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1.
Chirurg ; 90(6): 496-500, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31069415

RESUMO

At the end of January 2019 the German Federal Court of Justice (Bundesgerichtshof, BGH) heard oral arguments and made a judgment in cases regarding living organ donors. The core verdicts concerned questions regarding the necessary information which has to be provided in order to properly inform the donor. This article outlines the main findings of the BGH because every transplantation surgeon has to be aware of them. In addition, this article focuses on the possibilities for hospitals to fulfill the legal requirement of the presence of an impartial doctor during the informed consent for a living organ donor.


Assuntos
Doadores Vivos , Cirurgiões , Obtenção de Tecidos e Órgãos , Humanos , Consentimento Livre e Esclarecido , Doadores Vivos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
2.
Exp Clin Transplant ; 17(Suppl 1): 1-5, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777517

RESUMO

In Jordan, the history of organ transplantation started in 1972 with a kidney transplant from a deceased donor. At present, Jordan is in a good position with regard to organ transplantation among developing countries. It remains important to follow through with some decisions and enact laws that would increase the percentage of legal organ donations and transplant procedures. This has involved the expansion of relative degree donation. Until 2013, most relative degree donations involved 1st-degree and 2nd-degree relatives. The degree of genetical and legal relatives in living organ donation was then expanded to allow 4th- and 5th-degree relatives. This expansion to a 5th-degree relative came about when it was realized that the percentage of organ transplants in 2nd-degree relatives was high. Therefore, the idea of organ donation in these degrees may be beneficial, as it can lead to significantly higher numbers of organ donations.


Assuntos
Família , Doadores Vivos/provisão & distribução , Transplante de Órgãos/métodos , Linhagem , Política de Saúde , História do Século XX , História do Século XXI , Humanos , Islamismo , Jordânia , Doadores Vivos/história , Doadores Vivos/legislação & jurisprudência , Transplante de Órgãos/história , Transplante de Órgãos/legislação & jurisprudência , Formulação de Políticas , Religião e Medicina
4.
Saudi J Kidney Dis Transpl ; 29(5): 1181-1187, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30381516

RESUMO

Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Doadores Vivos/provisão & distribução , Obtenção de Tecidos e Órgãos , Prestação Integrada de Cuidados de Saúde , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Transplante de Rim/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Nigéria/epidemiologia , Formulação de Políticas , Sistema de Registros , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Listas de Espera
5.
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
6.
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
7.
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
9.
J Med Ethics ; 44(5): 310-313, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29102919

RESUMO

We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a 'spare' kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to sell one's kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market.


Assuntos
Transplante de Rim/economia , Doadores Vivos/ética , Coleta de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/economia , Coerção , Comércio , Ética Médica , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/ética , Humanos , Transplante de Rim/ética , Transplante de Rim/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Princípios Morais , Pobreza , Coleta de Tecidos e Órgãos/ética , Coleta de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
10.
Duodecim ; 133(10): 937-44, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29239576

RESUMO

While the majority of kidney transplantations in Finland have been traditionally performed from deceased donors, the frequency of living donors should be increased. Kidney donation is a safe procedure for a carefully examined donor, and for the recipient living donation enables elective surgery and preemptive transplantation. Potential risks for the donor must be minimized, but according to current recommendations, mild hypertension or obesity are not absolute contraindications for donation. Guidelines for donor selection and examination have been updated to simplify the process for all parties. Legislation in Finland requires changes to optimize the use of all potential living donors.


Assuntos
Transplante de Rim , Doadores Vivos , Finlândia , Humanos , Doadores Vivos/legislação & jurisprudência , Guias de Prática Clínica como Assunto
11.
Transplantation ; 101(9): 1996-2002, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-29633981

RESUMO

As organ donation rates remain unable to meet the needs of individuals waiting for transplants, it is necessary to identify reasons for this shortage and develop solutions to address it. The introduction of kidney paired donation (KPD) programs represents one such innovation that has become a valuable tool in donation systems around the world. Although KPD has been successful in increasing kidney donation and transplantation, there are lingering questions about its legality. Donation through KPD is done in exchange for-and with the expectation of-a reciprocal kidney donation and transplantation. It is this reciprocity that has caused concern about whether KPD complies with existing law. Organ donation systems around the world are almost universally structured to legally prohibit the commercial exchange of organs. Australia, Canada, and the United States have accomplished this goal by prohibiting the exchange of an organ for "valuable consideration," which is a legal term that has not historically been limited to monetary exchange. Whether or not KPD programs violate this legislative prohibition will depend on the specific legislative provision being considered, and the legal system and case law of the particular jurisdiction in question. This article compares the experiences of Australia, Canada, and the United States in determining the legality of KPD and highlights the need for legal clarity and flexibility as donation and transplantation systems continue to evolve.


Assuntos
Doação Dirigida de Tecido , Transplante de Rim/métodos , Doadores Vivos/provisão & distribução , Austrália , Canadá , Doação Dirigida de Tecido/legislação & jurisprudência , Regulamentação Governamental , Política de Saúde , Humanos , Transplante de Rim/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Formulação de Políticas , Desenvolvimento de Programas , Estados Unidos
15.
Transpl Infect Dis ; 18(6): 856-861, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27663143

RESUMO

BACKGROUND: With the introduction of combination antiretroviral therapy (cART) that has significantly improved survival, human immunodeficiency virus (HIV)-positive patients may be potential organ donors to HIV-positive recipients in a few countries. Organ shortage remains a challenge for organ transplantation in Taiwan, where organ donation by HIV-positive patients remains prohibited by law. METHODS: We assessed the willingness of organ donation (should they be pronounced brain dead, and the ban on HIV-positive organ donation be lifted) among HIV-positive patients who received regular HIV care at a university hospital in a cross-sectional survey between May and August 2015 with the use of an anonymous, self-administered questionnaire interview. RESULTS: Of the 1010 participants, 93.7% were receiving cART with the latest mean CD4 count and plasma HIV RNA load of 587 cells/mm3 and 2.73 log10 copies/mL, respectively. Overall, 71.9% were willing to donate organs. In multivariate analysis, factors associated with willingness to donate organs included college or graduate school diploma (odds ratio [OR] 1.571, 95% confidence interval [CI] 1.166-2.191), registered willingness to donate in the National Health Insurance system (OR 9.430, 95% CI 1.269-70.051), and knowledge of the information on HIV-positive deceased donors (HIVDD) (OR 1.673, 95% CI 1.073-2.608). CONCLUSIONS: We concluded that a significant proportion (71.9%) of HIV-positive Taiwanese patients were willing to donate their organs. The willingness was associated with a higher education level, prior registered willingness to donate organs, and awareness of HIVDD.


Assuntos
Soropositividade para HIV/psicologia , Doadores Vivos/psicologia , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Volição , Adulto , Antirretrovirais/uso terapêutico , Estudos Transversais , Combinação de Medicamentos , Feminino , Soropositividade para HIV/tratamento farmacológico , Humanos , Doadores Vivos/educação , Doadores Vivos/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Taiwan , Transplantados
16.
Clin Nephrol ; 86 (2016)(13): 96-100, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27509587

RESUMO

Latin America is a region made up of 33 countries that share many characteristics with each other. Since the first kidney transplant in Argentina in 1957, most of the Latin American countries have had a continuous increase in renal transplant activity, accounting for an increase in the total number of kidney transplants over time. In the last years, several advances have been made in the area of renal transplantation in Latin America: There are transplantation activities in almost all countries, the kidney transplantation rate from deceased donors has steadily increased, and almost all the countries have an appropriate legislation for transplantation activity. But much remains to be done to increase the kidney transplantation rate in order to cover the current demand. This could be achieved by ensuring unlimited access to renal transplantation, by improving deceased-donor programs to match the increasing burden of chronic diseases, and by incorporating new technology, new tools, and more trained people in transplant programs.


Assuntos
Transplante de Rim/tendências , Tecnologia Biomédica , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/legislação & jurisprudência , América Latina , Doadores Vivos/legislação & jurisprudência , Encaminhamento e Consulta , Fatores de Risco , Fatores Socioeconômicos , Doadores de Tecidos
17.
Am J Transplant ; 16(12): 3554-3561, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27172349

RESUMO

Living organ donation (LD) is an increasingly established practice. Whereas in the United States and Canada LD by minors has occasionally been reported, LD by minors seems to be largely absent in the European Union (EU). It is currently unclear whether this is the result of a different legal approach. This study is the first to systematically analyze the regulations of EU member states, Norway, and Iceland toward LD by minors. Relevant regulations were identified by searching government websites, translated, compared, and sent for verification to national legal experts. We identified five countries where LD by minors is allowed. In two of these (Belgium and the United Kingdom), some minors may be deemed sufficiently mature to make an autonomous decision regarding LD. In contrast, in the three other countries (Luxembourg, Norway, and Sweden), LD by minors is only allowed subject to parental permission and the assent (or absence of objection) of the donor. Where allowed, regulations differ significantly with regard to the substantive and procedural safeguards in place. In view of the controversial nature of the procedure, as illustrated by recent reports and surveys, we argue for a very cautious approach and greater harmonization in countries where LD by minors is allowed.


Assuntos
Tomada de Decisões , Consentimento Livre e Esclarecido/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Transplante de Órgãos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Adolescente , União Europeia , Humanos
18.
J Med Philos ; 41(3): 237-56, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27097648

RESUMO

Despite seeming uniformity in the law, end-of-life controversies have highlighted variations among state brain death laws and their interpretation by courts. This article provides a survey of the current legal landscape regarding brain death in the United States, for the purpose of assisting professionals who seek to formulate or assess proposals for changes in current law and hospital policy. As we note, the public is increasingly wary of the role of organ transplantation in determinations of death, and of the variability of brain death diagnosing criteria. We urge that any attempt to alter current state statutes or to adopt a national standard must balance the need for medical accuracy with sound ethical principles which reject the utilitarian use of human beings and are consistent with the dignity of the human person. Only in this way can public trust be rebuilt.


Assuntos
Morte Encefálica/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Estado Vegetativo Persistente , Coleta de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Humanos , Legislação Médica , Política Pública , Estados Unidos
19.
BMJ Open ; 6(4): e010594, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27036141

RESUMO

INTRODUCTION: Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary per centre, and even per individual healthcare professional. The basis for a standardised, uniform surgical informed consent procedure for live donor nephrectomy can be created by assessing what information donors need to hear to prepare them for the operation and convalescence. METHODS AND ANALYSIS: The PRINCE (Process of Informed Consent Evaluation) project is a prospective, multicentre cohort study, to be carried out in all eight Dutch kidney transplant centres. Donor knowledge of the procedure and postoperative course will be evaluated by means of pop quizzes. A baseline cohort (prior to receiving any information from a member of the transplant team in one of the transplant centres) will be compared with a control group, the members of which receive the pop quiz on the day of admission for donor nephrectomy. Donor satisfaction will be evaluated for all donors who completed the admission pop-quiz. The primary end point is donor knowledge. In addition, those elements that have to be included in the standardised format informed consent procedure will be identified. Secondary end points are donor satisfaction, current informed consent practices in the different centres (eg, how many visits, which personnel, what kind of information is disclosed, in which format, etc) and correlation of donor knowledge with surgeons' estimation thereof. ETHICS AND DISSEMINATION: Approval for this study was obtained from the medical ethical committee of the Erasmus MC, University Medical Center, Rotterdam, on 18 February 2015. Secondary approval has been obtained from the local ethics committees in six participating centres. Approval in the last centre has been sought. RESULTS: Outcome will be published in a scientific journal. TRIAL REGISTRATION NUMBER: NTR5374; Pre-results.


Assuntos
Consentimento Livre e Esclarecido , Transplante de Rim , Doadores Vivos , Nefrectomia , Insuficiência Renal/cirurgia , Coleta de Tecidos e Órgãos/legislação & jurisprudência , Acesso à Informação , Comunicação , Tomada de Decisões , Comissão de Ética , Necessidades e Demandas de Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Transplante de Rim/ética , Transplante de Rim/legislação & jurisprudência , Doadores Vivos/ética , Doadores Vivos/legislação & jurisprudência , Nefrectomia/ética , Nefrectomia/legislação & jurisprudência , Países Baixos/epidemiologia , Educação de Pacientes como Assunto , Estudos Prospectivos , Coleta de Tecidos e Órgãos/ética
20.
Bioethics ; 30(2): 119-28, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26194324

RESUMO

Living kidney transplantation offers the best treatment in terms of life-expectancy and quality of life for those with end-stage renal disease. The long-term risks of living donor nephrectomy, although real, are very small, with evidence of good medium-term outcomes. Who should be entitled to donate, and in which circumstances, is nevertheless a live question. We explore the ethical dimensions of a request by an individual to donate both of their kidneys during life: 'dual living kidney donation'. Our ethical analysis is tethered to a hypothetical case study in which a father asks to donate a kidney to each of his twin boys. We explore the autonomy of the protagonists, alongside different dimensions of the public interest, such as the need to protect not only the recipients, but also the donor and even the wider community. Whilst acknowledging objections to 'dual-donation', not least by reference to the harms that the donor might be expected to endure, we suggest there is a prima facie case for permitting this, provided that both donor and recipients are willing and that due attention is paid to such considerations as the autonomy and welfare of all parties, as well as to the wider ramifications of acting on such a request. We argue for broader interpretations of the concepts of autonomy and welfare, recognizing the importance of relationships and the relevance of more than merely physical well-being. Equipped with such a holistic assessment, we suggest there is a prima facie case for allowing 'dual living kidney donation'.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Doadores Vivos , Nefrectomia , Autonomia Pessoal , Qualidade de Vida , Coleta de Tecidos e Órgãos/ética , Transplantados , Ética Médica , Pai , Feminino , Liberdade , Humanos , Falência Renal Crônica/etnologia , Transplante de Rim/ética , Transplante de Rim/legislação & jurisprudência , Doadores Vivos/legislação & jurisprudência , Doadores Vivos/psicologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/ética , Núcleo Familiar , Valores Sociais , Transplantados/psicologia , Estados Unidos
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