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1.
S Afr Med J ; 110(8): 816-818, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880313

RESUMO

Faecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infection. The purpose of this article, the second of a series of three articles, is to explore the legal framework governing human FMT in South Africa (SA). FMT involves different modes of administration that require different regulatory considerations. The focus of this article is to explore the legal classification of human stool as tissue in terms of the National Health Act 61 of 2003, as well as the regulation of human stool banks as tissue banks. The article concludes with specific recommendations aimed at improving the current regulatory vacuum relating to the regulation of FMT in SA.


Assuntos
Transplante de Microbiota Fecal , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Bancos de Espécimes Biológicos/legislação & jurisprudência , Fezes , Humanos , África do Sul , Experimentação Humana Terapêutica/ética , Experimentação Humana Terapêutica/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética
2.
Pediatrics ; 146(Suppl 1): S48-S53, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737232

RESUMO

In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.


Assuntos
Doação Dirigida de Tecido/ética , Alocação de Recursos para a Atenção à Saúde/ética , Defesa do Paciente/ética , Alocação de Recursos/ética , Fatores Etários , Criança , Pré-Escolar , Fibrose Cística/cirurgia , Doação Dirigida de Tecido/legislação & jurisprudência , Feminino , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , História do Século XXI , Humanos , Deficiência Intelectual , Transplante de Rim , Transplante de Pulmão/ética , Transplante de Pulmão/legislação & jurisprudência , Masculino , Redes Sociais Online , Pais , Defesa do Paciente/legislação & jurisprudência , Pneumonia/cirurgia , Preconceito , Opinião Pública , Alocação de Recursos/legislação & jurisprudência , Alocação de Recursos/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirurgia , Adulto Jovem
3.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817267

RESUMO

In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.


Assuntos
Maus-Tratos Infantis/ética , Medicina Legal/ética , Homicídio/ética , Consentimento dos Pais/ética , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/ética , Autopsia/ética , Temas Bioéticos , Maus-Tratos Infantis/legislação & jurisprudência , Pré-Escolar , Família , Medicina Legal/legislação & jurisprudência , Homicídio/legislação & jurisprudência , Humanos , Masculino , Consentimento dos Pais/legislação & jurisprudência , Pais , Síndrome do Bebê Sacudido/etiologia , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
5.
Am J Transplant ; 20(7): 1795-1799, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32368850

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID-19)-positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID-19-positive donors. The factors we consider include (1) the risk of blood transmission of SARS-CoV-2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/tendências , Ética Médica , Humanos , Unidades de Terapia Intensiva , Exposição Ocupacional , Equipamento de Proteção Individual , Alocação de Recursos , Risco , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Estados Unidos
6.
Am J Transplant ; 20(7): 1787-1794, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32400087

RESUMO

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS-CoV-2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS-CoV-2 through organ transplantation. The isolation of SARS-CoV-2 from nonlung clinical specimens, the detection of SARS-CoV-2 in autopsy specimens, previous experience with the related coronaviruses SARS-CoV and MERS-CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS-CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS-CoV-2 infection.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/tendências , Betacoronavirus , Ética Médica , Coração/virologia , Transplante de Coração/efeitos adversos , Transplante de Coração/tendências , Humanos , Fígado/virologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/tendências , Pulmão/virologia , Exposição Ocupacional , Síndrome Respiratória Aguda Grave/prevenção & controle , Obtenção de Tecidos e Órgãos/ética , Listas de Espera
7.
Eur. j. anat ; 24(3): 239-248, mayo 2020. ilus, graf
Artigo em Inglês | IBECS | ID: ibc-191474

RESUMO

This article explores potential threats to the validity of consent in body donation and potential responses to such threats. To minimize abstract generalizations, the article draws particularly on United Kingdom regulations but each of the issues it explores is applicable in many countries. Methods used were searches of relevant (e. g. , medical ethical) literatures using pertinent search terms (e. g. , consent) and discussions with multiple stake-holders (e. g. , family members of body donors). The main threats identified were: (1) failing to ade-quately acknowledge relatives' roles in donation, particularly as donation often cannot be completed without relatives' active participation; (2) failing to ensure that donors are informed enough to be able to give valid consent, especially given 'specification' and 'temporality' problems inherent in establishing consent for body donation; and (3) failing to genuinely prioritize donors' motives and concerns during and after obtaining their consent. Possible ways of countering these threats include layering information given and made available to potential donors and having donors consent not to 'donation and anything that might follow', but instead to 'relative-acknowledged donation, selective explicit consent, and delegated decision-making'. The latter involves donors specifying and relatives acknowledging donors' key preferences and prohi-bitions, among which is nomination or acceptance of specified proxies who may make decisions on donors' behalf after their death. By making such changes, the validity of consent for body donation could be substantially improved in ways that also increase respect for both donors and their autonomy. These changes may also increase the number of completed donations


No disponible


Assuntos
Humanos , Educação Médica/métodos , Cadáver , Anatomia/educação , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Anatomia/ética , Obtenção de Tecidos e Órgãos/ética , Altruísmo , Termos de Consentimento
8.
J Hepatol ; 73(4): 873-881, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32454041

RESUMO

BACKGROUND & AIMS: The outbreak of COVID-19 has vastly increased the operational burden on healthcare systems worldwide. For patients with end-stage liver failure, liver transplantation is the only option. However, the strain on intensive care facilities caused by the pandemic is a major concern. There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources. METHODS: We performed an international multicenter study of transplant centers to understand the evolution of policies for transplant prioritization in response to the pandemic in March 2020. To describe the ethical tension arising in this setting, we propose a novel ethical framework, the quadripartite equipoise (QE) score, that is applicable to liver transplantation in the context of limited national resources. RESULTS: Seventeen large- and medium-sized liver transplant centers from 12 countries across 4 continents participated. Ten centers opted to limit transplant activity in response to the pandemic, favoring a "sickest-first" approach. Conversely, some larger centers opted to continue routine transplant activity in order to balance waiting list mortality. To model these and other ethical tensions, we computed a QE score using 4 factors - recipient outcome, donor/graft safety, waiting list mortality and healthcare resources - for 7 countries. The fluctuation of the QE score over time accurately reflects the dynamic changes in the ethical tensions surrounding transplant activity in a pandemic. CONCLUSIONS: This four-dimensional model of quadripartite equipoise addresses the ethical tensions in the current pandemic. It serves as a universally applicable framework to guide regulation of transplant activity in response to the increasing burden on healthcare systems. LAY SUMMARY: There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources during the COVID-19 pandemic. We describe a four-dimensional model of quadripartite equipoise that models these ethical tensions and can guide the regulation of transplant activity in response to the increasing burden on healthcare systems.


Assuntos
Infecções por Coronavirus/epidemiologia , Doença Hepática Terminal , Recursos em Saúde/tendências , Transplante de Fígado , Pandemias , Pneumonia Viral/epidemiologia , Obtenção de Tecidos e Órgãos , Betacoronavirus , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/cirurgia , Humanos , Cooperação Internacional , Transplante de Fígado/ética , Transplante de Fígado/métodos , Inovação Organizacional , Pandemias/ética , Pandemias/prevenção & controle , Seleção de Pacientes/ética , Inquéritos e Questionários , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/tendências , Listas de Espera/mortalidade
9.
Rev. bioét. derecho ; (48): 95-109, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192080

RESUMO

Los intensivistas constituyen la columna vertebral del modelo español de donación y trasplantes. En el proceso de información a familiares en la donación en asistolia no controlada hay que respetar la autonomía, no hacer maleficencia y velar por la justicia. Este procedimiento solo se activará una vez que todas las opciones de tratamientos posibles, incluida la E-CPR donde se disponga de ella, se hayan descartado por no indicación o se hayan demostrado inútiles. El uso de catéter para bloqueo aórtico con monitorización de presión arterial radial izquierda evita el problema ético de la reanimación indeseada en la donación en asistolia controlada, al garantizar que la circulación al corazón y al cerebro no se restaure después del inicio de la ECMO tras el fallecimiento. Los intensivistas deben recordar que, para los profesionales que atienden a pacientes en los escenarios del final de la vida, ofrecer la opción de la donación de órganos y tejidos, es una obligación para respetar la autonomía de nuestros pacientes


The intensivists constitute the cornerstone of the Spanish model of donation and transplants. In the process of informing relatives in uncontrolled donation after circulatory death, autonomy must be respected, not maleficence and justice must be observed. This procedure will only be activated once all possible treatment options, including E-CPR where available, have been ruled out due to non-indication or futility. The use of a catheter for an aortic block with left radial blood pressure monitoring avoids the ethical problem of unwanted resuscitation in controlled donation after circulatory death, by ensuring that circulation to the heart and brain is not restored after the onset of ECMO after the death. Intensivists should remember that, for professionals who care for patients in end-of-life scenarios, offering the option of organ and tissue donation is an obligation to respect the autonomy of our patients


Els intensivistes constitueixen la columna vertebral del model espanyol de donació I trasplantaments. En el procés d'informació als familiars en la donació en assistòlia no controlada cal respectar l'autonomia, no fer maleficència I vetllar per la justícia. Aquest procediment solament s'ha d'activar una cop totes les opcions de tractaments possibles, inclosa l'E-CPR on es disposi d'ella, s'hagin descartat, bé per no indicació o bé perquè s'hagin demostrat inútils. L'ús de catèter per a bloqueig aòrtic amb monitoratge de pressió arterial radial esquerra evita el problema ètic de la reanimació indesitjada en la donació en assistòlia controlada, en garantir que la circulació al cor I al cervell no es restauri després de l'inici de la ECMO post- defunció. Els intensivistes han de recordar que per als professionals que atenen pacients en els escenaris del final de la vida oferir l'opció de la donació d'òrgans I teixits, és una obligació a fi de respectar l'autonomia dels nostres pacients


Assuntos
Humanos , Obtenção de Tecidos e Órgãos/ética , Transplante de Órgãos/ética , Parada Cardíaca , Cuidados Críticos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Reanimação Cardiopulmonar/ética , Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea/legislação & jurisprudência , Cuidados Críticos/ética
11.
Rev Med Suisse ; 16(682): 370-373, 2020 Feb 19.
Artigo em Francês | MEDLINE | ID: mdl-32073773

RESUMO

Following a current trend in European countries, Switzerland is about to decide to adopt (or reject) a presumed consent legislation for organ donation. In such a system, every citizen is considered as a potential organ donor except in case of expressed refusal during lifetime. The presumed consent system raises ethical and practical issues that need to be carefully understood and weighed before deciding on its fate. This article reviews the most pressing ethical issues and provides the empirical data necessary for assessing the presumed consent legislation in Switzerland. At the end of the analysis, the reader will be able to form her own informed opinion on the issue.


Assuntos
Consentimento Presumido/ética , Consentimento Presumido/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Suíça , Doadores de Tecidos/ética , Doadores de Tecidos/psicologia
13.
Bioethics ; 34(3): 318-321, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32100332

RESUMO

With the emergence of organ donation and donation technology, the previous indivisibility of the human body becomes divisible, and different human organs form a new life subject. With reference to specific case studies in China, a new life, consisting of donated organs from different bodies by donation, can be called "donated life." Donated life is a win-win action between altruism and egoism, that is, to save the lives of others and to regenerate the organs of donors or their relatives. Due to the emergence of this kind of life, traditional social ethics theories based on the marriage-related family find it difficult to difficult to explain the new realities. Thus, new thinking about social ethics is necessary.


Assuntos
Valores Sociais/etnologia , Obtenção de Tecidos e Órgãos/ética , Valor da Vida , Adolescente , Adulto , China , Feminino , Humanos , Masculino
16.
BMC Med Ethics ; 20(1): 79, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31722695

RESUMO

BACKGROUND: Since 2010 the People's Republic of China has been engaged in an effort to reform its system of organ transplantation by developing a voluntary organ donation and allocation infrastructure. This has required a shift in the procurement of organs sourced from China's prison and security apparatus to hospital-based voluntary donors declared dead by neurological and/or circulatory criteria. Chinese officials announced that from January 1, 2015, hospital-based donors would be the sole source of organs. This paper examines the availability, transparency, integrity, and consistency of China's official transplant data. METHODS: Forensic statistical methods were used to examine key deceased organ donation datasets from 2010 to 2018. Two central-level datasets - published by the China Organ Transplant Response System (COTRS) and the Red Cross Society of China - are tested for evidence of manipulation, including conformance to simple mathematical formulae, arbitrary internal ratios, the presence of anomalous data artefacts, and cross-consistency. Provincial-level data in five regions are tested for coherence, consistency, and plausibility, and individual hospital data in those provinces are examined for consistency with provincial-level data. RESULTS: COTRS data conforms almost precisely to a mathematical formula (which first appeared to be a general quadratic, but with further confirmatory data was discovered to be a simpler one-parameter quadratic) while Central Red Cross data mirrors it, albeit imperfectly. The analysis of both datasets suggests human-directed data manufacture and manipulation. Contradictory, implausible, or anomalous data artefacts were found in five provincial datasets, suggesting that these data may have been manipulated to enforce conformity with central quotas. A number of the distinctive features of China's current organ procurement and allocation system are discussed, including apparent misclassification of nonvoluntary donors as voluntary. CONCLUSION: A variety of evidence points to what the authors believe can only be plausibly explained by systematic falsification and manipulation of official organ transplant datasets in China. Some apparently nonvoluntary donors also appear to be misclassified as voluntary. This takes place alongside genuine voluntary organ transplant activity, which is often incentivized by large cash payments. These findings are relevant for international interactions with China's organ transplantation system.


Assuntos
Transplante de Órgãos/ética , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , China , Humanos , Modelos Estatísticos , Obtenção de Tecidos e Órgãos/normas
17.
New Bioeth ; 25(4): 349-358, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31702479

RESUMO

The use of human biological materials (HBMs) involves a number of issues from both an ethical and a legal point of view. In recent decades, the purposes for which this material has been used have increased. The development of therapeutic products has led to the configuration of a market in which products have acquired an economic value. As soon as the private sector crosses the threshold of access to the use of human cells and tissues, a conflict may arise between the altruistic principles motivating the act of donation and the profit-making objectives . When donated material emerges from the public management setting and becomes a source of profit, the instrument of informed consent may not adequately protect the dignity of the donors. In the era of medical biotechnology revolution, any use of the donated material must be justified and consistent with the values motivating the act of donation.


Assuntos
Altruísmo , Bancos de Espécimes Biológicos , Mercantilização , Consentimento Livre e Esclarecido , Setor Privado , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Bancos de Espécimes Biológicos/economia , Bancos de Espécimes Biológicos/ética , Biotecnologia , União Europeia , Objetivos , Humanos , Pessoalidade , Setor Privado/economia , Setor Privado/ética , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/ética
18.
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
20.
Perspect Biol Med ; 62(3): 503-518, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495794

RESUMO

This essay analyzes the conflicts that arise between an individual's deeply held beliefs and the collective norms of society. Sometimes these conflicts are framed in religious terms. The author argues that such a framing is too narrow and inappropriately puts the focus on a specific set of (largely Christian) beliefs about matters related to sexuality. This essay attempts to broaden the discussion in order to highlight the ways in which conflicts between individual beliefs and practices, on the one hand, and prevailing societal norms, on the other, create the tension that can lead to societal change.


Assuntos
Recusa Consciente em Tratar-se , Cultura , Relações Médico-Paciente/ética , Normas Sociais , Aborto Induzido/ética , Cristianismo , Recusa Consciente em Tratar-se/ética , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Futebol Americano , Humanos , Imunização/ética , Obrigações Morais , Médicos , Gravidez , Obtenção de Tecidos e Órgãos/ética , Estados Unidos
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