes that the living organ transplant faces in China and try to find applicable solutions to these disputes. Design: Ethical Analysis. Setting: Living organ transplant in China. Results: The ideal approaches to solving the ethical disputes involve (1) preventing disease, strengthening physical fitness, and improving the health of the national citizen; (2) encouraging the citizens to donate their organs after death; and (3) developing new technologies for organ transplant. Realistic approaches to addressing the ethical disputes over the living organ transplant include choosing the lesser of two evils, reducing the harm to the donor as much as possible and improving the transplant quality. Conclusions: The living organ transplant in China is an expedient measure instead of an ideal option and should be conducted under strict laws and regulations.


Objetivos: Neste estudo, examinamos as questões éticas relativas ao transplante de órgãos vivos na China. Vamos tentar rever e analisar os conflitos éticos que o transplante de órgãos vivos enfrenta na China e tentar encontrar soluções aplicáveis a estas disputas. Projeto: Análise ética. Configuração: Transplante de órgão vivo na China. Resultados: As abordagens ideais para resolver os conflitos éticos envolvem (1) prevenção de doenças, fortalecimento da aptidão física e melhora da saúde do cidadão nacional; (2) incentivar os cidadãos a doar seus órgãos após a morte; e (3) desenvolvimento de novas tecnologias para transplante de órgão. Abordagens realistas para enfrentar as disputas éticas sobre o transplante de órgão vivos incluem escolher o menor de dois males, reduzindo o dano ao doador o máximo possível e melhorar a qualidade do transplante. Conclusões: Transplantes de órgãos vivos na China é uma medida conveniente ao invés de uma opção ideal e deve ser conduzida sob estritas leis e regulamentos.


O artigo traz à discussão a compreensão atual do comportamento ecológico do ser humano, a partir de uma relação de dominação utilitária do ambiente em contraste com a sua compreensão do ponto de vista ecológico, a qual responde a um modelo natural que faz parte de relações de seu funcionamento no ecossistema. A este respeito, é colocado em discussão o paradigma de crise ambiental, em que tal comportamento supõe um problema grave da sociedade. Para os autores, a questão está intimamente ligada ao sistema produtivo e econômico que promove a artificialização do ser humano, criando falsas necessidades que, por meio de seu consumo, garantam a sustentabilidade do modelo econômico. É realizada uma reflexão crítica a partir da educação, no sentido de uma nova compreensão do comportamento humano, cuja perspectiva ecológica impulsiona novas relações ecossistêmicas baseadas na cooperação.


Assuntos
Humanos , Transplante de Órgãos/ética , Doadores Vivos/ética , China
8.
J Law Med Ethics ; 46(2): 524-537, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30146980

RESUMO

While the practice of organ donation after cardiac death has long been trending upwards in acceptance and use, it is still a highly controversial and practically inefficient method of organ procurement. One policy that has recently been proposed to try and alleviate some of the ethical and practical concerns with organ donation after cardiac death is the practice of imminent death organ donation. This type of live organ donation comes in patients at the end of their life who have decided to withdraw life-sustaining treatment, but still want to ensure that their organs are donated and not wasted, which isn't always the case with organ donation after cardiac death. This paper then gives some ethical and practical reflections and recommendations regarding the potential implementation of this controversial practice into regular transplant practice and policy.


Assuntos
Morte , Doadores Vivos/ética , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/ética , Suspensão de Tratamento , Humanos , Consentimento Livre e Esclarecido , Competência Mental , Estado Vegetativo Persistente , Consentimento do Representante Legal , Estados Unidos
9.
J Eval Clin Pract ; 24(5): 999-1004, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30062839

RESUMO

Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end-stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex-based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex-based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.


Assuntos
Seleção do Doador , Transplante de Rim , Doadores Vivos , Fatores Sexuais , Seleção do Doador/economia , Seleção do Doador/ética , Inteligência Emocional , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/ética , Transplante de Rim/legislação & jurisprudência , Transplante de Rim/psicologia , Doadores Vivos/ética , Doadores Vivos/psicologia , Filosofia Médica , Saúde da Mulher
11.
J Med Ethics ; 44(12): 843-850, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29973389

RESUMO

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research (National Commission) articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation.


Assuntos
Pesquisa Biomédica/ética , Ética em Pesquisa , Consentimento Livre e Esclarecido/ética , Doadores Vivos/ética , Medição de Risco , Beneficência , Pesquisa Biomédica/tendências , Humanos , Autonomia Pessoal , Sujeitos da Pesquisa , Justiça Social
12.
Int Braz J Urol ; 44(6): 1071-1080, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30044592

RESUMO

Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.


Assuntos
Doações/ética , Falência Renal Crônica/cirurgia , Transplante de Rim/ética , Doadores Vivos/ética , Obtenção de Tecidos e Órgãos/economia , Humanos , Transplante de Rim/métodos
13.
Am J Bioeth ; 18(7): 6-15, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30040550

RESUMO

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward.


Assuntos
Seleção do Doador/ética , Doadores Vivos/ética , Coleta de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/ética , Útero/transplante , Feminino , Humanos , Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Técnicas de Reprodução Assistida/ética
14.
AMA J Ethics ; 20(1): 537-545, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29905131

RESUMO

This article considers the nature and scope of ethical decision making in monozygotic sibling (MZS) skin grafting. Although rare, identical twin-to-twin skin grafting has been reported with excellent survival rates in burn patients. Of 16 cases published to date, only a few address the ethical decision making process that is involved with monozygotic sibling skin grafting; this article discusses clinical indications and ethical challenges.


Assuntos
Tomada de Decisões/ética , Seleção do Doador/ética , Ética Médica , Doadores Vivos/ética , Irmãos , Transplante de Pele/ética , Gêmeos Monozigóticos , Queimaduras/cirurgia , Comportamento de Ajuda , Humanos , Risco
15.
J Med Ethics ; 44(10): 681-684, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29921619

RESUMO

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka's account of the value of attitudes, which suggests that disproportionate love of one's own good-either excessive or deficient-is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives-that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations.


Assuntos
Altruísmo , Doadores Vivos/ética , Obtenção de Tecidos e Órgãos/ética , Análise Ética , Humanos , Motivação
16.
Am J Law Med ; 44(1): 67-118, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29764323

RESUMO

Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors. It starts with the simplest - direct donation by family members - and ends with voucher donations, a very recent and unique innovation because the donor can donate 20 or more years before the intended recipient is expected to need a kidney. In return for the donation, the intended recipient receives a voucher that can be redeemed for a live kidney when it is needed. Other innovations that are discussed include kidney exchanges and list paired donation, which are used to facilitate donor swaps when donor/recipient pairs have incompatible blood types. The discussion of each new innovation shows how the equity issues build on each other and how, with each new innovation, it becomes progressively harder to find an acceptable balance between utility and justice. The article culminates with an analysis of two recent allocation methods that have the potential to save many additional lives, but also affirmatively harm some patients on the deceased donor waiting list by increasing their waiting time for a life-saving kidney. The article concludes that saving additional lives does not justify harming patients on the waiting list unless that harm can be minimized. It also proposes solutions to minimize the harm so these new innovations can equitably perform their intended function of stimulating additional transplants and extending the lives of many transplant patients.


Assuntos
Transplante de Rim/legislação & jurisprudência , Transplante de Fígado/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Doação Dirigida de Tecido/ética , Doação Dirigida de Tecido/legislação & jurisprudência , Seleção do Doador/ética , Humanos , Transplante de Rim/ética , Transplante de Fígado/ética , Doadores Vivos/ética , Obtenção de Tecidos e Órgãos/ética , Listas de Espera
17.
Transplantation ; 102(5): 803-808, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29708521

RESUMO

Due to the widening gap between supply and demand, patients who need a liver transplant due to metabolic disease may be asked to serve as domino liver donors-to have their native liver transplanted into another candidate. We here analyze the ethical problems surrounding informed consent for the implant and explant procedures in transplant candidates who will serve as domino donors, using the case of a child with maple syrup urine disease. We discuss the need for 2 distinct consent processes separated in time to ensure that potential domino donors (or their surrogates) give a truly voluntary consent. We propose a Domino Donor Advocate-based on the concept of the independent living donor advocate to help the patient and/or his or her surrogates consider the risks, benefits and alternatives. Finally, we evaluate the Organ Procurement and Transplantation Network policy regarding "therapeutic organ donation" and propose several modifications to ensure that the decision by the potential domino donor (and/or his or her surrogate) is voluntary and informed.


Assuntos
Análise Ética , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Transplante de Fígado/ética , Transplante de Fígado/legislação & jurisprudência , Doadores Vivos/ética , Doadores Vivos/legislação & jurisprudência , Doença da Urina de Xarope de Bordo/cirurgia , Formulação de Políticas , Tomada de Decisão Clínica/ética , Humanos , Transplante de Fígado/métodos , Doadores Vivos/psicologia , Doadores Vivos/provisão & distribução , Doença da Urina de Xarope de Bordo/diagnóstico , Doença da Urina de Xarope de Bordo/genética , Doença da Urina de Xarope de Bordo/metabolismo , Seleção de Pacientes/ética , Medição de Risco , Fatores de Risco , Volição
18.
AJOB Empir Bioeth ; 9(2): 77-81, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29611768

RESUMO

BACKGROUND: The purpose of this study was to determine whether biospecimen donors believe they should receive compensation. This is the first study to report biospecimen donors' views on compensation and can potentially improve informed consent and recruitment practices. METHODS: Researchers asked patients undergoing surgical removal of tissue to donate biological materials to a biobank; the request was made at their presurgical appointment or in the preoperative clinic of the Emory University Hospital. We interviewed 126 biospecimen donors within 30 days post surgery regarding their perspective on compensation for biospecimen donation. RESULTS: In response to the question "Should you be paid for your participation in the tissue bank?," 95 (95/126, 75%) participants answered "No." Of these, 55 (55/95, 58%) indicated that donating biological materials should be about altruism, not gaining a monetary reward. Only 11 (11/126, 9%) participants unequivocally believed they should receive compensation, while 14 (14/126, 11%) felt entitled to compensation only under specific circumstances. Eleven (11/14) "Depends" participants indicated that donors should only be compensated when researchers perform for-profit research. Responses varied by race and income level, with whites more likely to not feel entitled to compensation and higher income participants more likely to respond "Depends." CONCLUSIONS: The majority of biospecimen donors stated they should not be paid for tissue bank participation. However, a minority believe they should be paid for donating tissue if the tissue is used in revenue-generating projects. These results provide some support for the current biobanking practice of not providing compensation.


Assuntos
Bancos de Espécimes Biológicos , Compensação e Reparação/ética , Pesquisa sobre Serviços de Saúde/ética , Doadores Vivos/ética , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/ética , Altruísmo , Atitude Frente a Saúde , Análise Fatorial , Feminino , Humanos , Doadores Vivos/psicologia , Masculino
19.
Bioethics ; 32(5): 289-297, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29542172

RESUMO

In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable 'statistical victims' into 'real people' with whom we can identify and feel empathy: the so-called 'identifiable victim effect', which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non-directed altruistic donation; (b) personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two.


Assuntos
Altruísmo , Doação Dirigida de Tecido/ética , Doadores Vivos/ética , Coleta de Tecidos e Órgãos/ética , Empatia/ética , Humanos , Transplante de Rim/ética , Motivação , Mídias Sociais
20.
Isr J Health Policy Res ; 7(1): 11, 2018 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-29544525

RESUMO

In 2008, responding to a widening gap between need and availability of transplant organs, Israel's Ministry of Health adopted a program of incentivized cadaveric organ donation. The Organ Transplant Law rewards individuals with prioritized access to organs on the condition that they participate in procurement efforts. Priority is awarded in the form of additional points allocated to the individual's organ recipient profile. Although Israel has experienced moderate gains in the years since the law's implementation, these have not been sufficient to satisfy the demand. Furthermore, the law faces logistical and ethical challenges. These challenges could potentially be resolved by shifting the organ procurement default to routine retrieval rather than the current default of presumed refusal to organ retrieval.This paper examines philosophical and practical challenges to the priority points policy and weighs whether Israel should consider an alternative policy of routine retrieval of transplant organs with the option to opt out of the donor pool.


Assuntos
Doadores Vivos/ética , Obtenção de Tecidos e Órgãos/ética , Transplantes/provisão & distribução , Política de Saúde , Humanos , Doadores Vivos/legislação & jurisprudência , Motivação , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
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